Bowel cancer - guide for the GP

Many patients will remain asymptomatic until the advanced stages of colorectal cancer and hence, will only be identified by means of a coordinated screening program.

This article outlines the risk assessment, early detection primary prevention and management of colorectal cancer.

It is vital that general practitioners recognise the enormous variation in the patterns of clinical presentation of colorectal neoplasia such as rectal bleeding, iron deficiency anaemia, change in bowel habit, and unexplained weight loss. Any patient over 40 years of age presenting with rectal bleeding should be considered for colonoscopy. In patients in whom a colorectal neoplasm has been diagnosed, preoperative workup and counselling is of paramount importance. Primary treatment of colorectal cancer is surgical resection and often adjuvant chemotherapy. Patients with rectal tumours have a greater risk of complications of surgery and local recurrence than those with colonic tumours. Patients with node positive cancer remain at significant risk for recurrence, despite optimal surgery and removal of the primary tumour. Adding oxaliplatin to standard (5FU based) chemotherapy has improved disease free survival for high risk patients.