Overview of pathway

Patient with suspected colorectal cancer

NON-EMERGENCY PRESENTATION EMERGENCY PRESENTATION

Patient with major Patient presenting with acute large bowel

No Yes obstruction
co-morbidity?

Flexible sigmoidoscopy
Colonoscopy (with biopsy (with biopsy if needed) then
if needed) barium enema CT of chest, abdomen and pelvis
or or
CT colonography1 CT colonography1

Left sided Other sites of

Patient diagnosed with colorectal cancer obstruction obstruction

Contrast enhanced CT of chest, abdomen and pelvis to

estimate stage of disease Insert SEMS if Operate2. Do not
appropriate insert SEMS
Patient information and support

See “Management
of metastatic Yes Metastases?
disease” algorithm

No

Patient with rectal Patient with

cancer colon cancer

MRI to assess local recurrence

determined by anticipated resection
No further routine imaging required
margin, tumour and lymph node
staging, unless contraindicated

Offer endorectal ultrasound if MRI

shows disease amenable to local
excision or is contraindicated

Patient with Patient with locally Patient with Patient with locally
operable rectal advanced rectal operable colon advanced colon
cancer cancer cancer cancer

Appropriate treatment (see algorithms on “Management of local disease” and “Post-

operative care”)

Regular surveillance:
a minimum of 2 CT scans of chest, abdomen and pelvis within the first 3 years
regular serum CEA tests (at least every 6 months in the first 3 years)
surveillance colonoscopy at 1 year after initial treatment

1
If the local radiology service can demonstrate competency in this technique
2
This guideline does not make recommendations on what surgery is appropriate for this group of patients or when it is
appropriate