Treatment of colorectal cancer: surgery, chemotherapy and radiotherapy

Colorectal cancer is the second most common cancer in the United Kingdom. It occurs more frequently in middle age to elderly individuals; an increase in overall incidence has been demonstrated over recent years. Patients will often present with symptoms of anaemia, weight loss, rectal bleeding and abdominal pain with associated signs of abdominal or rectal mass. Treatment is based on multidisciplinary team assessment and is dependent upon accurate staging and preoperative physiological optimisation. The surgical resection performed takes into consideration the site of the tumour, associated co-morbidities and any extra-intestinal spread. If attempting a curative procedure it is important to obtain clear resection margins and provide a good functional result. In the elective setting there is a strong evidence base for the use of adjuvant and neoadjuvant chemoradiotherapy, although this should be tailored to the individual patient. Chemoradiotherapy may also be useful in the palliative setting to increase survival or provide symptom relief. Morbidity and mortality rates are significantly better for elective as opposed to emergency operations.