Colorectal cancer

Abstract

#### Summary points Colorectal cancer is common, the presenting symptoms are non-specific, and the stage of disease at diagnosis is closely related to survival. In this review we discuss disease presentation, criteria for urgent referral of patients to specialist care, and recent developments in the implementation of national screening programmes, which aim to reduce mortality from this common disease. Many general practitioners will also refer patients with suspected colorectal cancer ?direct to test? and this review covers the various modalities for investigation of patients with colorectal symptoms. We searched PubMed for recent papers using the keywords ?colorectal cancer?, ?screening?, ?investigation?, and ?incidence?. We also searched the Cochrane Database of Systematic Reviews using the search terms ?colorectal cancer? and ?inflammatory bowel disease?. In addition we used our personal reference archive. In the Western world colorectal cancer is the second most common cancer in women after breast cancer and the third most common in men after lung and prostate cancer.1 2 Rates vary largely worldwide, being lowest in Africa and Asia and highest in Europe, North America, and Australasia. In the United Kingdom the lifetime incidence of colorectal cancer in people at average risk is 5% and the age standardised incidence rate is 44.3 per 100?000 population.3 In most cases colorectal cancers arise from dysplastic adenomatous polyps. A multistep process involves …