Managing Colorectal Cancers In The NHS

How best to detect and manage bowel cancer is the subject of the latest issue of effective health care.

Colorectal (bowel) cancer is the second most common cause of cancer death in England and Wales. Early detection and good management result in improved survival rates.

Improvements have been made in the provision of services and treatment of colorectal cancers, but wide variations still exist across the country. There are still patients who fit the NHS ‘two-week wait’ criteria who are not being referred as urgent.

On 25 June 2004, the National Institute of Clinical Excellence (NICE) published an update of the guidance on improving outcomes in colorectal cancers. Effective health care summarises the research evidence that informed this update. This reveals that:

Where open-access clinics for patients with bowel symptoms are provided, they have helped reduce overall waiting times and detect cancers at an earlier stage.Lack of trained endoscopists is a major constraint to the expansion of secondary care services. This problem may be eased with the use of appropriately trained nurses and GPs, who are already providing a safe and accurate service in some centres, to the satisfaction of their patients.

Good surgery – in particular, total mesorectal excision (TME) for patients with rectal cancer – can reduce the chances of a recurrence and improve long term survival. The more frequently a surgeon undertakes a procedure, and gains experience in a specialization, the better the outcomes are for his/her patients.