Clinical practice guidelines for the prevention, early detection and management of colorectal cancer

The guideline recommendations were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 27 October 2017 under section 14A of the National Health and Medical Research Council Act 1992.

In approving the guideline recommendations, NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years.

NHMRC is satisfied that the guideline recommendations are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.

This publication reflects the views of the authors and not necessarily the views of the Australian Government.

Cite this guideline

Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia. [Version URL: https://wiki.cancer.org.au/australiawiki/index.php?oldid=213460, cited 2023 Mar 31]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer.

Clinical practice guidelines for the prevention, early detection and management of colorectal cancer

PDF download: Colorectal cancer guidelines short-form guidelines (recommendations only)

Please also see the following files:

• administrative report
• dissemination report.

This is a wiki-based guideline. A PDF version of the recommendations in the guideline (short-form guideline), has been made available for download using the link above.

Introduction

Summary of recommendations

Plain-language summary

Colorectal cancer in Australia

Primary prevention

• Dietary and lifestyle strategies

• Chemopreventive candidate agents (PPR1)

Population screening for colorectal cancer

• Population screening for colorectal cancer: Evidence

• Evidence: Screening benefit (PSC1a)

• Evidence: Screening test accuracy (PSC1b)

• Evidence: Screening cost effectiveness (PSC1c)

• Evidence: Screening age (PSC1d)

• Population screening for colorectal cancer: Evidence summary and recommendations

• Discussion

The symptomatic patient

• Signs and symptoms predictive of colorectal cancer (SPT1-2a)

• Optimal maximum time from referral to diagnosis and treatment (SPT1-2b)

Risk and screening based on family history

• Colorectal cancer risk according to family history (FHS2)

• Screening strategies for people with a family history of colorectal cancer

High-risk familial syndromes

• Familial adenomatous polyposis

• MUTYH associated polyposis

• Lynch syndrome

• Peutz-Jeghers syndrome

• Juvenile polyposis syndrome

• Serrated polyposis syndrome

• Supplement. State- and territory-based familial cancer registries

Imaging a patient with a diagnosis of colon/rectal adenocarcinoma

• Colon cancer

• Rectal cancer

• Addenda: rectal MRI cancer report

Pathology and staging

• Development of post-surgical staging

• Post-surgical staging following neoadjuvant therapy

• Notable differences between available clinicopathological staging systems

• Clinical input

• Additional information on pathology reporting

• Optimal molecular profiling (PTH1)

Preparation for surgery and perioperative optimisation

• Multidisciplinary meetings

• Perioperative anaemia management

• Thromboembolic prophylaxis

• Nutritional interventions

• Stomal therapy

• Body temperature

• Enhanced recovery after surgery

• Mechanical bowel preparation with or without antibiotic prophylaxis (PRP2-5,7)

Elective and emergency surgery for colon and rectal cancer

• Optimal approach to elective resection for colon cancers (COL1-2a)

• Optimal approach to elective resection for rectal cancers

• Optimal approach to elective resection for rectal cancers (COL1-2b)

• Local versus radical resection for T1-T2 rectal tumours (REC3)

• Emergency management of malignant large bowel obstruction (COLMNG5)

• Peritonectomy with hyperthermic intraperitoneal chemotherapy (COLMNG3)

Adjuvant therapy for colon cancer

• Adjuvant therapy for stage III colon cancer

• Adjuvant therapy for elderly patients with stage III colon cancer (ADJ1)

• Adjuvant therapy for stage II colon cancer

• Irinotecan and targeted (biological) agents in adjuvant therapy for Stage II and Stage III colon cancer

• Discussion: adjuvant therapy for colon cancer

Neoadjuvant and adjuvant therapy for rectal cancer

• Neoadjuvant therapy for rectal cancer

• Short course radiation treatment

• Neoadjuvant long-course chemoradiation (NEO1b)

• 'Watch and wait' approach after clinical complete response to neoadjuvant chemoradiation (NEO1a)

• Neoadjuvant chemotherapy regimen

• Optimal timing surgery after neoadjuvant therapy

• Adjuvant therapy for rectal cancer

• Postoperative chemotherapy

• Postoperative radiation treatment

• Discussion

Management of resectable locally recurrent disease and metastatic disease

• Investigation of recurrent colorectal cancer

• Management of locally recurrent resectable colorectal cancer (MNG13)

• Management of resectable metastatic colorectal cancer (MNG14)

Management non-resectable locally recurrence disease and metastatic disease

• Liver-directed therapies for patients with incurable metastatic colorectal cancer (MNG16)

• Synchronous primary in metastatic colorectal cancer

• Discussion

The role of systemic therapies in non-resectable metastatic disease

• Systemic therapy molecular pathology

• Systemic chemotherapy treatment options for first-line treatment

• Role of biological agents in first-line treatment of metastatic colorectal cancer

• Subsequent treatment and the continuum-of-care model

• Systemic options for second-line treatment

• Systemic options for third-line treatment

• Supportive care options for patients with non-resectable metastatic colorectal cancer

Follow-up after curative resection for colorectal cancer

• Rationale for follow-up

• Optimal surveillance protocol (FUR1-2)

• Health professionals performing follow-up and suggested follow-up schedule

Psychosocial care

Appendices

• Guideline development process

• Clinical question list

• Journal articles

• Technical report

• Additional resources

• Glossary and abbreviations

• Working party and sub-committee membership

• Project team contributions

• Conflict of interest register

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