Technical report

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This Technical Report accompanies the Clinical practice guidelines for the prevention, early detection and management of colorectal cancer, developed by Cancer Council Australia.

It outlines the guideline development process and methodology, lists the clinical questions, provides all accompanying NHMRC Statement Forms, the detailed technical documentation for each question and the risk of bias assessment tools used to assess the included literature as a result of a systematic review.

Guideline development process

Clinical question list

Evidence statement forms, systematic review reports and modelling reports

The following reports are for questions that were answered by a new systematic literature review or modelling. The associated technical documentation appears at the bottom of the relevant content pages.

The questions were given alphanumeric codes when they were developed, please refer to the codes below and see the clinical question list for more detail.


PPR1: In an asymptomatic population at average risk or increased risk of colorectal cancer, what is the cost-benefit ratio of prophylactic AspirinA common medication used to treat pain, fever, and inflammation. Also known as acetylsalicylic acid (ASA). use in reducing the mortality and incidence of colorectal cancer?
Evidence statement form PPR1
Systematic review report PPR1


PSC1a: In persons without a colorectal cancer diagnosis or symptoms that might indicate colorectal cancer, which screening modality (immunochemical FOBT, flexible sigmoidoscopy, colonoscopy, CT colonographyAlso known as virtual colonoscopy, a medical imaging procedure that uses low dose radiation CT scanning to obtain an interior view of the colon (the large bowel) that is otherwise only seen with a more invasive procedure where an endoscope is inserted into the rectum and passed through the entire colon., faecal or blood biomarkers, or any combinations) compared with no screening, reduces colorectal cancer mortality, or the incidence of metastases at diagnosis?
Evidence statement form PSC1a
Systematic review report PSC1a


PSC1b: For persons without a colorectal cancer diagnosis or symptoms that might indicate colorectal cancer, which screening modality (immunochemical FOBT, flexible sigmoidoscopy, colonoscopy, faecal or blood biomarkers, or any combinations) performs best in detecting colorectal cancer, and how does the diagnostic performance change with family history, age, or gender?
Evidence statement form PSC1b
Systematic review report PSC1b


PSC1c: In persons without a bowel cancer diagnosis or symptoms that might indicate bowel cancer, what is the most cost-effective, feasible and acceptable screening modality (immunochemical FOBT, flexible sigmoidoscopy, colonoscopy, CT colonographyAlso known as virtual colonoscopy, a medical imaging procedure that uses low dose radiation CT scanning to obtain an interior view of the colon (the large bowel) that is otherwise only seen with a more invasive procedure where an endoscope is inserted into the rectum and passed through the entire colon., faecal or blood biomarkers, or any combinations) compared with no screening?
Modelling report PSC1c


PSC1d: Is population screening starting at an earlier age more effective and as feasible, acceptable and cost-effective as screening starting at age 50 yr? In population screening, do the harms outweigh the benefits if routine screening is continued beyond the age of 75yr?
Modelling report PSC1d


SPT1-2a: In symptomatic patients without a colorectal cancer diagnosis, what signs or symptoms (persistent changed bowel movements, persistent diarrhoea or constipation, unexplained rectal bleeding, general or localised abdominal pain, unexplained palpable abdominal or rectal mass, unexplained weight loss, iron deficient anaemia, tiredness, fatigue, or any combination) correlate best with a diagnosis of colorectal cancer?
Evidence statement form SPT1-2a
Systematic review report SPT1-2a


SPT1-2b: In symptomatic patients without a colorectal cancer diagnosis, what is the optimal maximum diagnostic interval that achieves better than or equivalent outcomes in terms of survival, mortality, and diagnosis of metastatic disease?
Evidence statement form SPT1-2b
Systematic review report SPT1-2b


FHS2: For individuals, has a family history of colorectal cancer been shown to be reliably associated with an increase in risk of occurrence of or death from colorectal cancer when compared to individuals who do not have a family history of colorectal cancer?
Evidence statement form FHS2
Systematic review report FSH2


PTH1: In patients diagnosed with colorectal cancer and have undergone surgical resection of the primary colorectal tumour, which molecular marker (BRAF/KRAS/NRAS/MMRD/MSI) best predicts response to surgery, or adjuvant therapy or radiotherapy (disease-free survival, overall survival, disease-specific mortality, overall mortality, or relapse incidence)?
Evidence statement form PTH1
Systematic review report PTH1


PRP2-5,7: In patients diagnosed with colorectal cancer and undergoing surgical tumour resection, does mechanical bowel preparation with or without antibiotic prophylaxis, when compared to usual care, achieve better outcomes in terms of anastomotic leakage, surgical site infection, length of hospital stay and ileus?
Evidence statement form PRP2-5,7
Systematic review report PRP2-5,7


COL1-2a: In patients diagnosed with colon cancer, what is the optimal resection strategy to achieve the best outcomes in terms of length and quality of life?
Evidence statement form COL1-2a
Systematic review report COL1-2a


COL1-2b: In patients diagnosed with rectal cancer, what is the optimal resection strategy to achieve the best outcomes in terms of length and quality of life?
Evidence statement form COL1-2b
Systematic review report COL1-2b


REC3: In patients diagnosed with stage I-II rectal cancer, what is the most effective treatment strategy to achieve the best outcomes in terms of length and quality of life?
Evidence statement form REC3
Systematic review report REC3


COLMNG5: In patients diagnosed with colorectal cancer and acute obstruction, does stenting or colostomy achieve equivalent or better outcomes compared to acute resection with primary anastomosis?
Evidence statement form COLMNG5
Systematic review report COLMNG5


COLMNG3: For patients diagnosed with colorectal cancer and peritoneal involvement or isolated peritoneal recurrence of colorectal cancer, does peritonectomy, with or without perioperative intraperitoneal chemotherapy (PIC), achieve better outcomes in terms of length and quality of life than usual care?
Evidence statement form COLMNG3
Systematic review report COLMNG3


ADJ1: In elderly patients (≥70 years) diagnosed with colon cancer, what is the efficacy of surgery and adjuvant combination chemotherapy (involving either 5-flurouracil or capecitabine combined with oxaliplatin), compared to surgery with a single chemotherapeutic agent (fluoropyrimidine based) in achieving the best outcomes in terms of colorectal cancer mortality, recurrence, quality of life and adverse effects?
Evidence statement form ADJ1
Systematic review report ADJ1


NEO1b: For patients diagnosed with stage I-III rectal cancer, for which patients does neoadjuvant treatment (short or long course chemoradiotherapy) with surgery achieve equivalent or better outcomes in terms of length and quality of life than surgery alone?
Evidence statement form NEO1b
Systematic review report NEO1b


NEO1a: For patients diagnosed with stage I-III rectal cancer, for which patients does neoadjuvant treatment (short or long course chemoradiotherapy) with surgery achieve equivalent or better outcomes in terms of length and quality of life than neoadjuvant chemoradiotherapy alone?
Evidence statement form NEO1a
Systematic review report NEO1a


MNG13: In patients with locally recurrent colon or rectal cancer, what is the role of curative surgery (+/- chemotherapy +/- radiotherapy) when compared to surgical palliation +/- palliative chemotherapy +/- palliative radiotherapy or other palliative interventions in terms of outcomes (overall survival, disease free survival, quality of life and complications)?
Evidence statement form MNG13
Systematic review report MNG13


MNG14: In patients with resectable synchronous or metachronous metastatic colorectal cancer, what is the role of surgical resection +/- chemotherapy when compared to non-surgical /palliative interventions in terms of outcomes (overall survival, disease free survival, progression free survival, quality of life and complications?)
Evidence statement form MNG14
Systematic review report MNG14


MNG16: In patients with incurable metastatic colorectal cancer, what are the effects of liver-directed therapies on survival and quality-of-life outcomes, compared with standard care?
Evidence statement form MNG16
Systematic review report MNG16


FUR1-2a: In patients who have had curative resection of colorectal cancer, what surveillance protocol achieves the best outcomes in terms of detected recurrent disease, 5-year survival, quality of life, and colorectal cancer-related mortality?
Evidence statement form FUR1-2a
Systematic review report FUR1-2a

Cohort studies (risk factors) risk of bias assessment tool

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