Bowel cancer: the outcome is improving

The management of rectal cancer has been revolutionised over the last 20 years through improvements in staging, surgery and the use of radiotherapy and combination chemoradiotherapy. The traditional approach involved surgery followed by pathological assessment of the specimen reporting the completeness of excision. Incomplete excision in many cases led to local recurrence of the cancer within the pelvis with the disabling symptoms of pelvic pain, bowel fistulation and bowel and bladder dysfunction. Indeed, many patients died with local recurrence alone and salvage therapy in these patients was rarely successful. However, the recognition of the advantage of pre-operative therapy for patients in whom surgery would not provide local cure has been a major advance. The ability to downstage/downsize the tumour before curative surgery has improved outcome. However, these pre-operative therapies are toxic and not without their own complications, therefore the select use, targeted at the appropriate patient, represents the 'gold-standard'. The development of magnetic resonance imaging staging that accurately predicts operability has completed this triad approach which is focused through the weekly multidisciplinary team meeting. National acceptance of these techniques and standards can only improve the outcome for patients with this disease.