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Colorectal cancer

Disease overview

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Colorectal cancer is the fourth most common cancer in the UK, with approximately 44,100 new cases and 16,800 deaths per year1

  • The number of cases in the UK are highest in people aged 70–74 years, although case numbers in younger people are increasing2
  • The majority of cases in the UK (53%) are diagnosed at Stage 3 or 4,3 with estimated 5-year survival rates of 65% and 10%, respectively4
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Symptoms of colorectal cancer include changes in bowel habit, abdominal pain, unexplained weight loss and rectal bleeding5,6

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The risk of colorectal cancer increases with family history of colorectal cancer and certain inherited syndromes, as well as lifestyle factors7

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Various lifestyle factors may impart a protective effect against colorectal cancer. These include a healthy diet, increased fibre intake and physical activity.8 Screening programmes, such as the UK faecal immunochemical test (FIT), have also been shown to lead to the reduction of incidence of colorectal cancer and deaths9

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Diagnosis of colorectal cancer is carried out using various methods, including FIT, colonoscopy and computed tomography (CT) colonography10,11

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The main treatments recommended by the National Institute of Health and Care Excellence (NICE) for colon cancer include surgery, neoadjuvant systemic anti-cancer therapy (SACT) and adjuvant SACT12

Treatments recommended by NICE for rectal cancer include surgery, neoadjuvant radiotherapy or chemoradiotherapy and adjuvant SACT12

Classification of colorectal cancer

The highest incidence of colorectal cancer in the UK occurs in people aged 70-74, with 43% of cases diagnosed in those aged ≥ 75 years. However, rates in younger patients are increasing; since the 1990s, diagnosis rates have increased by 74% in the 0−24 years age group and 51% in the 25–49 years age.2

Most colorectal cases diagnosed in the UK (62-71%) are located in the colon (25-34% right-sided, 24-28% left sided), with 27-37% located in the rectum or rectosigmoid junction.13

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Figure 1. Percentage distribution of colorectal cancer by anatomical site in males and females in the UK, 2016–2018.13
ICD-10 C18–C20; cases and percentages may not sum due to rounding.

Credit: Cancer Research UK

The most common classification of bowel cancer is adenocarcinoma, which includes mucinous and signet ring tumours.14

*Other classifications of bowel cancer include medullary, micropapillary, adenosquamous, spindle cell, squamous cell, undifferentiated, neuroendocrine and mixed adenoneuroendocrine carcinomas; and cribiform comedo-type and serrated adenocarcinomas.7

Symptoms of colorectal cancer

Symptoms of colorectal cancer are usually associated with relatively large tumours and/or an advanced stage of disease.5 Depending on disease severity, symptoms may include:5–7

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Altered bowel habits

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Abdominal pain or mass

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Rectal bleeding (fresh red blood is associated with left-sided tumours)

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Weight loss

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Fatigue

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Iron deficiency anaemia

Symptoms associated with emergency presentation include those associated with large bowel obstructions, such as absolute constipation, abdominal pain, abdominal distention and vomiting.7

Risk factors for colorectal cancer

The risk of colorectal cancer may be increased by:7

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Increasing age

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Male sex

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Family history of colorectal cancer

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Inherited syndromes, such as Lynch syndrome and familial adenomatous polyposis

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Inflammatory bowel disease

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Diabetes

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Smoking

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Obesity

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High alcohol consumption

Lynch syndrome

Approximately 3–5% of colorectal cancers can be attributed to Lynch syndrome.7

Lynch syndrome (also known as Hereditary Nonpolyposis Colon Cancer) is an inherited genetic condition characterised by a mutation in the mismatch repair (MMR) system and associated with an increased risk of several cancers.7,15

People with Lynch syndrome have a lifetime risk of up to 80% of developing colorectal cancer, with the cancer developing 25–30 years sooner than the general population.7,15

Click to view further educational materials on Lynch syndrome

Beyond the national lynch syndrome transformation
project and mainstreaming videos

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Diagnosis of colorectal cancer

Colonoscopy with biopsy is considered the gold standard diagnostic test for colorectal cancer.16

NICE diagnostic guideline DG56 recommends FIT testing and CT colonography in primary and secondary care, respectively, which may trigger a colonoscopy and biopsy, thereby prioritising colonoscopy services for those who most need them.10

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NICE guidelines on colorectal cancer diagnosis (DG56 and DG27)10,17

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Figure 2. Summary of NICE colorectal cancer diagnostic guidelines. Adapted from NICE diagnostic guidelines DG27 and DG56. Refer to the individual guidelines for further information.10,17

CT, computed tomography; FIT, faecal immunochemical testing; IHC, immunohistochemistry; MLH1, MutL homolog 1; MSH2/6, MutS homolog 2/6; MSI, microsatellite instability; NGS, next generation sequencing; PCR, polymerase chain reaction; PMS2, postmeiotic segregation increased 2.


*If CT of the colon has already been completed, CT of only the thorax may be performed for staging.

Where a CT colonography detects a mass suspicious of colorectal cancer, British Society of Gastrointestinal and Abdominal Radiology and The Royal College of Radiologists recommend same-day colonoscopy/biopsy and staging.18

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Biomarker testing

NICE recommend testing all patients with colorectal cancer for MMR or MSI at diagnosis and RAS and BRAF V600E in all patients with metastatic colorectal cancer.12,17

Overview of Staging (TNM)5,7

Following a diagnosis of colorectal cancer, staging may be undertaken using the following:

  • CT scan with intraveous (IV) contrast (chest, abdomen, pelvis)
  • MRI (pelvis) – for rectal cancer
Stage7
 TNM7
 Brief description7 Incidence3
 Estimated 5-year Survival4
1 T1 or T2
N0
M0		 T1: extending into submucosa
T2: extending into muscularis propria		 47% 90%
2 T3 or T4
N0
M0		 T3: extending beyond muscularis propria
T4: extending into adjacent organs and/or visceral peritoneum		 85%
3 Any T
N1 or N2
M0		 Limited to or extension through muscularis propria with involved lymph nodes 53% 65%
4 Any T
Any N
M1		 Distant metastasis 10%

Staging based on UICC TNM Classification of Malignant Tumours 9th edition and AJCC 8th edition.
AJCC, American Joint Committee on Cancer; UICC; Union for International Cancer Control.

Treatment of colorectal cancer

Treatment of colorectal cancer depends on the type and stage of cancer and may include:12

  • Surgery
  • Chemotherapy
  • Radiotherapy (external beam radiotherapy [EBRT] or brachytherapy)
  • Chemoradiotherapy
  • Immunotherapy
  • Targeted therapy

Treatment of local disease may differ depending on whether the tumour is located in the rectum or colon; however, metastatic disease is treated similarly irrespective of whether it originated in the colon or rectum.12

Treatment of localised rectal cancer has a surgical focus and may include neoadjuvant (chemo)radiotherapy for more advanced stages.12 The treatment approach depends on many factors such as stage, height of the tumour in the rectum, presence of high-risk features such as extramural venous invasion (EMVI) and threatened circumferential resection margin (CRM), patient preference and non-operative management considerations.19 NICE guidance states that non-operative management can be used for patients who achieve a clinical complete response if they are well-counselled on the risks of regrowth.12

Colon cancer is not usually treated with radiotherapy. Surgery is often the primary treatment for early stages and may include adjuvant chemotherapy for Stage 3 disease.12 However, the FOXTROT trial demonstrated that giving 6 weeks of chemotherapy in the neoadjuvant setting significantly improved rates of complete (R0) resection and 2-year disease control, providing evidence that this treatment approach may be an option for some colon cancer patients with operable disease.20

Metastatic colorectal cancer may be treated with chemotherapy, with or without targeted therapies. If a metastatic tumour is MMR-deficient, immunotherapy may be used. Targeted therapies are appropriate if actionable mutations are present:12

  • Epidermal growth factor receptor (EGFR) inhibitor – for untreated EGFR-expressing, RAS wild-type metastatic colorectal cancer
  • B-Raf proto-oncogene, serine/threonine kinase (BRAF) inhibitor – for BRAF V600E mutation-positive metastatic colorectal cancer
  • Vascular endothelial growth factor (VEGF) inhibitor – for metastatic colorectal cancer when targeted treatments or immunotherapy are unsuitable
  • Neurotrophic tyrosine receptor kinase (NTRK) inhibitor – for NTRK fusion-positive tumours with no other satisfactory treatment options

See the full NICE guidelines to learn more

NICE guideline NG151

By clicking the following link the user will be directed to an external site not owned by GSK

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Figure 3. Summary of NICE colorectal cancer treatment recommendations (NG151). See the full NICE guidelines for more details.12

BRAF, B-Raf proto-oncogene, serine/threonine kinase; EGFR, epidermal growth factor receptor; NICE, National Institute for Health and Care Excellence; NTRK, neurotrophic tyrosine receptor kinase; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor.

References

  1. Cancer Research UK. Bowel cancer statistics.
    https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer
    (accessed December 2025);
  2. Cancer Research UK. Bowel cancer incidence.
    https://crukcancerintelligence.shinyapps.io/CancerStatsDataHub/_w_2ccddebaef1044059a95eca103867df1/?_inputs_&nav=%22Incidence%20Breakdowns%20and%20Trends%22&app_select_CancerSite=%22Bowel%22&app_ select_Country=%22United%20Kingdom%22
    (accessed December 2025);
  3. NHS England. Cancer Registration Statistics, England, 2022.
    https://digital.nhs.uk/data-and-information/publications/statistical/cancer-registration-statistics/england-2022/incidence-by-stage-at-diagnosis
    (accessed December 2025);
  4. Cancer Research UK. Survival for bowel cancer.
    https://www.cancerresearchuk.org/about-cancer/bowel-cancer/survival
    (accessed December 2025);
  5. Argilés G et al. Ann Oncol 2020;31:1291–1305;
  6. National Institute of Health and Care Excellence. Clinical knowledge summary: Gastrointestinal tract (lower) cancers - recognition and referral.
    https://cks.nice.org.uk/topics/gastrointestinal-tract-lower-cancers-recognition-referral/
    (accessed December 2025);
  7. Lawler M et al. Colorectal cancer. In: Niederhuber JE, et al. eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA, USA: Elsevier; 2020:1219–1279;
  8. Roshandel G et al. Cancers (Basel) 2024;16:1530;
  9. Granger SP et al. Colorectal Dis 2023;25:1771–1782;
  10. National Institute of Health and Care Excellence. Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care. Diagnostics guidance DG56.
    https://www.nice.org.uk/guidance/dg56
    (accessed December 2025);
  11. Monahan KJ et al. Gut 2022;71:1939–1962;
  12. National Institute of Health and Care Excellence. Colorectal cancer. NICE guideline NG151.
    https://www.nice.org.uk/guidance/ng151
    (accessed December 2025);
  13. Cancer Research UK. Bowel cancer incidence statistics.
    https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence
    (accessed December 2025);
  14. Cancer Research UK. Grades and types of bowel cancer.
    https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades/grades-and-types
    (accessed December 2025);
  15. Bhattacharya P et al. Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer). In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024.
    https://www.ncbi.nlm.nih.gov/books/NBK431096/
    (accessed December 2025);
  16. National Institute of Health and Care Excellence. Clinical knowledge summary: Gastrointestinal tract (lower) cancers - recognition and referral: Presentation.
    https://cks.nice.org.uk/topics/gastrointestinal-tract-lower-cancers-recognition-referral/background-information/presentation/
    (accessed December 2025);
  17. National Institute of Health and Care Excellence. Molecular testing strategies for Lynch syndrome in people with colorectal cancer. Diagnostics guidance DG27.
    https://www.nice.org.uk/guidance/dg27
    (accessed December 2025);
  18. Royal College of Radiologists. Standards of practice for computed tomography colonography (CTC).
    https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/standards-of-practice-for-computed-tomography-colonography-ctc/
    (accessed December 2025);
  19. Holfeinz RD et al. Ann Oncol 2025;36:1007–1024;
  20. Morton D et al. J Clin Oncol 2023;41:1541–1552.

May 2026 I NX-GB-DST-WCNT-250001 (v1.0)