Introduction

Introduction

Colorectal cancer is a major cause of morbidity and mortality in Australia. It is the second most common cancer diagnosed in both men and women, and is more common in those aged over 50 years. Colorectal cancer is also the second most common cause of cancer death and accounts for 9% of all cancer deaths.

This profile of colorectal cancer in Australia highlights the need for guidelines to ensure clinical best practice in its prevention, detection and management.

Purpose and scope

These guidelines aim to provide information and recommendations to guide practice across the continuum of cancer care including colorectal cancer prevention, screening and diagnosis, clinical aspects of surgery, radiotherapy and chemotherapy, follow-up and psychosocial care. The guidelines also provide an evidence base for the National Bowel Cancer Screening Program.

These clinical practice guidelines are a revision and update of the 2005 clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Australian guidelines were originally developed in 1999 and, since then, have been widely used as a reference and referred to by health practitioners, including general practitioners (GPs) and specialists, to guide clinical practice.

These guidelines do not cover surveillance colonoscopy in adenoma follow-up, surveillance colonoscopy following curative resection of colorectal cancer, or colonoscopic surveillance in inflammatory bowel disease. The Clinical Practice Guidelines for Surveillance Colonoscopy were launched March 2019.

Intended users

These guidelines are intended for health professionals caring for people with colorectal cancer.

They may also be of interest to policy makers and people with training in medicine or other health sciences.

They are not intended as health information for the general public.

Target populations

These guidelines cover a range of Australian populations, including:

• people without symptoms or signs of colorectal cancer to whom prevention and screening apply
• people with a family history of colorectal cancer or known familial syndromes
• people with symptoms and signs that may suggest colorectal cancer
• people with a positive faecal occult blood test
• people with precancerous lesions detected on colonoscopy
• people with a diagnosis of colorectal cancer at any disease stage.

Clinicians should consider the specific needs of diverse patients, including younger people, Aboriginal and Torres Strait Islanders and culturally and linguistically diverse people diagnosed with colorectal cancer. Please note: for each systematic review, the search strategies specifically included terms relevant to Aboriginal and Torres Strait Islander peoples. However, the literature searches did not identify any studies specifically relevant to Aboriginal and Torres Strait Islander populations that met the inclusion criteria.

Healthcare settings in which the guideline will be applied

These guidelines apply to the range of public and private healthcare settings in which services are provided for the target populations. These include:

• general practice
• screening services
• hospitals
• specialist clinics
• imaging services
• pathology services
• allied health care services.

Funding

The Australian Government Department of Health commissioned and funded Cancer Council Australia to undertake the current revision and update of this guideline.

Scheduled review of these guidelines

It is inevitable that parts of this guideline will become out of date as further literature is published. Newly published evidence relevant to each systematic review question will be monitored. If strong evidence supporting a change in the guideline is published, the Working Party will consider if an update is required for a specific section.

We recommend that the guideline as a whole should be reviewed and updated every 5 years.

Acknowledgement

The update of the guidelines was overseen by a multidisciplinary working party with input by subcommittees. We thank the members of the Working Party, subcommittee, systematic reviewers and all others who contributed to the development of these guidelines.

References

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Referring to the large bowel, comprising the colon and rectum.

An Australian screening program that aims to reduce illness and death from bowel cancer through early detection or prevention of the disease.