{"cancerId":"colorectal","aliases":["rectal-cancer","msi-high-colorectal","braf-v600e-colorectal","kras-g12c-colorectal","her2-amplified-colorectal","early-onset-colorectal","colorectal-mucinous-adenocarcinoma","colorectal-signet-ring-cell-carcinoma","colorectal-medullary-carcinoma","colorectal-serrated-adenocarcinoma"],"cancerName":"Colorectal (bowel) cancer","asOf":"2026-09-24","intro":"Around 48,200 people a year are diagnosed with bowel cancer in the UK and around 17,700 die of it: the fourth most common cancer and the second most common cause of cancer death. It is also the one the NHS reports on best. A home stool test arrives by post from the age of 50 in Great Britain and 60 in Northern Ireland; a second stool test in the GP surgery now decides who is referred urgently; a national audit publishes every trust's results; and more than half of all cases are found at stage 1 or 2 in Scotland. This page follows the NHS route from the screening kit through the referral rules, the 28, 31 and 62 day standards, the colorectal multidisciplinary team and the rectal MRI, to surgery, stoma care and the drugs. It sets out what the National Bowel Cancer Audit found, lists every NICE, Scottish Medicines Consortium and Welsh decision on a bowel cancer medicine with its reference and date, names the tests to ask for, and says plainly where a figure could not be found.","presentation":[{"title":"A kit through the letterbox","share":"12.2% of diagnoses (England and Wales, 2023)","detail":"The commonest planned route. Everyone aged 50 to 74 registered with a GP in England, Scotland or Wales, and 60 to 74 in Northern Ireland, is sent a faecal immunochemical test kit every two years; a result above the programme threshold leads to a colonoscopy, or a CT colonography if colonoscopy is unsuitable. The National Bowel Cancer Audit found the screening share rising from 10.9 percent of diagnoses in 2019 to 12.2 percent in 2023, and the emergency share falling in step. Screen-detected cancers are the earliest: in Scotland, three in five cancers found this way were stage 1 or 2.","sources":[{"label":"GOV.UK: bowel cancer screening programme overview (age 50 to 74 every two years; the 50, 52 and 54 transition cohorts; faecal immunochemical test since June 2019; last updated 17 March 2026)","url":"https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview","date":"2026-03-17"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"GOV.UK: bowel cancer screening pathway requirements specification (colonoscopy for an abnormal result, CT colonography where colonoscopy is unsuitable)","url":"https://www.gov.uk/government/publications/bowel-cancer-screening-pathway-requirements-specification/bowel-cancer-screening-pathway-requirements-specification","date":"2026-03-06"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics, full report (PDF, 7 April 2026): uptake by sex and deprivation, positivity, colonoscopy waits and cancers found","url":"https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","date":"2026-04-07"}]},{"title":"Symptoms, then a stool test at the GP surgery","detail":"Since 2023 the faecal immunochemical test decides the referral, not the symptom. NICE NG12 recommendation 1.3.1 tells GPs to offer the test to anyone with an abdominal mass, a change in bowel habit or iron-deficiency anaemia; to anyone 40 or over with unexplained weight loss and abdominal pain; to anyone under 50 with rectal bleeding plus abdominal pain or weight loss; to anyone 50 or over with unexplained rectal bleeding, abdominal pain or weight loss; and to anyone 60 or over with anaemia even without iron deficiency. Recommendation 1.3.2 then says: refer on a suspected cancer pathway at a result of at least 10 micrograms of haemoglobin per gram of faeces. A previous negative screening test does not exempt you. Scotland sets its own threshold, twice England's, in the four-nations table below.","sources":[{"label":"NICE NG12: suspected cancer, recommendations by site (colorectal 1.3.1 to 1.3.5, anal 1.3.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023)","url":"https://www.nice.org.uk/guidance/htg690/chapter/1-Recommendations","date":"2023-08-24"},{"label":"Scottish Government: Scottish referral guidelines for suspected cancer 2025, lower gastrointestinal (an urgent suspicion of cancer referral at a quantitative faecal immunochemical test result of 20 micrograms of haemoglobin per gram or more)","url":"https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/pages/5/","date":"2025-08-06"}]},{"title":"An emergency admission","share":"19.2% of diagnoses (England and Wales, 2023)","detail":"Nearly one in five bowel cancers still comes to light through an emergency admission, often with an obstructed bowel. The share has fallen from 21.4 percent in 2019, which the audit attributes to the rollout of the faecal immunochemical test and the extension of screening down to age 50. NICE NG151 recommendations 1.3.1 and 1.3.2 cover what happens next in acute left-sided large bowel obstruction: a stent if treatment is palliative, and either a stent or emergency surgery if cure is still possible. Bowel Cancer UK published paired clinician and patient reports on emergency diagnosis, Behind the emergency, in 2026.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"Bowel Cancer UK: policy reports and consultations, including the 2026 Behind the emergency reports on diagnosis in accident and emergency and the 2024 Lynch syndrome report","url":"https://www.bowelcanceruk.org.uk/campaigning/policy-reports-and-consultations/","date":"2026-09-24"}]},{"title":"Under 50, and told it is something else","share":"8.0% of diagnoses (England and Wales, 2023)","detail":"The proportion of people diagnosed under 50 rose from 6.4 percent in 2021 and 2022 to 8.0 percent in 2023, and the audit has made this group a focus of further study. Bowel Cancer UK's Never Too Young survey of over a thousand younger patients found that four in ten had visited their GP three or more times before being referred, that half had not known they could get bowel cancer at their age, and that nearly half of those diagnosed after 2017 had not been offered Lynch syndrome testing. NG12's rules do not have a lower age limit: rectal bleeding with abdominal pain or weight loss under 50 is a reason to be tested.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"Bowel Cancer UK: Never Too Young, the campaign for younger patients launched in 2013, with the findings of its 2020 report","url":"https://www.bowelcanceruk.org.uk/campaigning/never-too-young/","date":"2026-09-24"},{"label":"NICE NG12: suspected cancer, recommendations by site (colorectal 1.3.1 to 1.3.5, anal 1.3.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"}]}],"timeline":[{"id":"screening","label":"Before any symptoms: the screening kit","standard":"A faecal immunochemical test by post every two years from 50 (60 in Northern Ireland) to 74","target":"Uptake: England acceptable 62%, achievable 73 to 76% at ages 60 to 74; Scotland minimum 60%","detail":"England's programme started in 2006 for people aged 60 to 69 and widened to 74 in 2010. Wales extended down to 50 from October 2024. Northern Ireland still starts at 60. The nation-by-nation ages are in the table below. Anyone over 74 can ask for a kit: 0800 707 60 60 in England, 0800 0121 833 in Scotland; Wales and Northern Ireland do not currently allow self-referral. England invited 7,963,115 people in 2024 to 2025 and 5,195,407 took part, an uptake of 65.2 percent, finding 5,170 cancers. Lynch syndrome carriers were added to the English programme from July 2023 with colonoscopy every two years.","sources":[{"label":"GOV.UK: bowel cancer screening programme overview (age 50 to 74 every two years; the 50, 52 and 54 transition cohorts; faecal immunochemical test since June 2019; last updated 17 March 2026)","url":"https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview","date":"2026-03-17"},{"label":"GOV.UK: bowel cancer screening standards data report 2024 to 2025 (the programme history, the age extension completed in 2025, uptake and outcomes; published 11 July 2026)","url":"https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","date":"2026-07-11"},{"label":"NHS: bowel cancer screening (the home test kit, the 0800 707 6060 helpline, results in about two weeks)","url":"https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/","date":"2024-10-11"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics (age 50 to 74 every two years; May 2023 to April 2025 uptake; published 7 April 2026)","url":"https://publichealthscotland.scot/publications/scottish-bowel-screening-programme-statistics/scottish-bowel-screening-programme-statistics-for-the-period-of-invitations-from-may-2023-to-april-2025/","date":"2026-04-07"},{"label":"Public Health Wales: bowel screening (people aged 50 to 74 registered with a doctor in Wales, every two years)","url":"https://phw.nhs.wales/topic/screening/bowel-screening/","date":"2026-09-24"},{"label":"nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years)","url":"https://www.nidirect.gov.uk/articles/bowel-cancer-screening","date":"2026-09-24"},{"label":"Bowel Cancer UK: screening (the four nations' age ranges and the over-75 self-referral helplines)","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/screening/","date":"2026-09-24"},{"label":"UK National Screening Committee: bowel cancer recommendation (screening every two years for men and women aged 50 to 74 in the UK using the faecal immunochemical test)","url":"https://view-health-screening-recommendations.service.gov.uk/bowel-cancer/","date":"2026-09-24"}]},{"id":"referral","label":"Day 0: the stool test decides the referral","standard":"Quantitative faecal immunochemical test in primary care; refer on a suspected cancer pathway at 10 micrograms of haemoglobin per gram or more","detail":"NICE HTG690, published 24 August 2023 as DG56 and now carried inside NG12 as recommendations 1.3.1 to 1.3.4, made the test the gatekeeper. Below 10 micrograms per gram, safety netting must be in place and referral must not be delayed if there is strong clinical concern, for example an abdominal mass. People with a rectal mass, an unexplained anal mass or unexplained anal ulceration do not need a stool test first. The National Cancer Plan for England says this has already cut inappropriate lower gastrointestinal referrals by 22 percent against the projected trend for 2024 to 2025 and improved faster diagnosis performance on those pathways by 15 percentage points between 2022 and 2025. Scotland's referral guidelines set the threshold at 20 micrograms per gram, Northern Ireland's at 10.","sources":[{"label":"NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023)","url":"https://www.nice.org.uk/guidance/htg690/chapter/1-Recommendations","date":"2023-08-24"},{"label":"NICE NG12: suspected cancer, recommendations by site (colorectal 1.3.1 to 1.3.5, anal 1.3.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Scottish Government: Scottish referral guidelines for suspected cancer 2025, lower gastrointestinal (an urgent suspicion of cancer referral at a quantitative faecal immunochemical test result of 20 micrograms of haemoglobin per gram or more)","url":"https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/pages/5/","date":"2025-08-06"}]},{"id":"fds","label":"28 days: diagnosis or all-clear","standard":"Faster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of the referral","target":"75%, with 80% in the 2025/26 planning guidance and by March 2029","detail":"England measures the time from an urgent suspected cancer referral, a breast symptomatic referral, an urgent screening referral or a consultant upgrade to the day the patient is told. The National Cancer Plan for England commits to 80 percent by March 2029 and notes that in March 2025 the NHS met the 77 percent target then in force. The colonoscopy that answers the question is itself a bottleneck: in Scotland only 41.5 percent of people with a positive screening test had their colonoscopy within four weeks and 18.6 percent waited more than eight.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics, full report (PDF, 7 April 2026): uptake by sex and deprivation, positivity, colonoscopy waits and cancers found","url":"https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","date":"2026-04-07"},{"label":"NHS England: changes to cancer waiting times standards from 1 October 2023 (HTTP 202 with an empty body to OnCo)","url":"https://www.england.nhs.uk/long-read/changes-to-cancer-waiting-times-standards-from-1-october-2023/"}]},{"id":"mdt","label":"The colorectal multidisciplinary team and the rectal MRI","standard":"Staging CT of chest, abdomen and pelvis for everyone; high-resolution pelvic MRI for every rectal cancer, read by a specialist team","detail":"Rectal cancer is staged by magnetic resonance imaging before any treatment because the scan predicts whether the surgeon will get a clear circumferential resection margin. The MERCURY study of 408 consecutive patients across 11 European units showed the prediction was right in 94 percent of cases and reproducible between centres, which is what made it a national standard. The team then chooses between the options in NICE NG151: for early rectal cancer (cT1-T2 cN0 M0) transanal excision, endoscopic submucosal dissection or total mesorectal excision, compared in its table 1 (1.3.3), and explicitly no preoperative radiotherapy outside a trial (1.3.4); for cT1-T2 cN1-N2 M0 or cT3-T4 disease, preoperative radiotherapy or chemoradiotherapy (1.3.5). Locally advanced or recurrent disease that might need surgery beyond the mesorectum should be referred to a specialist exenteration centre (1.3.12).","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"MERCURY Study Group, Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study, BMJ 2006","url":"https://europepmc.org/article/MED/16984925","date":"2006-09-19"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"}]},{"id":"genomics","label":"Mismatch repair testing for every new diagnosis","standard":"Immunohistochemistry or microsatellite instability testing on every colorectal cancer at diagnosis; RAS and BRAF on every stage 4 tumour","detail":"NICE HTG430 (formerly DG27) recommendation 1.1 is unambiguous: offer testing to all people with colorectal cancer when first diagnosed, by four-panel immunohistochemistry for MLH1, MSH2, MSH6 and PMS2 or by microsatellite instability testing, and do not wait for the result before starting treatment. An abnormal MLH1 result triggers BRAF V600E testing and then MLH1 promoter hypermethylation testing to separate sporadic from Lynch tumours; an abnormal MSH2, MSH6 or PMS2 result goes straight to germline testing. Separately, NG151 recommendation 1.4.1 says test for RAS and BRAF V600E in all people with metastatic colorectal cancer suitable for systemic treatment. The audit found one in three people with stage 4 disease had no record of that testing.","sources":[{"label":"NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017)","url":"https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","date":"2017-02-22"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"GeNotes: patient with colorectal cancer and a constitutional (germline) variant causing Lynch syndrome (reviewed 22 September 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/results-patient-with-colorectal-cancer-constitutional-germline-variant-causing-lynch-syndrome-identified/","date":"2024-09-22"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"}]},{"id":"cns","label":"The clinical nurse specialist","standard":"A colorectal clinical nurse specialist as the named contact from diagnosis","target":"More than 95% seen by a clinical nurse specialist","detail":"The audit's first performance indicator. Of people with a record, 93 percent were seen by a clinical nurse specialist in 2023, but only 61 percent of trusts and multidisciplinary teams met the 95 percent target, and the record itself was missing for 29 percent of people (England 31 percent, Wales 1 percent). Counting everyone diagnosed, 67 percent had a recorded nurse specialist contact, up from 64 percent in 2019. Bowel Cancer UK's survey of younger patients found one in five had no access to one at all.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NBOCA State of the Nation 2025 infographic (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Infographic.pdf","date":"2025-10"},{"label":"Bowel Cancer UK: Never Too Young, the campaign for younger patients launched in 2013, with the findings of its 2020 report","url":"https://www.bowelcanceruk.org.uk/campaigning/never-too-young/","date":"2026-09-24"}]},{"id":"dtt","label":"31 days: decision to first treatment","standard":"Treatment starts within 31 days of the decision to treat","target":"96% (England); 95% (Scotland); 98% (Northern Ireland)","detail":"Applies to first and subsequent treatments: surgery, chemotherapy, radiotherapy or a stent as definitive palliation. Scotland met the 31-day standard for colorectal cancer in the quarter ending 31 March 2026 at 96.7 percent for non-screening referrals and 91.0 percent for screening referrals. Northern Ireland's lower gastrointestinal figure for the same quarter was 90.1 percent against a 98 percent target, and no trust met it.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral","url":"https://publichealthscotland.scot/media/39233/2026-06-30_cwt-report_final.pdf","date":"2026-06-30"},{"label":"Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026","url":"https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-cancer-waiting-times-january-march-2026","date":"2026-07-02"}]},{"id":"sixtytwo","label":"62 days: referral to first treatment","standard":"First treatment within 62 days of the urgent referral","target":"85% (England, by March 2029); 95% (Scotland); 75% (Wales); 95% (Northern Ireland)","detail":"The headline standard, and the one the NHS in England has not met nationally since late 2015. Scotland reported 72.2 percent overall in the quarter to 31 March 2026 with no board meeting the standard; for colorectal specifically, 79.0 percent of non-screening referrals and 57.6 percent of screening referrals started treatment within 62 days, and the report names colorectal surgery capacity as a reason. Wales reported 60.1 percent of pathways in July 2026 against its 75 percent target, ranging from 44.7 percent in Swansea Bay to 67.5 percent in Cwm Taf Morgannwg. Northern Ireland's revised figure for the quarter to March 2026 was 29.6 percent.","sources":[{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral","url":"https://publichealthscotland.scot/media/39233/2026-06-30_cwt-report_final.pdf","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target)","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026)","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"}]},{"id":"surgery","label":"Surgery","standard":"Major resection at a unit doing at least 20 rectal cancer operations a year; laparoscopic resection offered","detail":"Of the 37,730 people diagnosed in England and Wales in 2023, 21,395 (56.7 percent) had a major resection and 2,132 (5.7 percent) a local excision. NG151 offers laparoscopic surgery for both colon and rectal cancer (1.3.8 and 1.3.17) and asks teams to consider open surgery where clinically indicated (1.3.9), robotic surgery only within established programmes with audited outcomes (1.3.10) and transanal total mesorectal excision only in research (1.3.11); recommendations 1.3.13 and 1.3.14 set minimum volumes of 10 rectal resections a year per hospital and 5 per surgeon. In 2023, 75 percent of major resections were minimally invasive (60 percent laparoscopic, 15 percent robotic), against 66 percent in 2019 when robotic surgery was 3 percent. Ninety-day mortality after major resection was 2.5 percent, down from 3.1 percent in 2019, and two-year survival after major resection was 84.9 percent.","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NBOCA State of the Nation 2025 infographic (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Infographic.pdf","date":"2025-10"},{"label":"NICE TA105: laparoscopic surgery for colorectal cancer (23 August 2006); its recommendations are carried in NG151","url":"https://www.nice.org.uk/guidance/ta105","date":"2006-08-23"}]},{"id":"stoma","label":"The stoma, and getting rid of it","standard":"A trained stoma professional to give information and support; the diverting ileostomy closed within 18 months","target":"Fewer than 35% still unclosed at 18 months","detail":"NG151 recommendation 1.2.4 requires a trained stoma professional to provide information on caring for and living with a stoma, and 1.2.2 asks teams to warn people in advance about the likelihood of a stoma and how long it might be needed. The audit's worst-performing indicator is the one that follows: about 38 percent of people who had a diverting ileostomy at anterior resection still had it 18 months later, and only 40 percent of units met the under-35 percent target. The proportion given a diverting ileostomy at the operation has itself fallen from 59.8 percent in 2019 to 54.9 percent in 2023. NBOCA and the Royal College of Surgeons run a quality improvement collaborative, Close It Quick, aimed at this number; GIRFT's April 2026 general surgery follow-up report names timely stoma closure as a national priority.","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NATCAN: National Bowel Cancer Audit (NBOCA)","url":"https://www.natcan.org.uk/audits/bowel/","date":"2026-09-24"},{"label":"GIRFT: general surgery follow-up report, executive summary (April 2026, PDF), which carries the colorectal priorities: timely stoma closure, less variation in rectal cancer treatment and better access to quantitative faecal immunochemical testing","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2026/04/GIRFT-General-Surgery-Follow-Up-Report-FINAL-April-2026-exec-summary.pdf","date":"2026-04"}]},{"id":"lars","label":"Life after a low resection","standard":"Information about low anterior resection syndrome before sphincter-preserving surgery, and treatment in primary care if it happens","detail":"NG151 recommendations 1.6.2 to 1.6.4 name the syndrome, tell teams to warn people who may have sphincter-preserving surgery, to assess it with a validated patient questionnaire such as the low anterior resection syndrome score, and to treat it in primary care with dietary management, laxatives, anti-bulking, anti-diarrhoeal or anti-spasmodic agents, seeking secondary care advice if that fails. Recommendation 1.6.1 sets the follow-up after potentially curative surgery: three years of carcinoembryonic antigen testing and CT of chest, abdomen and pelvis.","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"}]},{"id":"oncology","label":"Chemotherapy and the drugs","standard":"Three months of CAPOX for stage 3; RAS and BRAF results before any targeted treatment in stage 4","target":"More than 55% of people with stage 3 colon cancer to receive adjuvant chemotherapy","detail":"For stage 3 colon cancer and for stage 3 rectal cancer treated with short-course or no preoperative radiotherapy, NG151 recommendations 1.3.15 and 1.3.18 offer three months of capecitabine with oxaliplatin, or FOLFOX for three to six months, or a single fluoropyrimidine for six months. The three-month option is the SCOT result. The audit found 66 percent of people with resected stage 3 colon cancer received adjuvant chemotherapy, above the 55 percent target, but with 15 units below the 95 percent funnel limit; severe acute toxicity was 20 percent against a 33 percent ceiling. Neoadjuvant radiotherapy for rectal cancer was given to 33 percent overall, ranging from 6 percent to 87 percent between units.","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"Iveson TJ, Kerr RS et al, 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT), Lancet Oncology 2018","url":"https://europepmc.org/article/MED/29611518","date":"2018-04"},{"label":"NICE TA100: capecitabine and oxaliplatin in the adjuvant treatment of stage 3 (Dukes' C) colon cancer (26 April 2006)","url":"https://www.nice.org.uk/guidance/ta100","date":"2006-04-26"}]}],"centres":[{"institutionId":"leeds-cancer-centre","name":"St James's University Hospital","trust":"Leeds Teaching Hospitals NHS Trust","city":"Leeds","nation":"England","offers":["Colorectal surgery and oncology","Home of the Leeds Clinical Trials Research Unit, sponsor of the FOxTROT platform and ARIEL","Lead centre for MRC CR07; TARGET tranexamic acid trial"],"url":"https://www.leedsth.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN28785842: MRC CR07, pathology-guided treatment of rectal cancer","url":"https://www.isrctn.com/ISRCTN28785842","date":"2026-09-24"}],"institutionName":"Leeds Cancer Centre, St James's University Hospital"},{"institutionId":"royal-marsden","name":"The Royal Marsden","trust":"The Royal Marsden NHS Foundation Trust","city":"London","nation":"England","offers":["Colorectal and gastrointestinal oncology","Sponsor of TRACC, the UK circulating tumour DNA trial","FOxTROT, ARIEL, OrigAMI-2 and OrigAMI-3 site; the FORTRESS rectal trial"],"url":"https://www.royalmarsden.nhs.uk/","sources":[{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"}],"institutionName":"The Royal Marsden"},{"institutionId":"birmingham-cancer-centre","name":"Queen Elizabeth Hospital Birmingham","trust":"University Hospitals Birmingham NHS Foundation Trust","city":"Birmingham","nation":"England","offers":["Colorectal surgery","Birmingham Clinical Trials Unit sponsors STAR-TREC and the ROSSINI surgical site infection trials","FOxTROT and ARIEL site"],"url":"https://www.uhb.nhs.uk/","sources":[{"label":"ISRCTN14240288: STAR-TREC, organ preservation after chemoradiotherapy or short-course radiotherapy against total mesorectal excision in early and intermediate rectal cancer (University of Birmingham; recruitment 1 November 2016 to 31 December 2023, 34 centres)","url":"https://www.isrctn.com/ISRCTN14240288","date":"2026-09-24"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"}],"institutionName":"University Hospitals Birmingham / University of Birmingham Cancer Research Centre"},{"institutionId":"oxford-cancer","name":"Churchill Hospital","trust":"Oxford University Hospitals NHS Foundation Trust","city":"Oxford","nation":"England","offers":["Colorectal cancer multidisciplinary team and oncology","Oncology Clinical Trials Office: QUASAR 2 and SCOT","FOxTROT, BICCC and PRIME-RT site; the PACES pathology artificial-intelligence study"],"url":"https://www.ouh.nhs.uk/","sources":[{"label":"ISRCTN12706992: PACES, machine-learning algorithms in the colorectal cancer pathway from histopathology to the multidisciplinary team (University of Oxford; recruiting 1 October 2024 to 1 October 2026)","url":"https://www.isrctn.com/ISRCTN12706992","date":"2026-09-24"},{"label":"ISRCTN12508004: BICCC, a brief course of cyclophosphamide after completion of colorectal cancer treatment (Cardiff University; recruiting 13 September 2024 to 12 March 2028)","url":"https://www.isrctn.com/ISRCTN12508004","date":"2026-09-24"},{"label":"University of Oxford, Department of Oncology: Rachel Kerr","url":"https://www.oncology.ox.ac.uk/team/rachel-kerr","date":"2026-09-24"}],"institutionName":"Oxford Cancer (Oxford University Hospitals and University of Oxford)"},{"institutionId":"the-christie","name":"The Christie","trust":"The Christie NHS Foundation Trust","city":"Manchester","nation":"England","offers":["Colorectal oncology and radiotherapy","FOxTROT, ARIEL, BICCC and PRIME-RT site","TRACC site"],"url":"https://www.christie.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN12508004: BICCC, a brief course of cyclophosphamide after completion of colorectal cancer treatment (Cardiff University; recruiting 13 September 2024 to 12 March 2028)","url":"https://www.isrctn.com/ISRCTN12508004","date":"2026-09-24"}],"institutionName":"The Christie NHS Foundation Trust"},{"institutionId":"addenbrookes-cambridge","name":"Addenbrooke's Hospital","trust":"Cambridge University Hospitals NHS Foundation Trust","city":"Cambridge","nation":"England","offers":["Colorectal surgery and oncology","FOxTROT, ARIEL, OrigAMI-2 and TRACC site","Pilot of a microchip blood and stool test for bowel cancer markers"],"url":"https://www.cuh.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"}],"institutionName":"Addenbrooke's Hospital, Cambridge University Hospitals"},{"institutionId":"uclh","name":"University College Hospital","trust":"University College London Hospitals NHS Foundation Trust","city":"London","nation":"England","offers":["Colorectal cancer service","ARIEL, OrigAMI-2 and OrigAMI-3 site","FORTRESS: an anti-CD40 adenoviral vector with chemoradiotherapy in rectal cancer"],"url":"https://www.uclh.nhs.uk/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN12595783: NG-350A, a tumour-selective anti-CD40 adenoviral vector, with chemoradiotherapy in locally advanced rectal cancer (Akamis Bio; recruiting 15 February 2025 to 30 November 2026)","url":"https://www.isrctn.com/ISRCTN12595783","date":"2026-09-24"},{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"}],"institutionName":"University College London Hospitals / UCL Cancer Institute"},{"institutionId":"barts-cancer-institute","name":"St Bartholomew's Hospital","trust":"Barts Health NHS Trust","city":"London","nation":"England","offers":["Colorectal oncology for North East London","OrigAMI-2 and OrigAMI-3 site","FOxTROT site"],"url":"https://www.bartshealth.nhs.uk/","sources":[{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"},{"label":"ISRCTN39913423: OrigAMI-3, amivantamab with FOLFIRI against cetuximab or bevacizumab with FOLFIRI (Janssen-Cilag; recruiting 26 November 2024 to 13 October 2026, seven UK centres)","url":"https://www.isrctn.com/ISRCTN39913423","date":"2026-09-24"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"}],"institutionName":"Barts Cancer Institute / Barts Health NHS Trust"},{"institutionId":"nottingham-cancer-centre","name":"Nottingham University Hospitals","trust":"Nottingham University Hospitals NHS Trust","city":"Nottingham","nation":"England","offers":["Colorectal surgery and oncology","Home of the Nottingham faecal occult blood screening trial that created the national programme","GIRFT lower gastrointestinal cancer clinical lead Alastair Simpson; EPiC prehabilitation trial at Royal Derby"],"url":"https://www.nuh.nhs.uk/","sources":[{"label":"Hardcastle JD et al, Randomised controlled trial of faecal-occult-blood screening for colorectal cancer, Lancet 1996","url":"https://europepmc.org/article/MED/8942775","date":"1996-11-30"},{"label":"GIRFT: lower gastrointestinal cancer workstream (clinical lead Alastair Simpson, Nottingham University Hospitals; no national report published, guidance and academy resources only)","url":"https://gettingitrightfirsttime.co.uk/surgical_specialties/lower-gi-cancer/","date":"2026-09-24"},{"label":"ISRCTN18133394: EPiC, exercise prehabilitation before curative colorectal surgery (University of Nottingham; recruiting 28 July 2023 to 28 February 2027)","url":"https://www.isrctn.com/ISRCTN18133394","date":"2026-09-24"}],"institutionName":"Nottingham University Hospitals Cancer Centre (City Hospital)"},{"institutionId":"imperial-cancer-centre","name":"Charing Cross and St Mary's Hospitals","trust":"Imperial College Healthcare NHS Trust","city":"London","nation":"England","offers":["Colorectal surgery and oncology","Imperial College London ran the UK Flexible Sigmoidoscopy Screening Trial","FOxTROT and PICCOS site"],"url":"https://www.imperial.nhs.uk/","sources":[{"label":"Atkin WS et al, Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial, Lancet 2010","url":"https://europepmc.org/article/MED/20430429","date":"2010-05-08"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN17575409: PICCOS, pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases from bowel, ovary and stomach cancers (Cardiff and Vale University Health Board; recruiting 22 January 2024 to 31 October 2027, all four nations)","url":"https://www.isrctn.com/ISRCTN17575409","date":"2026-09-24"}],"institutionName":"Imperial College Healthcare NHS Trust / Imperial College London Cancer Research"},{"institutionId":"weston-park-sheffield","name":"Weston Park Cancer Centre","trust":"Sheffield Teaching Hospitals NHS Foundation Trust","city":"Sheffield","nation":"England","offers":["Colorectal oncology","FOxTROT and ARIEL site"],"url":"https://www.sth.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"}],"institutionName":"Weston Park Cancer Centre, Sheffield Teaching Hospitals"},{"institutionId":"southampton-cancer","name":"University Hospital Southampton","trust":"University Hospital Southampton NHS Foundation Trust","city":"Southampton","nation":"England","offers":["Colorectal surgery and oncology","ARIEL site; the GIRFT lower gastrointestinal surgical advisor is at the University of Southampton"],"url":"https://www.uhs.nhs.uk/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"GIRFT: lower gastrointestinal cancer workstream (clinical lead Alastair Simpson, Nottingham University Hospitals; no national report published, guidance and academy resources only)","url":"https://gettingitrightfirsttime.co.uk/surgical_specialties/lower-gi-cancer/","date":"2026-09-24"}],"institutionName":"University Hospital Southampton / Centre for Cancer Immunology"},{"institutionId":"hull-castle-hill","name":"Castle Hill Hospital (Queen's Centre)","trust":"Hull University Teaching Hospitals NHS Trust","city":"Cottingham","nation":"England","offers":["Colorectal oncology","ARIEL, OrigAMI-2 and OrigAMI-3 site"],"url":"https://www.hull.nhs.uk/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"},{"label":"ISRCTN39913423: OrigAMI-3, amivantamab with FOLFIRI against cetuximab or bevacizumab with FOLFIRI (Janssen-Cilag; recruiting 26 November 2024 to 13 October 2026, seven UK centres)","url":"https://www.isrctn.com/ISRCTN39913423","date":"2026-09-24"}],"institutionName":"Castle Hill Hospital, Hull (Queen's Centre)"},{"institutionId":"mount-vernon-cancer-centre","name":"Mount Vernon Cancer Centre","trust":"East and North Hertfordshire NHS Trust","city":"Northwood","nation":"England","offers":["Colorectal oncology and radiotherapy","OrigAMI-2 and OrigAMI-3 site"],"url":"https://www.enherts-tr.nhs.uk/hospitals/mount-vernon/","sources":[{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"},{"label":"ISRCTN39913423: OrigAMI-3, amivantamab with FOLFIRI against cetuximab or bevacizumab with FOLFIRI (Janssen-Cilag; recruiting 26 November 2024 to 13 October 2026, seven UK centres)","url":"https://www.isrctn.com/ISRCTN39913423","date":"2026-09-24"}],"institutionName":"Mount Vernon Cancer Centre"},{"institutionId":"clatterbridge","name":"The Clatterbridge Cancer Centre","trust":"The Clatterbridge Cancer Centre NHS Foundation Trust","city":"Liverpool","nation":"England","offers":["Colorectal oncology for Cheshire and Merseyside","FOxTROT site","ACRE study of the supportive care needs of people with advanced bowel cancer"],"url":"https://www.clatterbridgecc.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN80318573: ACRE, the supportive care needs of people with advanced bowel cancer and their carers (University of Liverpool, funded by North West Cancer Research; recruiting from 1 September 2026)","url":"https://www.isrctn.com/ISRCTN80318573","date":"2026-09-24"}],"institutionName":"The Clatterbridge Cancer Centre NHS Foundation Trust"},{"institutionId":"leicester-cancer-research-centre","name":"Leicester Royal Infirmary and Leicester General Hospital","trust":"University Hospitals of Leicester NHS Trust","city":"Leicester","nation":"England","offers":["Colorectal surgery and oncology","The University of Leicester sponsors COLO-PREVENT, the polyp prevention platform run inside the screening programme"],"url":"https://www.uhleicester.nhs.uk/","sources":[{"label":"ISRCTN13526628: COLO-PREVENT, aspirin, aspirin with metformin or resveratrol to prevent polyps in people under surveillance in the bowel cancer screening programme (University of Leicester; recruiting 30 September 2022 to 31 January 2028)","url":"https://www.isrctn.com/ISRCTN13526628","date":"2026-09-24"}],"institutionName":"Leicester Cancer Research Centre / University Hospitals of Leicester"},{"institutionId":"bristol-haematology-oncology-centre","name":"Bristol Cancer Centre","trust":"University Hospitals Bristol and Weston NHS Foundation Trust","city":"Bristol","nation":"England","offers":["Colorectal oncology","FOxTROT and TRACC site"],"url":"https://www.uhbw.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"}],"institutionName":"Bristol Haematology and Oncology Centre"},{"institutionId":"derriford-plymouth","name":"Derriford Hospital","trust":"University Hospitals Plymouth NHS Trust","city":"Plymouth","nation":"England","offers":["Colorectal surgery and oncology for Devon and Cornwall","FOxTROT site; the GIRFT lower gastrointestinal radiology advisor is at Plymouth"],"url":"https://www.plymouthhospitals.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"GIRFT: lower gastrointestinal cancer workstream (clinical lead Alastair Simpson, Nottingham University Hospitals; no national report published, guidance and academy resources only)","url":"https://gettingitrightfirsttime.co.uk/surgical_specialties/lower-gi-cancer/","date":"2026-09-24"}],"institutionName":"Derriford Hospital, University Hospitals Plymouth"},{"institutionId":"uhcw-coventry","name":"University Hospital Coventry","trust":"University Hospitals Coventry and Warwickshire NHS Trust","city":"Coventry","nation":"England","offers":["Colorectal surgery and oncology","FOxTROT and TRACC site"],"url":"https://www.uhcw.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"}],"institutionName":"University Hospital Coventry"},{"institutionId":"guys-st-thomas","name":"Guy's and St Thomas'","trust":"Guy's and St Thomas' NHS Foundation Trust","city":"London","nation":"England","offers":["Colorectal surgery and oncology for South East London","ARIEL and TRACC site"],"url":"https://www.guysandstthomas.nhs.uk/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"}],"institutionName":"Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre"},{"institutionId":"royal-free-hospital","name":"Royal Free Hospital","trust":"Royal Free London NHS Foundation Trust","city":"London","nation":"England","offers":["Colorectal surgery","FOxTROT site"],"url":"https://www.royalfree.nhs.uk/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"}],"institutionName":"Royal Free Hospital, Royal Free London NHS Foundation Trust"},{"institutionId":"beatson-glasgow","name":"Beatson West of Scotland Cancer Centre","trust":"NHS Greater Glasgow and Clyde","city":"Glasgow","nation":"Scotland","offers":["Colorectal oncology for the West of Scotland","NHS Greater Glasgow and Clyde sponsored SCOT and PRIME-RT","FOxTROT, ARIEL, BICCC and TRACC site"],"url":"https://www.nhsggc.scot/","sources":[{"label":"ISRCTN59757862: SCOT, short course oncology therapy (NHS Greater Glasgow and Clyde with the University of Glasgow; recruitment 9 May 2008 to 29 November 2013)","url":"https://www.isrctn.com/ISRCTN59757862","date":"2026-09-24"},{"label":"ISRCTN18138369: PRIME-RT, durvalumab with two radiotherapy schedules and chemotherapy in rectal cancer (NHS Greater Glasgow and Clyde; recruitment 7 January 2021 to 25 May 2023, 46 people)","url":"https://www.isrctn.com/ISRCTN18138369","date":"2026-09-24"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"}],"institutionName":"Beatson West of Scotland Cancer Centre / CRUK Scotland Institute"},{"institutionId":"edinburgh-cancer-centre","name":"Western General Hospital","trust":"NHS Lothian","city":"Edinburgh","nation":"Scotland","offers":["Colorectal oncology for South East Scotland","ARIEL and OrigAMI-2 site"],"url":"https://www.nhslothian.scot/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN11118663: OrigAMI-2, amivantamab with chemotherapy against cetuximab with chemotherapy, first line in RAS and BRAF wild-type metastatic colorectal cancer (Janssen-Cilag; recruiting 21 October 2024 to 23 December 2026, nine UK centres)","url":"https://www.isrctn.com/ISRCTN11118663","date":"2026-09-24"}],"institutionName":"Edinburgh Cancer Centre / CRUK Scotland Centre"},{"institutionId":"ninewells-dundee","name":"Ninewells Hospital","trust":"NHS Tayside","city":"Dundee","nation":"Scotland","offers":["Colorectal surgery and oncology for Tayside","FOxTROT site","TAYCAN: a liquid biopsy study in colorectal and pancreatic cancer"],"url":"https://www.nhstayside.scot.nhs.uk/index.htm","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN93548632: TAYCAN, a liquid biopsy blood test for pancreatic and colorectal cancer in NHS Tayside (recruiting 1 May 2025 to 1 May 2027)","url":"https://www.isrctn.com/ISRCTN93548632","date":"2026-09-24"}],"institutionName":"Ninewells Hospital, Dundee"},{"institutionId":"aberdeen-royal-infirmary","name":"Aberdeen Royal Infirmary","trust":"NHS Grampian","city":"Aberdeen","nation":"Scotland","offers":["Colorectal surgery and oncology for the North of Scotland","ARIEL, PRIME-RT and TRACC site"],"url":"https://www.nhsgrampian.org/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN18138369: PRIME-RT, durvalumab with two radiotherapy schedules and chemotherapy in rectal cancer (NHS Greater Glasgow and Clyde; recruitment 7 January 2021 to 25 May 2023, 46 people)","url":"https://www.isrctn.com/ISRCTN18138369","date":"2026-09-24"},{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"}],"institutionName":"Aberdeen Royal Infirmary"},{"institutionId":"velindre-cardiff","name":"Velindre Cancer Centre","trust":"Velindre University NHS Trust","city":"Cardiff","nation":"Wales","offers":["Colorectal oncology and radiotherapy for South East Wales","FOxTROT, ARIEL and BICCC site"],"url":"https://velindre.nhs.wales/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN12508004: BICCC, a brief course of cyclophosphamide after completion of colorectal cancer treatment (Cardiff University; recruiting 13 September 2024 to 12 March 2028)","url":"https://www.isrctn.com/ISRCTN12508004","date":"2026-09-24"}],"institutionName":"Velindre Cancer Centre"},{"institutionId":"university-hospital-wales-cardiff","name":"University Hospital of Wales","trust":"Cardiff and Vale University Health Board","city":"Cardiff","nation":"Wales","offers":["Colorectal surgery","Cardiff University sponsors BICCC; Cardiff and Vale sponsors PICCOS, the aerosolised intraperitoneal chemotherapy trial"],"url":"https://cavuhb.nhs.wales/","sources":[{"label":"ISRCTN12508004: BICCC, a brief course of cyclophosphamide after completion of colorectal cancer treatment (Cardiff University; recruiting 13 September 2024 to 12 March 2028)","url":"https://www.isrctn.com/ISRCTN12508004","date":"2026-09-24"},{"label":"ISRCTN17575409: PICCOS, pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases from bowel, ovary and stomach cancers (Cardiff and Vale University Health Board; recruiting 22 January 2024 to 31 October 2027, all four nations)","url":"https://www.isrctn.com/ISRCTN17575409","date":"2026-09-24"}],"institutionName":"University Hospital of Wales, Cardiff"},{"institutionId":"morriston-swansea","name":"Morriston and Singleton Hospitals","trust":"Swansea Bay University Health Board","city":"Swansea","nation":"Wales","offers":["Colorectal surgery and oncology for South West Wales","FOxTROT and PICCOS site"],"url":"https://sbuhb.nhs.wales/","sources":[{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN17575409: PICCOS, pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases from bowel, ovary and stomach cancers (Cardiff and Vale University Health Board; recruiting 22 January 2024 to 31 October 2027, all four nations)","url":"https://www.isrctn.com/ISRCTN17575409","date":"2026-09-24"}],"institutionName":"Morriston Hospital, Swansea"},{"institutionId":"northern-ireland-cancer-centre","name":"Northern Ireland Cancer Centre, Belfast City Hospital","trust":"Belfast Health and Social Care Trust","city":"Belfast","nation":"Northern Ireland","offers":["Colorectal oncology for Northern Ireland","ARIEL and PICCOS list Northern Ireland among their recruiting countries"],"url":"https://belfasttrust.hscni.net/","sources":[{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"ISRCTN17575409: PICCOS, pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases from bowel, ovary and stomach cancers (Cardiff and Vale University Health Board; recruiting 22 January 2024 to 31 October 2027, all four nations)","url":"https://www.isrctn.com/ISRCTN17575409","date":"2026-09-24"}],"institutionName":"Northern Ireland Cancer Centre, Belfast City Hospital"}],"centresNote":{"text":"Bowel cancer is not a hub-and-spoke cancer. Unlike pancreatic or gallbladder cancer, it is diagnosed and operated on in almost every acute trust: the National Bowel Cancer Audit reports 119 NHS trusts in England plus the Welsh multidisciplinary teams. What is concentrated is volume and complexity. NICE NG151 asks that hospitals doing major rectal resection perform at least 10 a year and individual surgeons at least 5 (recommendations 1.3.13 and 1.3.14); the audit sets a higher local target of 20 rectal resections a year per trust or team, which 78 percent met in 2023, while 28 units (22 percent) did fewer than 20 and 4 (3 percent) did fewer than 10. Locally advanced and recurrent rectal cancer that needs surgery beyond the mesorectum goes to a specialist exenteration centre, and peritoneal disease goes to a nationally commissioned cytoreductive surgery and heated intraperitoneal chemotherapy centre (NG151 1.3.12 and 1.5.21). The centres below are not a complete list: they are the UK units named on the records of the trials open now and on the landmark trials, which is a reasonable proxy for where the research-active colorectal services are.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN11061442: ARIEL, a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer (University of Leeds; recruiting 25 April 2022 to 1 October 2027, 43 centres across all four nations)","url":"https://www.isrctn.com/ISRCTN11061442","date":"2026-09-24"},{"label":"GIRFT: lower gastrointestinal cancer workstream (clinical lead Alastair Simpson, Nottingham University Hospitals; no national report published, guidance and academy resources only)","url":"https://gettingitrightfirsttime.co.uk/surgical_specialties/lower-gi-cancer/","date":"2026-09-24"}]},"funding":[{"line":"After surgery (adjuvant), stage 3 colon or rectal cancer","treatment":"Capecitabine with oxaliplatin (CAPOX) for three months; FOLFOX for three to six months; or a single fluoropyrimidine for six months","refs":["capox","folfox","capecitabine","oxaliplatin","scot"],"england":{"body":"NICE","decision":"Capecitabine and oxaliplatin are both recommended options after surgery for stage 3 (Dukes' C) colon cancer; NG151 recommendations 1.3.15 and 1.3.18 set the three-month CAPOX default from the SCOT result. Some of these uses are off label","ref":"TA100","date":"2006-04-26","url":"https://www.nice.org.uk/guidance/ta100"},"scotland":{"body":"SMC","decision":"Capecitabine with oxaliplatin accepted for use within NHS Scotland for adjuvant stage 3 (Dukes' C) colon cancer (SMC 716/11, 8 August 2011)","date":"2011-08-08","url":"https://scottishmedicines.org.uk/medicines-advice/capecitabine-xeloda-fullsubmission-71611/"},"wales":"As England, under NICE TA100 and NG151.","northernIreland":"As England.","note":"SCOT, sponsored by NHS Greater Glasgow and Clyde with the University of Glasgow, is why three months is offered first: three-year disease-free survival 76.7 percent against 77.1 percent for six months, with grade 2 or worse peripheral neuropathy in 25 percent against 58 percent. The audit found 66 percent of people with resected stage 3 colon cancer had adjuvant chemotherapy against a 55 percent local target.","refNames":["CAPOX (capecitabine, oxaliplatin)","FOLFOX (5-FU, leucovorin, oxaliplatin)","Capecitabine","Oxaliplatin","SCOT"]},{"line":"Before surgery (neoadjuvant), locally advanced colon cancer","treatment":"Six weeks of preoperative oxaliplatin with a fluoropyrimidine","refs":["folfox","capox","foxtrot"],"england":{"body":"NHS England","decision":"NG151 recommendation 1.3.16 says consider preoperative systemic anticancer therapy for people with cT4 colon cancer; the medicines are generics funded under national chemotherapy protocols","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},"scotland":{"body":"SMC","decision":"Not appraised (generic medicines); given under regional protocols","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal"},"wales":"As England.","northernIreland":"As England.","note":"FOxTROT, chaired from Birmingham and now sponsored by the University of Leeds, is the UK evidence: complete resection in 94 percent against 89 percent, and residual or recurrent disease within two years cut from 21.5 percent to 16.9 percent. The guideline's cT4 wording is narrower than the trial's T3-4 population, so ask the multidisciplinary team what it offers locally.","refNames":["FOLFOX (5-FU, leucovorin, oxaliplatin)","CAPOX (capecitabine, oxaliplatin)","FOxTROT"]},{"line":"Before surgery, rectal cancer","treatment":"Short-course radiotherapy (25 Gy in five fractions) or long-course chemoradiotherapy with capecitabine","refs":["capecitabine","cr07"],"england":{"body":"NHS England","decision":"NG151 recommendation 1.3.5 offers preoperative radiotherapy or chemoradiotherapy for cT1-T2 cN1-N2 M0 or cT3-T4 any cN M0 rectal cancer; 1.3.4 says do not offer it in early (cT1-T2 cN0 M0) disease except in a trial. Radiotherapy is commissioned, not appraised","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},"scotland":{"body":"SMC","decision":"Not appraised (radiotherapy and generic capecitabine)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal"},"wales":"As England.","northernIreland":"As England.","note":"MRC CR07 established the short course: local recurrence at three years 4.4 percent against 10.6 percent. The audit found 33 percent of people with rectal cancer received neoadjuvant radiotherapy in 2023, with unit-level variation from 6 percent to 87 percent against a local target band of 10 to 60 percent.","refNames":["Capecitabine","MRC CR07"]},{"line":"Metastatic, first line, MSI-high or mismatch repair deficient","treatment":"Nivolumab with ipilimumab; or pembrolizumab alone","refs":["nivolumab","ipilimumab","pembrolizumab","keynote-177","checkmate-8hw"],"england":{"body":"NICE","decision":"Nivolumab plus ipilimumab recommended for untreated unresectable or metastatic disease with high microsatellite instability or mismatch repair deficiency, within its marketing authorisation, with commercial arrangements; pembrolizumab alone is the alternative under TA709 (23 June 2021), stopped after two years","ref":"TA1065","date":"2025-05-28","url":"https://www.nice.org.uk/guidance/ta1065"},"scotland":{"body":"SMC","decision":"Nivolumab with ipilimumab accepted for use within NHSScotland (19 January 2026); pembrolizumab accepted for restricted use with a two-year clinical stopping rule (SMC2375, 13 September 2021)","ref":"SMC2820","date":"2026-01-19","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-full-smc2820/"},"wales":"Follows NICE TA1065 and TA709 (both marked as meeting the AWMSG exclusion criteria because NICE has appraised them).","northernIreland":"Follows NICE TA1065 and TA709.","note":"Nivolumab with ipilimumab reached patients in England before the appraisal: form NIV24 on the Cancer Drugs Fund list version 1.365 made it available from 22 April 2025, five weeks before TA1065 published on 28 May 2025.","refNames":["Nivolumab","Ipilimumab","Pembrolizumab","KEYNOTE-177","CheckMate 8HW"]},{"line":"Metastatic, first line, RAS wild-type","treatment":"Cetuximab or panitumumab with FOLFOX or FOLFIRI","refs":["cetuximab","panitumumab","folfox","folfiri","coin","paradigm"],"england":{"body":"NICE","decision":"Cetuximab recommended for untreated EGFR-expressing, RAS wild-type metastatic colorectal cancer with FOLFOX or FOLFIRI; panitumumab recommended for untreated RAS wild-type disease with the same backbones. A commercial access agreement replaced the cetuximab patient access scheme in the September 2017 update","ref":"TA439","date":"2017-03-29","url":"https://www.nice.org.uk/guidance/ta439"},"scotland":{"body":"SMC","decision":"Cetuximab was accepted for restricted use after an end of life full submission with PACE (SMC 1012/14, 12 January 2015, since superseded); panitumumab first line with FOLFIRI was not recommended on non-submission (SMC 1082/15, 13 July 2015)","date":"2015-01-12","url":"https://scottishmedicines.org.uk/medicines-advice/cetuximab-erbitux-fullsubmission-101214/"},"wales":"Follows NICE TA439; Blueteq list entries exist for both cetuximab and panitumumab.","northernIreland":"Follows NICE TA439.","note":"NHS England has run a best value framework for cetuximab and panitumumab in first-line colorectal cancer since 1 December 2020, recorded in the Cancer Drugs Fund list criteria. MRC COIN had already shown that adding cetuximab to oxaliplatin-based chemotherapy does not extend survival even in KRAS wild-type disease; sidedness, not just RAS status, is how teams choose now.","refNames":["Cetuximab","Panitumumab","FOLFOX (5-FU, leucovorin, oxaliplatin)","FOLFIRI (5-FU, leucovorin, irinotecan)","MRC COIN","PARADIGM"]},{"line":"Metastatic, first and second line, when targeted treatment and immunotherapy are unsuitable","treatment":"Bevacizumab (originator or biosimilar) with fluoropyrimidine-based chemotherapy","refs":["bevacizumab","capecitabine","folfox"],"england":{"body":"NICE","decision":"Recommended as an option for first- and second-line treatment of metastatic colorectal cancer only when targeted treatments or immunotherapy are unsuitable and chemotherapy would otherwise be offered, subject to an agreed price. It updates and replaces TA212 and partly replaces TA242 and TA118, reversing a long-standing refusal","ref":"TA1136","date":"2026-02-25","url":"https://www.nice.org.uk/guidance/ta1136"},"scotland":{"body":"SMC","decision":"Not recommended: bevacizumab for first-line metastatic colorectal cancer was refused on resubmission because the economic case was not demonstrated, and no newer colorectal advice exists (SMC 221/05, 5 June 2006)","date":"2006-06-05","url":"https://scottishmedicines.org.uk/medicines-advice/bevacizumab-avastin-resubmission-22105/"},"wales":"Follows NICE TA1136 (listed as meeting the AWMSG exclusion criteria).","northernIreland":"Follows NICE TA1136.","note":"This is the newest change on the page and the clearest reversal: bevacizumab was refused for bowel cancer in England for almost twenty years. Scotland has not revisited its 2006 refusal.","refNames":["Bevacizumab","Capecitabine","FOLFOX (5-FU, leucovorin, oxaliplatin)"]},{"line":"Metastatic, first line, chemotherapy","treatment":"Capecitabine with or without oxaliplatin or irinotecan (FOLFOX, FOLFIRI, CAPOX)","refs":["capecitabine","folfox","folfiri","capox","irinotecan"],"england":{"body":"NICE","decision":"Capecitabine recommended as an option for untreated metastatic colorectal cancer (tegafur with uracil, also covered, is no longer available); the combinations are generics funded under national chemotherapy protocols","ref":"TA61","date":"2003-05-27","url":"https://www.nice.org.uk/guidance/ta61"},"scotland":{"body":"SMC","decision":"Capecitabine accepted for use within NHS Scotland for metastatic colorectal cancer (SMC 507/08, 13 October 2008)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal","date":"2008-10-13"},"wales":"As England.","northernIreland":"As England.","note":"FOCUS and FOCUS4-N, both UK trials, are why a planned break from chemotherapy is a legitimate option rather than a failure: FOCUS4-N compared capecitabine maintenance with active monitoring after 16 weeks of first-line treatment.","refNames":["Capecitabine","FOLFOX (5-FU, leucovorin, oxaliplatin)","FOLFIRI (5-FU, leucovorin, irinotecan)","CAPOX (capecitabine, oxaliplatin)","Irinotecan (and liposomal irinotecan)"]},{"line":"Previously treated, MSI-high or mismatch repair deficient","treatment":"Nivolumab with ipilimumab; pembrolizumab only if that combination cannot be used","refs":["nivolumab","ipilimumab","pembrolizumab"],"england":{"body":"NICE","decision":"Nivolumab with ipilimumab recommended after fluoropyrimidine-based combination chemotherapy; pembrolizumab recommended in the same place under TA914 (20 September 2023) only if nivolumab with ipilimumab cannot be used, stopped at two years","ref":"TA716","date":"2021-07-28","url":"https://www.nice.org.uk/guidance/ta716"},"scotland":{"body":"SMC","decision":"Nivolumab with ipilimumab accepted for use within NHSScotland (13 December 2021); pembrolizumab monotherapy for MSI-high or mismatch repair deficient tumours accepted (SMC2589, 15 January 2024)","ref":"SMC2394","date":"2021-12-13","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-full-smc2394/"},"wales":"Follows NICE TA716 and TA914.","northernIreland":"Follows NICE TA716 and TA914.","note":"Both are on the Cancer Drugs Fund list as routinely funded: form NIV10 from 26 October 2021, form PEMB24 from 19 December 2023.","refNames":["Nivolumab","Ipilimumab","Pembrolizumab"]},{"line":"Previously treated, BRAF V600E mutation-positive","treatment":"Encorafenib with cetuximab","refs":["encorafenib","cetuximab","beacon-crc","braf"],"england":{"body":"NICE","decision":"Recommended within its marketing authorisation for BRAF V600E mutation-positive metastatic colorectal cancer after previous systemic treatment; the committee found it met the end of life criteria","ref":"TA668","date":"2021-01-06","url":"https://www.nice.org.uk/guidance/ta668"},"scotland":{"body":"SMC","decision":"Accepted for use within NHSScotland after a full submission under the end of life and orphan equivalent process with PACE (10 May 2021)","ref":"SMC2312","date":"2021-05-10","url":"https://scottishmedicines.org.uk/medicines-advice/encorafenib-braftovi-full-smc2312/"},"wales":"Follows NICE TA668.","northernIreland":"Follows NICE TA668.","note":"Cancer Drugs Fund form ENC2 has been routinely funded since 6 April 2021, and its criteria allow people who had neoadjuvant encorafenib with cetuximab in the FOxTROT 4 trial. A first-line appraisal of encorafenib with cetuximab and FOLFOX, after BREAKWATER, is in development with an expected publication date of 2 September 2027.","refNames":["Encorafenib","Cetuximab","BEACON CRC","BRAF"]},{"line":"Third line and beyond","treatment":"Trifluridine-tipiracil with bevacizumab; then fruquintinib if that is unsuitable; regorafenib; trifluridine-tipiracil alone","refs":["trifluridine-tipiracil","bevacizumab","fruquintinib","regorafenib","sunlight","fresco-2"],"england":{"body":"NICE","decision":"Trifluridine-tipiracil with bevacizumab recommended after two systemic treatments including fluoropyrimidine, oxaliplatin and irinotecan chemotherapies and anti-VEGF or anti-EGFR therapy; fruquintinib recommended at third line or later only if that combination is unsuitable (TA1079, 23 July 2025); regorafenib (TA866, 8 February 2023) and trifluridine-tipiracil alone (TA405, 24 August 2016) also recommended","ref":"TA1008","date":"2024-09-25","url":"https://www.nice.org.uk/guidance/ta1008"},"scotland":{"body":"SMC","decision":"Trifluridine-tipiracil with bevacizumab accepted (12 August 2024); fruquintinib accepted on resubmission under the end of life and orphan equivalent process with PACE (SMC2858, 13 October 2025); regorafenib accepted (SMC2562, 9 October 2023); trifluridine-tipiracil alone accepted (SMC 1221/17, 13 February 2017)","ref":"SMC2654","date":"2024-08-12","url":"https://scottishmedicines.org.uk/medicines-advice/trifluridine-tipiracil-lonsurf-full-smc2654/"},"wales":"Follows NICE TA1008, TA1079, TA866 and TA405; Blueteq entries exist for fruquintinib and regorafenib.","northernIreland":"Follows the same NICE appraisals.","note":"Trifluridine-tipiracil with bevacizumab (form TRI3) and trifluridine-tipiracil alone (TRI1) and regorafenib (REG3) are routinely funded on the Cancer Drugs Fund list version 1.365; fruquintinib is not on that version because TA1079 postdates it. Regorafenib had been refused once before: TA334 was terminated in February 2015 because Bayer made no submission.","refNames":["Trifluridine/tipiracil","Bevacizumab","Fruquintinib","Regorafenib","SUNLIGHT","FRESCO-2"]},{"line":"NTRK fusion-positive disease, any line","treatment":"Larotrectinib","refs":["larotrectinib"],"england":{"body":"NICE","decision":"Recommended for use within the Cancer Drugs Fund for locally advanced or metastatic NTRK fusion-positive solid tumours when there are no satisfactory treatment options, under a managed access agreement","ref":"TA630","date":"2020-05-27","cdf":true,"url":"https://www.nice.org.uk/guidance/ta630"},"scotland":{"body":"SMC","decision":"Not listed among the colorectal cancer advice; search the register by medicine name","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal"},"wales":"Follows NICE TA630.","northernIreland":"Follows NICE TA630.","note":"The other NTRK inhibitor is gone: TA1118 terminated the entrectinib appraisal on 7 January 2026 because Roche did not provide a complete evidence submission, withdrawing TA644, and the link to it was removed from NG151 in the same month. Larotrectinib appears on the Cancer Drugs Fund list as form LAR1a.","refNames":["Larotrectinib"]},{"line":"Previously treated, after oxaliplatin (aflibercept)","treatment":"Aflibercept with irinotecan and fluorouracil-based therapy","refs":["ziv-aflibercept","irinotecan","fluorouracil"],"england":{"body":"NICE","decision":"Not recommended within its marketing authorisation; people already having it could continue until they and their clinician chose to stop","ref":"TA307","date":"2014-03-25","url":"https://www.nice.org.uk/guidance/ta307"},"scotland":{"body":"SMC","decision":"Accepted for use within NHS Scotland on resubmission, contingent on the patient access scheme (SMC 878/13, 10 March 2014)","date":"2014-03-10","url":"https://scottishmedicines.org.uk/medicines-advice/aflibercept-zaltrap-resubmission-87813/"},"wales":"Not recommended: AWMSG advice 0315 says the case for cost-effectiveness has not been proven (ratified 8 June 2015).","northernIreland":"Not available (follows NICE TA307).","note":"The clearest border on this page. A Scottish patient can be offered aflibercept after oxaliplatin; an English or Welsh patient cannot.","refNames":["Ziv-aflibercept","Irinotecan (and liposomal irinotecan)","Fluorouracil (5-FU)"]},{"line":"Rechallenge with an anti-EGFR antibody (Wales only)","treatment":"Panitumumab after a previous anti-EGFR antibody and at least one other treatment, in left-sided disease with RAS wild-type circulating tumour DNA","refs":["panitumumab","egfr"],"england":{"body":"NICE","decision":"Not recommended: cetuximab monotherapy or with chemotherapy, and panitumumab monotherapy, remain unrecommended after first-line chemotherapy; no rechallenge appraisal exists","ref":"TA242","date":"2012-01-25","url":"https://www.nice.org.uk/guidance/ta242"},"scotland":{"body":"SMC","decision":"No rechallenge advice; the panitumumab records are non-submissions","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal"},"wales":"Available. One Wales OW29 supports panitumumab rechallenge in stage 4 left-sided colorectal cancer with RAS wild-type status confirmed by circulating tumour DNA, after a previous anti-EGFR antibody and at least one other line; off-label, with a simple discount patient access scheme, endorsed by AWMSG and ratified by Welsh Government at the meeting of 12 May 2025, for review after 12 months.","northernIreland":"Not available.","note":"The catch is the test. Circulating tumour DNA RAS testing is not on the National Genomic Test Directory and is not routinely commissioned in Wales, so health boards must fund it themselves. The recommendation rests on CHRONOS, 27 patients, a 30 percent objective response rate.","refNames":["Panitumumab","EGFR"]}],"fundingNote":{"text":"NICE's colorectal cancer topic page listed 65 products on the check date. Thirteen technology appraisals recommend a medicine, two refuse one (TA307 aflibercept, TA242 cetuximab and panitumumab after first-line chemotherapy) and three were terminated because a company made no submission (TA1118 entrectinib in January 2026, TA334 regorafenib in February 2015, TA240 panitumumab in December 2011). Everything else the NHS gives for bowel cancer is generic chemotherapy prescribed under NG151 and national protocols. Only one colorectal medicine sits in the Cancer Drugs Fund proper on the latest readable list, version 1.365 of 6 June 2025: nivolumab with ipilimumab first line, from 22 April 2025, ahead of TA1065. Nine more are in the routinely funded section with their Blueteq forms and funding dates. Scotland's register carries 21 colorectal entries and diverges in two places: it accepted aflibercept that NICE refused, and it has never revisited its 2006 refusal of bevacizumab that NICE reversed in February 2026. Wales funds one thing neither England nor Scotland does, panitumumab rechallenge under One Wales OW29. In development at NICE: atezolizumab with chemotherapy for adjuvant stage 3 MSI-high disease (expected 6 May 2027), encorafenib with cetuximab and FOLFOX first line (2 September 2027), dostarlimab for untreated mismatch repair deficient locally advanced rectal cancer, tucatinib with trastuzumab for untreated HER2-positive metastatic disease and adagrasib with cetuximab for KRAS G12C, all with dates to be confirmed.","sources":[{"label":"NICE: all products on colorectal cancer (65 products on the check date)","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/colorectal-cancer/products","date":"2026-09-24"},{"label":"NICE TA1136: bevacizumab (originator and biosimilars) with fluoropyrimidine-based chemotherapy for metastatic colorectal cancer (25 February 2026, recommended first and second line when targeted treatment or immunotherapy is unsuitable)","url":"https://www.nice.org.uk/guidance/ta1136","date":"2026-02-25"},{"label":"NICE TA1118: entrectinib for NTRK fusion-positive solid tumours, terminated 7 January 2026 because Roche did not provide a complete evidence submission; it replaces TA644, which is withdrawn","url":"https://www.nice.org.uk/guidance/terminated/ta1118","date":"2026-01-07"},{"label":"NICE TA307: aflibercept with irinotecan and fluorouracil-based therapy after oxaliplatin-based chemotherapy, not recommended (25 March 2014)","url":"https://www.nice.org.uk/guidance/ta307","date":"2014-03-25"},{"label":"NICE TA242: cetuximab, bevacizumab and panitumumab after first-line chemotherapy (25 January 2012; cetuximab and panitumumab not recommended, the bevacizumab recommendation replaced by TA1136)","url":"https://www.nice.org.uk/guidance/ta242","date":"2012-01-25"},{"label":"NICE TA334: regorafenib for metastatic colorectal cancer, terminated 25 February 2015 because Bayer did not provide an evidence submission (superseded in practice by TA866)","url":"https://www.nice.org.uk/guidance/terminated/ta334","date":"2015-02-25"},{"label":"NICE TA240: panitumumab with chemotherapy for metastatic colorectal cancer, terminated 14 December 2011 because Amgen did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/terminated/ta240","date":"2011-12-14"},{"label":"Scottish Medicines Consortium: medicines advice, keyword colorectal (21 matches on the check date)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal","date":"2026-09-24"},{"label":"All Wales Therapeutics and Toxicology Centre: medicine recommendations, keyword colorectal (24 matches on the check date; most marked as meeting the AWMSG exclusion criteria because NICE has appraised the medicine)","url":"https://awttc.nhs.wales/accessing-medicines/medicine-recommendations/","date":"2026-09-24"},{"label":"One Wales OW29: panitumumab rechallenge for metastatic colorectal cancer, supported for use via the One Wales Medicines process (OWMAG meeting 12 May 2025); a Wales-only option with no NICE or SMC equivalent","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/panitumumab-rechallenge-for-metastatic-colorectal-cancer/","date":"2025-05-12"},{"label":"NHS England: national Cancer Drugs Fund list, version 1.365 (6 June 2025), read in full: nine colorectal medicines in the routinely funded section, nivolumab with ipilimumab first line in the Cancer Drugs Fund section from 22 April 2025","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-version-1.365.pdf","date":"2025-06-06"},{"label":"NHS England: national Cancer Drugs Fund list (the page answered HTTP 202 with an empty body to OnCo on 24 September 2026)","url":"https://www.england.nhs.uk/cancer/cdf/cancer-drugs-fund-list/"}]},"tests":[{"target":"Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2) or microsatellite instability","code":"pathology (HTG430 strategy)","test":"Four-panel immunohistochemistry on the tumour block, or a microsatellite instability test","opens":"Immunotherapy in advanced disease (nivolumab with ipilimumab, TA1065 and TA716; pembrolizumab, TA709 and TA914), a different adjuvant conversation in stage 2 disease, and the route to a Lynch syndrome diagnosis for the whole family","how":"Automatic: NICE HTG430 recommendation 1.1 says offer it to all people with colorectal cancer when first diagnosed, and not to wait for the result before starting treatment. Ask the team for the result and what it showed; around 15 percent of colorectal adenocarcinomas are mismatch repair deficient","sources":[{"label":"NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017)","url":"https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","date":"2017-02-22"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"},{"label":"NICE TA1065: nivolumab plus ipilimumab for untreated unresectable or metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency (28 May 2025)","url":"https://www.nice.org.uk/guidance/ta1065","date":"2025-05-28"}]},{"target":"BRAF V600E and MLH1 promoter hypermethylation, as a reflex test","code":"pathology (HTG430 steps 2 to 4)","test":"Sequential BRAF V600E testing then MLH1 promoter hypermethylation testing, done only when the MLH1 immunohistochemistry is abnormal or the microsatellite instability test is positive","opens":"It separates a sporadic cancer from Lynch syndrome. A BRAF V600E variant in an MLH1-deficient tumour points to a sporadic cancer; if both reflex tests are negative, germline testing follows","how":"Requested by the pathologist as part of the HTG430 strategy; two-thirds of mismatch repair deficiency comes from MLH1 promoter hypermethylation, and BRAF variants are found in about two-thirds of those","sources":[{"label":"NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017)","url":"https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","date":"2017-02-22"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"}]},{"target":"Germline MLH1, MSH2, MSH6, PMS2 and EPCAM (Lynch syndrome)","code":"germline panel","test":"Constitutional (germline) testing on a blood sample, after an abnormal MSH2, MSH6 or PMS2 result, or after negative reflex testing in an MLH1-deficient tumour","opens":"Colonoscopy every two years from 25 (MLH1 and MSH2) or 35 (MSH6 and PMS2) for you and for relatives, daily aspirin as chemoprevention, a different operation (subtotal rather than segmental colectomy) if the diagnosis is known before surgery, and risk-reducing gynaecological surgery. First-degree relatives have a 50 percent chance of carrying it","how":"Through clinical genetics, which also arranges cascade testing of relatives. Lynch carriers are invited into the English bowel cancer screening programme's surveillance arm, added in July 2023","sources":[{"label":"NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017)","url":"https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","date":"2017-02-22"},{"label":"GeNotes: patient with colorectal cancer and a constitutional (germline) variant causing Lynch syndrome (reviewed 22 September 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/results-patient-with-colorectal-cancer-constitutional-germline-variant-causing-lynch-syndrome-identified/","date":"2024-09-22"},{"label":"GOV.UK: bowel cancer screening standards data report 2024 to 2025 (the programme history, the age extension completed in 2025, uptake and outcomes; published 11 July 2026)","url":"https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","date":"2026-07-11"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"}]},{"target":"RAS (KRAS and NRAS)","code":"somatic panel","test":"Next-generation sequencing of KRAS exons 2, 3 and 4 and NRAS exons 2 to 4 on the tumour","opens":"A wild-type result opens cetuximab or panitumumab with FOLFOX or FOLFIRI in the first line (TA439). A mutation closes them: people with a RAS variant do worse on anti-EGFR antibodies, so the test is as much about avoiding a drug as reaching one","how":"NG151 recommendation 1.4.1: test for RAS and BRAF V600E in all people with metastatic colorectal cancer suitable for systemic treatment. About 40 percent of colorectal cancers carry a KRAS variant and a further 3 to 5 percent an NRAS variant","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"GeNotes: patient with colorectal cancer and a somatic (tumour) KRAS variant (reviewed 16 May 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/results-patient-with-colorectal-cancer-somatic-tumour-kras-variant-identified/","date":"2024-05-16"},{"label":"NICE TA439: cetuximab and panitumumab for previously untreated metastatic colorectal cancer (29 March 2017, last updated 25 September 2017)","url":"https://www.nice.org.uk/guidance/ta439","date":"2017-03-29"}]},{"target":"BRAF V600E in the tumour","code":"somatic panel","test":"Next-generation sequencing on the tumour block, usually on the same panel as RAS","opens":"Encorafenib with cetuximab after previous systemic treatment (TA668); it also carries a poor prognosis, which changes the conversation about how hard to treat","how":"Same request as RAS under NG151 1.4.1. Around 8 to 10 percent of colorectal cancers carry BRAF V600E, with a further 2 to 4 percent carrying a non-V600 variant","sources":[{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"},{"label":"NICE TA668: encorafenib plus cetuximab for previously treated BRAF V600E mutation-positive metastatic colorectal cancer (6 January 2021)","url":"https://www.nice.org.uk/guidance/ta668","date":"2021-01-06"}]},{"target":"NTRK1, NTRK2 and NTRK3 rearrangement","code":"somatic panel","test":"Multi-target next-generation sequencing for structural variants on the tumour block","opens":"Larotrectinib through the Cancer Drugs Fund (TA630) when there is no satisfactory alternative. Entrectinib is no longer an option: TA1118 terminated its appraisal in January 2026","how":"Requested by the oncologist through the Genomic Laboratory Hub, usually on an existing specimen; NTRK fusions are rare in colorectal cancer","sources":[{"label":"NICE TA630: larotrectinib for NTRK fusion-positive solid tumours (27 May 2020, Cancer Drugs Fund)","url":"https://www.nice.org.uk/guidance/ta630","date":"2020-05-27"},{"label":"NICE TA1118: entrectinib for NTRK fusion-positive solid tumours, terminated 7 January 2026 because Roche did not provide a complete evidence submission; it replaces TA644, which is withdrawn","url":"https://www.nice.org.uk/guidance/terminated/ta1118","date":"2026-01-07"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"}]},{"target":"Inherited polyposis and early-onset colorectal cancer (APC, MUTYH and others)","code":"R211","test":"The R211 panel, tested in people presenting with colorectal cancer and polyposis","opens":"A diagnosis of familial adenomatous polyposis or MUTYH-associated polyposis, which changes the operation (total colectomy in classic familial adenomatous polyposis) and puts relatives into surveillance","how":"APC and MUTYH are tested simultaneously because the phenotypes overlap and about one in 50 people of European ancestry carries a single MUTYH variant; GeNotes names the R211 panel as the route. Fewer than 1 percent of colorectal cancers are linked to germline APC variants and about 0.3 percent to MUTYH-associated polyposis","sources":[{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"}]},{"target":"Blood in the stool, before any of this","code":"primary care","test":"Quantitative faecal immunochemical test using HM-JACKarc or OC-Sensor","opens":"A suspected cancer pathway referral at 10 micrograms of haemoglobin per gram of faeces or more in England, Wales and Northern Ireland; 20 micrograms per gram in Scotland","how":"Ask the GP for it if you have any of the symptoms in NG12 recommendation 1.3.1. A previous negative screening test does not exempt you, and a result below the threshold does not close the door if a clinician is still concerned","sources":[{"label":"NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023)","url":"https://www.nice.org.uk/guidance/htg690/chapter/1-Recommendations","date":"2023-08-24"},{"label":"NICE NG12: suspected cancer, recommendations by site (colorectal 1.3.1 to 1.3.5, anal 1.3.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"Scottish Government: Scottish referral guidelines for suspected cancer 2025, lower gastrointestinal (an urgent suspicion of cancer referral at a quantitative faecal immunochemical test result of 20 micrograms of haemoglobin per gram or more)","url":"https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/pages/5/","date":"2025-08-06"}]},{"target":"Circulating tumour DNA","code":"not in the directory","test":"A blood test for tumour DNA left behind after surgery, or for RAS status at progression","opens":"In Wales, a RAS wild-type circulating tumour DNA result opens panitumumab rechallenge under One Wales OW29. Everywhere else it is research: TRACC is testing whether the result should decide who gets adjuvant chemotherapy","how":"Ask about a trial. The test is not on the National Genomic Test Directory, so Welsh health boards commissioning OW29 have to fund it themselves","sources":[{"label":"One Wales OW29: panitumumab rechallenge for metastatic colorectal cancer, supported for use via the One Wales Medicines process (OWMAG meeting 12 May 2025); a Wales-only option with no NICE or SMC equivalent","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/panitumumab-rechallenge-for-metastatic-colorectal-cancer/","date":"2025-05-12"},{"label":"Slater S, Chau I, Cunningham D, Starling N et al, Tissue-free liquid biopsies combining genomic and methylation signals for minimal residual disease detection in early colorectal cancer (UK TRACC Part B), Clinical Cancer Research 2024","url":"https://europepmc.org/article/MED/38864835","date":"2024-08"},{"label":"TRACC: a protocol for circulating tumour DNA-guided adjuvant chemotherapy in resected colorectal cancer, BMC Cancer 2023","url":"https://europepmc.org/article/MED/36941575","date":"2023-03"},{"label":"NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026)","url":"https://www.england.nhs.uk/publication/national-genomic-test-directories/"}]}],"testsNote":{"text":"Two rules govern genomic testing in bowel cancer and they work in opposite directions. Mismatch repair testing is universal: HTG430 says every colorectal cancer, at first diagnosis, no exceptions, and do not wait for the result. RAS and BRAF testing is conditional: NG151 1.4.1 asks for it in everyone with metastatic disease fit for systemic treatment. The audit shows the second rule is not being kept. Across all English trusts, only 39.9 percent of people with histologically confirmed stage 4 disease between 2019 and 2021 had a record of KRAS, NRAS or BRAF testing; restricted to the 44 of 119 trusts whose data submission was complete enough to trust, the figure was 66.2 percent in 2021, and 44.9 percent of those tested were tested within a month of diagnosis. Older people are tested less: 75.5 percent of those under 75 against 47.9 percent of those 75 and over. The audit's fourth recommendation asks Cancer Alliances and Genomic Laboratory Hubs to fix it. Test Directory codes are not quoted here because NHS England's directory page answered HTTP 202 with an empty body; the one code on this page, R211, comes from GeNotes.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017)","url":"https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","date":"2017-02-22"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026)","url":"https://www.england.nhs.uk/publication/national-genomic-test-directories/"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"},{"label":"GeNotes: genomic testing in the devolved nations","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/genomic-testing-in-the-devolved-nations/","date":"2026-09-24"}]},"trials":[{"trialId":"foxtrot","registry":"ISRCTN83842641","name":"FOxTROT: personalising neoadjuvant chemotherapy in locally advanced but operable colon cancer","status":"Recruiting, 7 February 2022 to 1 April 2027 (platform runs to August 2029)","setting":"Operable colon cancer; the continuing phase 2/3 platform, target 1,703","sites":["77 centres, including St James's University Hospital (Leeds)","Addenbrooke's, The Christie, the Royal Marsden and Churchill Hospital","Beatson West of Scotland, Ninewells, Velindre, Singleton and Ysbyty Gwynedd"],"url":"https://www.isrctn.com/ISRCTN83842641","note":"Sponsor University of Leeds; also open in Australia, France, India, the Netherlands and Sweden."},{"registry":"ISRCTN11061442","name":"ARIEL: a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer","status":"Recruiting, 25 April 2022 to 1 October 2027","setting":"Advanced colorectal cancer with a right-sided primary and wild-type RAS: extra molecular testing to see who could still benefit from cetuximab or panitumumab","sites":["43 centres across all four nations, including St James's (Leeds), The Christie, UCLH and Southampton General","NHS Greater Glasgow and Clyde, NHS Grampian and NHS Lothian","Velindre, Withybush, Bronglais, Prince Philip and Betsi Cadwaladr"],"url":"https://www.isrctn.com/ISRCTN11061442","note":"Sponsor University of Leeds; phase 4."},{"registry":"ISRCTN14240288","name":"STAR-TREC: organ preservation against total mesorectal excision in early and intermediate rectal cancer","status":"Closed to recruitment 31 December 2023; follow-up to December 2027, 12-month results published 2026","setting":"Early and intermediate rectal cancer: chemoradiotherapy or short-course radiotherapy, each with response-adapted watch and wait or local excision, against surgery","sites":["34 centres in England, Scotland, Wales, Denmark and the Netherlands"],"url":"https://www.isrctn.com/ISRCTN14240288","note":"Sponsor University of Birmingham. No UK rectal organ-preservation trial is recruiting on ISRCTN at present.","trialId":"star-trec"},{"registry":"NCT04050345","name":"TRACC: tracking mutations in circulating tumour DNA to predict relapse in early colorectal cancer","status":"Recruiting","setting":"Resected stage II and III colorectal cancer: does a blood test for residual tumour DNA after surgery say who needs chemotherapy?","sites":["71 UK sites led by The Royal Marsden, including Guy's and St Thomas', The Christie, Addenbrooke's, Aberdeen Royal Infirmary and the Beatson","District general hospitals from Carlisle and Milton Keynes to Glangwili and Withybush"],"url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=TRACC%20colorectal","note":"Registered on ClinicalTrials.gov rather than ISRCTN; the link above is the NIHR Be Part of Research search, because this page cites UK public sources only.","trialId":"tracc"},{"registry":"ISRCTN13526628","name":"COLO-PREVENT: aspirin, aspirin with metformin, or resveratrol to prevent colorectal polyps","status":"Recruiting, 30 September 2022 to 31 January 2028","setting":"People under polyp surveillance within the bowel cancer screening programme; phase 2/3 randomised platform","sites":["Sponsor University of Leicester; the registry record does not list centres"],"url":"https://www.isrctn.com/ISRCTN13526628"},{"registry":"ISRCTN11118663","name":"OrigAMI-2: amivantamab with chemotherapy against cetuximab with chemotherapy, first line","status":"Recruiting, 21 October 2024 to 23 December 2026","setting":"Untreated RAS and BRAF wild-type metastatic colorectal cancer; phase 3","sites":["St Bartholomew's, University College Hospital, Castle Hill (Cottingham), Western General (Lothian)","Addenbrooke's, The Royal Marsden (Sutton), Mount Vernon, Birmingham Heartlands, St James's (Leeds)"],"url":"https://www.isrctn.com/ISRCTN11118663","note":"Sponsor Janssen-Cilag International."},{"registry":"ISRCTN39913423","name":"OrigAMI-3: amivantamab with FOLFIRI against cetuximab or bevacizumab with FOLFIRI","status":"Recruiting, 26 November 2024 to 13 October 2026","setting":"KRAS, NRAS and BRAF wild-type metastatic colorectal cancer; phase 3","sites":["St Bartholomew's, University College Hospital, Castle Hill (Cottingham)","The Royal Marsden, Mount Vernon, Birmingham Heartlands, St James's (Leeds)"],"url":"https://www.isrctn.com/ISRCTN39913423","note":"Sponsor Janssen-Cilag International."},{"registry":"ISRCTN12508004","name":"BICCC: a brief course of cyclophosphamide after completing treatment for bowel cancer","status":"Recruiting, 13 September 2024 to 12 March 2028","setting":"People who have completed standard colorectal cancer treatment; phase 2 randomised","sites":["University Hospital of Wales and Velindre (Cardiff)","Beatson West of Scotland, The Christie, Churchill Hospital (Oxford)","Royal Liverpool University Hospital, Lincoln County Hospital"],"url":"https://www.isrctn.com/ISRCTN12508004","note":"Sponsor Cardiff University."},{"registry":"ISRCTN12595783","name":"NG-350A with chemoradiotherapy for locally advanced rectal cancer","status":"Recruiting, 15 February 2025 to 30 November 2026","setting":"Locally advanced rectal cancer: a tumour-selective anti-CD40-expressing adenoviral vector added to neoadjuvant chemoradiotherapy; phase 1b","sites":["University College London Hospitals","The Royal Marsden"],"url":"https://www.isrctn.com/ISRCTN12595783","note":"Sponsor Akamis Bio."},{"registry":"ISRCTN17575409","name":"PICCOS: pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases","status":"Recruiting, 22 January 2024 to 31 October 2027","setting":"Peritoneal metastases from bowel, ovarian and stomach cancers; randomised phase 2","sites":["Cardiff and Vale University Health Board","Imperial College Healthcare","Swansea Bay","Royal United Hospitals Bath"],"url":"https://www.isrctn.com/ISRCTN17575409","note":"Open in all four nations."},{"registry":"ISRCTN18133394","name":"EPiC: exercise prehabilitation before curative colorectal surgery","status":"Recruiting, 28 July 2023 to 28 February 2027","setting":"People awaiting curative colorectal surgery: high-intensity interval training with or without resistance training","sites":["Royal Derby Hospital","University of Nottingham Medical School at Derby"],"url":"https://www.isrctn.com/ISRCTN18133394"},{"registry":"ISRCTN16126290","name":"ColoCap: colon capsule endoscopy against standard colonoscopy","status":"Recruiting, 1 January 2025 to 31 December 2026","setting":"People at risk of colorectal disease: diagnostic accuracy of a swallowed camera capsule against colonoscopy","sites":["Sponsor York and Scarborough Teaching Hospitals; the registry record does not list centres"],"url":"https://www.isrctn.com/ISRCTN16126290"},{"registry":"ISRCTN12706992","name":"PACES: machine-learning algorithms in the colorectal cancer pathway","status":"Recruiting, 1 October 2024 to 1 October 2026","setting":"Artificial intelligence applied from histopathology through to the multidisciplinary team","sites":["Oxford University Hospitals"],"url":"https://www.isrctn.com/ISRCTN12706992"},{"registry":"ISRCTN93548632","name":"TAYCAN: a liquid biopsy blood test in colorectal and pancreatic cancer","status":"Recruiting, 1 May 2025 to 1 May 2027","setting":"Observational: circulating tumour DNA as a marker of progression or recurrence in NHS Tayside","sites":["NHS Tayside (Ninewells Hospital, Dundee)"],"url":"https://www.isrctn.com/ISRCTN93548632"},{"registry":"ISRCTN80318573","name":"ACRE: the supportive care needs of people with advanced bowel cancer and their carers","status":"Recruiting from 1 September 2026 to 1 February 2028","setting":"Observational cross-sectional study of unmet supportive care needs","sites":["Clatterbridge Cancer Centre (Wirral)","Liverpool University Hospitals, Warrington, Arrowe Park, Countess of Chester, Mersey and West Lancashire"],"url":"https://www.isrctn.com/ISRCTN80318573","note":"Sponsor University of Liverpool, funded by North West Cancer Research."}],"trialsNote":{"text":"ISRCTN is the UK registry. Its public record pages answer HTTP 200 but serve a JavaScript cookie challenge rather than the record, so every trial above was read through the registry's public API instead, one record at a time, for status, dates, sponsor and centres. Searches on colorectal cancer, bowel cancer and rectal cancer returned 872 unique records between them. Two well-known UK trials are not on ISRCTN at all: TRACC is registered on ClinicalTrials.gov, and the FOxTROT 2 and 3 arms sit inside the original FOxTROT platform record rather than having their own. Two organ-preservation trials, STAR-TREC and PRIME-RT, have closed to recruitment, which leaves no UK rectal watch-and-wait trial recruiting on the registry today.","sources":[{"label":"ISRCTN registry search: colorectal cancer","url":"https://www.isrctn.com/search?q=colorectal+cancer","date":"2026-09-24"},{"label":"ISRCTN83842641: the FOxTROT platform, preoperative chemotherapy in locally advanced but operable colon cancer (University of Leeds; recruiting 7 February 2022 to 1 April 2027, 77 centres)","url":"https://www.isrctn.com/ISRCTN83842641","date":"2026-09-24"},{"label":"ISRCTN14240288: STAR-TREC, organ preservation after chemoradiotherapy or short-course radiotherapy against total mesorectal excision in early and intermediate rectal cancer (University of Birmingham; recruitment 1 November 2016 to 31 December 2023, 34 centres)","url":"https://www.isrctn.com/ISRCTN14240288","date":"2026-09-24"},{"label":"ISRCTN18138369: PRIME-RT, durvalumab with two radiotherapy schedules and chemotherapy in rectal cancer (NHS Greater Glasgow and Clyde; recruitment 7 January 2021 to 25 May 2023, 46 people)","url":"https://www.isrctn.com/ISRCTN18138369","date":"2026-09-24"},{"label":"NIHR Be Part of Research: bowel cancer","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=bowel%20cancer"}]},"legacy":[{"title":"The adjuvant question (1994 to 2018): QUASAR and SCOT, or how much chemotherapy is enough","trialIds":["quasar","scot"],"story":"British trials have twice reset how much chemotherapy someone should have after bowel cancer surgery, and both times the answer was less than people assumed. QUASAR, run from Oxford and Birmingham from 1994, randomised 3,239 people whose need for chemotherapy was genuinely unclear, nine in ten with stage II disease, to fluorouracil and folinic acid or to observation. It found a real but small effect: a relative risk of death of 0.82, which the authors converted into the figure a patient can use, an absolute five-year survival gain of about 3.6 percent. That number turned a default into a conversation. QUASAR 2, led by Rachel Kerr, then showed that adding bevacizumab to adjuvant capecitabine added nothing. SCOT, sponsored by NHS Greater Glasgow and Clyde with the University of Glasgow, randomised 6,088 people between three and six months of oxaliplatin-containing chemotherapy and found three months non-inferior, with grade 2 or worse peripheral neuropathy in a quarter of people rather than well over half. NICE NG151 now offers three months of CAPOX first. Between them these trials spared a great many people months of treatment and a lifetime of numb fingers.","sources":[{"label":"QUASAR Collaborative Group, Adjuvant chemotherapy versus observation in patients with colorectal cancer, Lancet 2007","url":"https://europepmc.org/article/MED/18083404","date":"2007-12-15"},{"label":"Kerr RS et al, Adjuvant capecitabine plus bevacizumab versus capecitabine alone in patients with colorectal cancer (QUASAR 2), Lancet Oncology 2016","url":"https://europepmc.org/article/MED/27660192","date":"2016-11"},{"label":"Iveson TJ, Kerr RS et al, 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT), Lancet Oncology 2018","url":"https://europepmc.org/article/MED/29611518","date":"2018-04"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"},{"label":"ISRCTN82375386: QUASAR, adjuvant chemotherapy against observation after curative resection of colorectal cancer","url":"https://www.isrctn.com/ISRCTN82375386","date":"2026-09-24"},{"label":"ISRCTN59757862: SCOT, short course oncology therapy (NHS Greater Glasgow and Clyde with the University of Glasgow; recruitment 9 May 2008 to 29 November 2013)","url":"https://www.isrctn.com/ISRCTN59757862","date":"2026-09-24"}]},{"title":"The rectum (2002 to 2026): MERCURY, CR07 and STAR-TREC","trialIds":["mercury","cr07","star-trec"],"story":"Rectal cancer care in the NHS was rebuilt in three steps, each British. MERCURY, reported in the BMJ in 2006, showed that a high-resolution magnetic resonance scan could predict whether the surgeon would get a clear circumferential resection margin, correctly in 94 percent of cases and reproducibly across 11 units in four countries. That made pre-treatment MRI the standard and gave the multidisciplinary team something to plan with. MRC CR07, led from Leeds by David Sebag-Montefiore with Phil Quirke's pathology, then answered what to do with that information: a week of preoperative radiotherapy for everyone cut local recurrence at three years from 10.6 percent to 4.4 percent, better than waiting to see whose margin was involved and treating them afterwards. The third step is to stop operating at all where the tumour disappears. STAR-TREC, sponsored by the University of Birmingham with Simon Bach and Sebag-Montefiore, randomised people between surgery and two response-adapted radiotherapy schedules with watch and wait or local excision; its 12-month results were published in Lancet Oncology in 2026, the first randomised comparison of the two schedules for organ preservation.","sources":[{"label":"MERCURY Study Group, Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study, BMJ 2006","url":"https://europepmc.org/article/MED/16984925","date":"2006-09-19"},{"label":"Sebag-Montefiore D et al, Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Lancet 2009","url":"https://europepmc.org/article/MED/19269519","date":"2009-03-07"},{"label":"Bach SP, Sebag-Montefiore D et al, Chemoradiotherapy versus short-course radiotherapy for response-adapted organ preservation in early-stage and intermediate-stage rectal cancer (STAR-TREC): 12-month results, Lancet Oncology 2026","url":"https://europepmc.org/article/MED/42633754","date":"2026"},{"label":"ISRCTN28785842: MRC CR07, pathology-guided treatment of rectal cancer","url":"https://www.isrctn.com/ISRCTN28785842","date":"2026-09-24"},{"label":"ISRCTN14240288: STAR-TREC, organ preservation after chemoradiotherapy or short-course radiotherapy against total mesorectal excision in early and intermediate rectal cancer (University of Birmingham; recruitment 1 November 2016 to 31 December 2023, 34 centres)","url":"https://www.isrctn.com/ISRCTN14240288","date":"2026-09-24"},{"label":"NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","date":"2020-01-29"}]},{"title":"The screening programme (1981 to 2021): Nottingham and the flexible sigmoidoscopy trial","trialIds":["nottingham-fob","ukfss"],"story":"The kit that arrives through the letterbox exists because of two enormous British randomised trials. From 1981 Nottingham randomised 152,850 people to be offered a faecal occult blood test every two years or to nothing at all; the control group were never even told. Fewer than four in ten completed every test they were offered, and even so colorectal cancer deaths fell 15 percent, and a fifth of the screened group's cancers were stage A against one in nine in the controls. The authors wrote that a national programme should be considered; England's began in 2006. The second trial asked whether one look was enough. The UK Flexible Sigmoidoscopy Screening Trial offered 57,237 people a single flexible sigmoidoscopy between 55 and 64: incidence fell 23 percent and mortality 31 percent, and among those who attended, distal cancer incidence halved. The 17-year follow-up showed the effect lasted. That result created Bowel Scope Screening, which the NHS then withdrew in January 2021, choosing instead to push the stool test down to age 50, a rollout completed in 2025.","sources":[{"label":"Hardcastle JD et al, Randomised controlled trial of faecal-occult-blood screening for colorectal cancer, Lancet 1996","url":"https://europepmc.org/article/MED/8942775","date":"1996-11-30"},{"label":"Atkin WS et al, Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial, Lancet 2010","url":"https://europepmc.org/article/MED/20430429","date":"2010-05-08"},{"label":"Atkin W et al, Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up, Lancet 2017","url":"https://europepmc.org/article/MED/28236467","date":"2017-04-01"},{"label":"GOV.UK: bowel cancer screening programme overview (age 50 to 74 every two years; the 50, 52 and 54 transition cohorts; faecal immunochemical test since June 2019; last updated 17 March 2026)","url":"https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview","date":"2026-03-17"},{"label":"GOV.UK: bowel cancer screening standards data report 2024 to 2025 (the programme history, the age extension completed in 2025, uptake and outcomes; published 11 July 2026)","url":"https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","date":"2026-07-11"},{"label":"ISRCTN11631712: the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer (Medical Research Council)","url":"https://www.isrctn.com/ISRCTN11631712","date":"2026-09-24"},{"label":"ISRCTN28352761: the UK Flexible Sigmoidoscopy Screening Trial (Imperial College London; recruitment 1 July 1995 to 28 February 2014, 167,882 people)","url":"https://www.isrctn.com/ISRCTN28352761","date":"2026-09-24"}]}],"figures":[{"label":"New cases a year","value":"48,213","nation":"UK","period":"2019, 2021-2022 average","source":{"label":"Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer","date":"2026-09-24"},"note":"The fourth most common cancer, 12 percent of all new cases, more than 130 a day: around 26,800 in males and 21,400 in females."},{"label":"Deaths a year","value":"17,700","nation":"UK","period":"2022-2024 average","source":{"label":"Cancer Research UK: bowel cancer mortality","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/mortality","date":"2026-09-24"},"note":"The second most common cause of cancer death, 48 a day; 59 percent in people aged 75 and over. Mortality rates are down 46 percent since the early 1970s and 6 percent in the last decade."},{"label":"Ten-year survival","value":"54.3% colon, 53.9% rectal","nation":"UK","period":"2018 (predicted)","source":{"label":"Cancer Research UK: bowel cancer survival","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival","date":"2026-09-24"},"note":"In the 1970s it was 22.4 percent for colon and 24.6 percent for rectal cancer. Population averages, not a personal prognosis."},{"label":"Five-year survival by deprivation","value":"55% most deprived, 62.9% least deprived","nation":"England","period":"2018-2022","source":{"label":"Cancer Research UK: bowel cancer survival","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival","date":"2026-09-24"}},{"label":"Diagnosed at an early stage (I or II)","value":"47%","nation":"England","period":"2022, cases with a known stage","source":{"label":"Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer","date":"2026-09-24"},"note":"Around 15,000 people. Scotland 49 percent (2023, around 1,700), Northern Ireland 46 percent (2015-2019, around 490 a year), Wales 42 percent (2017-2019, around 940 a year)."},{"label":"Routes to diagnosis","value":"38% urgent referral, 22% emergency, 12% screening","nation":"England","period":"2019","source":{"label":"Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer","date":"2026-09-24"},"note":"Northern Ireland 2019: 35 percent red flag referral, 26 percent emergency, 11 percent screening."},{"label":"Treatment in the first course","value":"60% surgery, 34% systemic therapy, 12% radiotherapy","nation":"England","period":"2022","source":{"label":"Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer","date":"2026-09-24"},"note":"In 2024 there were around 4,400 curative and 2,800 palliative radiotherapy episodes for bowel cancer in England."},{"label":"Preventable cases","value":"54%","nation":"UK","period":"current estimate","source":{"label":"Cancer Research UK: bowel cancer risk (lifetime risk and the preventable fraction)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/risk-factors","date":"2026-09-24"},"note":"Lifetime risk is 1 in 17 for males and 1 in 20 for females born in 1961."},{"label":"Change in incidence rate since the early 1990s","value":"+6%","nation":"UK","period":"to 2019, 2021-2022","source":{"label":"Cancer Research UK: bowel cancer incidence","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence","date":"2026-09-24"},"note":"Down 3 percent in the last decade, and projected to fall a further 7 percent by 2038-2040, to around 47,700 cases a year."},{"label":"People diagnosed, in the audit","value":"37,730","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation 2025 infographic (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Infographic.pdf","date":"2025-10"},"note":"England 35,243, Wales 2,487. Male 54.9 percent. Of these, 21,395 (56.7 percent) had a major resection and 2,132 (5.7 percent) a local excision."},{"label":"Diagnosed at stage 1 or 2","value":"41.5%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Up from 39.3 percent in 2019 (England 39 to 42 percent, Wales 36 to 39 percent). The NHS Long Term Plan target is 75 percent by 2028. Stage data are missing for 11.5 percent, unchanged since 2019."},{"label":"Diagnosed through screening","value":"12.2%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Up from 10.9 percent in 2019, with the emergency share falling from 21.4 percent to 19.2 percent over the same period."},{"label":"Diagnosed under the age of 50","value":"8.0%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"3,023 people, up from 6.4 percent in 2021 and 2022. The audit has made this group a focus of further study."},{"label":"Died within 90 days of major resection","value":"2.5%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Down from 3.1 percent in 2019, with a temporary rise to 3.4 percent in 2020. The local target is under 6 percent and 96 percent of units met it; four English trusts were above the 95 percent funnel limit and none above 99.8 percent."},{"label":"Alive two years after major resection","value":"84.9%","nation":"England and Wales","period":"surgery April 2021 to March 2022","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Up from 82.3 percent for surgery in the previous year. Every unit met the 70 percent local target."},{"label":"Major resections done by keyhole or robot","value":"75%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"60 percent laparoscopic and 15 percent robotic, against 66 percent in 2019 when robotic surgery was 3 percent: a five-fold rise in robotic operations in four years."},{"label":"Still had a diverting ileostomy 18 months after anterior resection","value":"38%","nation":"England and Wales","period":"surgery April 2018 to March 2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"The audit's worst indicator: the local target is under 35 percent and only 40 percent of units met it. The proportion given a diverting ileostomy at the operation has fallen from 59.8 percent in 2019 to 54.9 percent in 2023."},{"label":"Units doing at least 20 rectal cancer resections a year","value":"78%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"28 of 128 units (22 percent) did fewer than 20 and four (3 percent) fewer than 10. Abdominoperineal excision rose from 26.7 percent of rectal resections in 2019 to 29.4 percent in 2023."},{"label":"Stage 3 colon cancer given adjuvant chemotherapy","value":"66%","nation":"England and Wales","period":"surgery April 2021 to October 2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Above the 55 percent local target, met by 89 percent of units, but 15 units (12 percent) sat below the 95 percent funnel limit. Severe acute toxicity after adjuvant chemotherapy was 20 percent against a 33 percent ceiling."},{"label":"Rectal cancer given neoadjuvant radiotherapy","value":"33%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Unit-level variation from 6 percent to 87 percent against a local target band of 10 to 60 percent; 84 percent of units fell inside the band."},{"label":"Seen by a clinical nurse specialist, where recorded","value":"93%","nation":"England and Wales","period":"2023","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Only 61 percent of units met the 95 percent target. The record itself was available for 71 percent of people (England 69 percent, Wales 99 percent); counting everyone diagnosed, 67 percent had a recorded contact, up from 64 percent in 2019."},{"label":"Stage 4 disease with a record of RAS or BRAF testing","value":"66.2%","nation":"England","period":"2021, in the 44 of 119 trusts with usable data","source":{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},"note":"Across all English trusts the recorded figure for 2019 to 2021 was 39.9 percent, which the audit says understates reality because submission is not mandatory. Under 75s 75.5 percent against 47.9 percent for those 75 and over; only 44.9 percent of those tested were tested within a month of diagnosis."},{"label":"Screening uptake","value":"65.2%","nation":"England","period":"2024-2025","source":{"label":"GOV.UK: bowel cancer screening standards data report 2024 to 2025 (the programme history, the age extension completed in 2025, uptake and outcomes; published 11 July 2026)","url":"https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","date":"2026-07-11"},"note":"7,963,115 people invited and 5,195,407 adequately participated; positivity 1.71 percent, 89,030 referred, 5,170 cancers found and 21,093 people placed in surveillance. Coverage at 31 March 2025 was 72.9 percent. Of 64 screening centres, 56 were at or above the 60 percent achievable standard and three below the 52 percent acceptable one, the lowest at 48.6 percent."},{"label":"Screening uptake","value":"65.2%","nation":"Scotland","period":"May 2023 to April 2025","source":{"label":"Public Health Scotland: Scottish bowel screening programme statistics, full report (PDF, 7 April 2026): uptake by sex and deprivation, positivity, colonoscopy waits and cancers found","url":"https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","date":"2026-04-07"},"note":"Over 1.9 million invited, meeting the 60 percent minimum. Women 67.7 percent against men 62.7 percent, and a 22.1 percentage point deprivation gap (52.3 percent most deprived against 74.4 percent least). Positivity 2.8 percent; 1,295 cancers found, 63.4 percent at stage 1 or 2."},{"label":"Screening uptake","value":"65.5%","nation":"Wales","period":"April 2023 to March 2024","source":{"label":"Bowel Screening Wales annual statistical report 2023-24 (PDF, January 2026): the threshold moved from 150 to 120 micrograms of haemoglobin per gram in October 2023, with a plan to move to 80, and the age range extended towards 50","url":"https://phw.nhs.wales/app/uploads/sites/2/2026/01/Bowel-Screening-Wales-Annual-Statistical-Report-2023-24.pdf","date":"2026-01"},"note":"494,051 invited; 1.9 percent of tests positive. Health board range 64.2 percent (Swansea Bay) to 67.3 percent (Powys). Women 67.7 percent against men 63.3 percent, and 72.7 percent in the least deprived against 55.8 percent in the most."},{"label":"Colonoscopy within four weeks of a positive screening test","value":"41.5%","nation":"Scotland","period":"May 2023 to April 2025","source":{"label":"Public Health Scotland: Scottish bowel screening programme statistics, full report (PDF, 7 April 2026): uptake by sex and deprivation, positivity, colonoscopy waits and cancers found","url":"https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","date":"2026-04-07"},"note":"18.6 percent waited more than eight weeks, and only 75.4 percent of the 34,676 people with a positive result had a colonoscopy at all."},{"label":"62 days from urgent referral to first treatment, colorectal","value":"79.0% non-screening, 57.6% screening","nation":"Scotland","period":"quarter ending 31 March 2026","source":{"label":"Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral","url":"https://publichealthscotland.scot/media/39233/2026-06-30_cwt-report_final.pdf","date":"2026-06-30"},"note":"Against a 95 percent standard. The previous quarter was 75.2 percent and 65.0 percent; the report names colorectal surgery capacity as a cause. Across all cancers 72.2 percent met the standard and no board met it."},{"label":"31 days from decision to treat, colorectal","value":"96.7% non-screening, 91.0% screening","nation":"Scotland","period":"quarter ending 31 March 2026","source":{"label":"Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral","url":"https://publichealthscotland.scot/media/39233/2026-06-30_cwt-report_final.pdf","date":"2026-06-30"},"note":"Against a 95 percent standard; colorectal was among the cancer types that met the 31-day standard overall."},{"label":"31 days from decision to treat, lower gastrointestinal","value":"90.1%","nation":"Northern Ireland","period":"quarter ending 31 March 2026","source":{"label":"Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026","url":"https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-cancer-waiting-times-january-march-2026","date":"2026-07-02"},"note":"322 people treated, down 21 on the previous quarter. Across all cancers 87.3 percent were treated within 31 days against a 98 percent target, and no trust met it."},{"label":"62 days from urgent GP referral to first treatment, all cancers","value":"29.6%","nation":"Northern Ireland","period":"quarter ending 31 March 2026","source":{"label":"Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026)","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"},"note":"Against a 95 percent target; the revised series has run between 25.0 and 30.9 percent since December 2023."},{"label":"62 days from suspicion to first treatment, all cancers","value":"60.1%","nation":"Wales","period":"July 2026","source":{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target)","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},"note":"Against a 75 percent target. Health board range 44.7 percent (Swansea Bay) to 67.5 percent (Cwm Taf Morgannwg). 18,429 new suspected cancer pathways started, the second highest since records began."},{"label":"New cases (C18 to C20)","value":"4,275","nation":"Scotland","period":"2024","source":{"label":"Public Health Scotland open data: annual cancer incidence, Scotland-level file (opendata_inc0024_scotland.csv; site Colorectal cancer, ICD-10 C18 to C20)","url":"https://www.opendata.nhs.scot/dataset/annual-cancer-incidence","date":"2026-09-24"},"note":"2,295 in men and 1,980 in women; European age-standardised rate 74.7 per 100,000. 4,395 in 2023, 4,413 in 2022, 4,332 in 2021 and 3,369 in the pandemic year 2020. Colon accounted for 3,006 and rectum and rectosigmoid junction for 1,269."},{"label":"New cases (C18 to C20)","value":"2,714","nation":"Wales","period":"2022","source":{"label":"Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026), summed over C18 to C20","url":"https://phw.nhs.wales/data/cancer-incidence-in-wales-data/","date":"2026-02"},"note":"1,565 in men and 1,149 in women; 2,689 in 2021, 2,156 in 2020 and 2,533 in 2019, summed from the WCISU counts by four-digit ICD-10 code, age band and sex."},{"label":"Deaths (C18 to C20)","value":"1,061","nation":"Wales","period":"2025 (year of registration)","source":{"label":"Public Health Wales, WCISU: cancer mortality in Wales 2002-2025, counts by ICD-10 code (xlsx, March 2026), summed over C18 to C20","url":"https://phw.nhs.wales/data/cancer-mortality-in-wales-data/","date":"2026-03"},"note":"601 men and 460 women; 988 in 2024, 958 in 2023, 986 in 2022 and 990 in 2021, summed from the WCISU counts by ICD-10 code."},{"label":"Stage at diagnosis (colorectal)","value":"I 16%, II 23%, III 29%, IV 25%, unknown 8%","nation":"Wales","period":"2020-2022 (7,559 cases)","source":{"label":"Public Health Wales, WCISU: cancer incidence in Wales 2011-2022, stage data table (xlsx), colorectal three-year rolling period 2020 to 2022","url":"https://phw.nhs.wales/app/uploads/sites/2/2026/02/CancerIncidenceWales_DataTables_2011-2022_Stage.xlsx","date":"2026-02"},"note":"Of the 6,950 cases with a known stage, 42 percent were stage I or II and 27 percent stage IV. The rectum is caught earlier than the colon: 20 percent of rectal cancers were stage I against 14 percent of colon cancers."},{"label":"New cases (C18 to C20)","value":"1,340","nation":"Northern Ireland","period":"2023","source":{"label":"Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","date":"2026-09-24"},"note":"6,557 cases in 2019-2023, 1,311 a year (728 men, 583 women); median age 71; European age-standardised rate 75.0 per 100,000. The registry's 25-year prevalence at the end of 2023 was 9,768 people."},{"label":"Stage at diagnosis (colorectal)","value":"I 18%, II 23%, III 27%, IV 22%, unknown 11%","nation":"Northern Ireland","period":"2019-2023 (6,557 cases)","source":{"label":"Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","date":"2026-09-24"},"note":"Of the 5,832 cases with a known stage: I 20 percent, II 26 percent, III 30 percent, IV 25 percent."},{"label":"Deaths (C18 to C20)","value":"496","nation":"Northern Ireland","period":"2023","source":{"label":"Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","date":"2026-09-24"},"note":"256 men and 240 women; 513 in 2022 and 453 in 2021. The factsheet gives an average of 474 deaths a year over 2019-2023."},{"label":"Net survival by stage","value":"Stage I 93%, stage II 88%, stage III 68%, stage IV 7% at five years","nation":"Northern Ireland","period":"diagnosed 2014-2018","source":{"label":"Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","date":"2026-09-24"},"note":"Age-standardised net survival; all stages together, 81 percent at one year and 61 percent at five years. The gap between stage I and stage IV is the whole argument for screening."}],"support":[{"institutionId":"bowel-cancer-uk","name":"Bowel Cancer UK","kind":"charity","provides":["Ask the Nurse: a free email service answered by colorectal nurses within two working days, for non-urgent questions","Information on symptoms, screening in each nation, diagnosis, treatment, prehabilitation, trials, advanced disease and end of life care","An online community, a stage 4 group and Stage4You","Never Too Young, the campaign and support for people diagnosed under 50"],"url":"https://www.bowelcanceruk.org.uk/","source":{"label":"Bowel Cancer UK (registered charity 1071038 in England and Wales, SC040914 in Scotland)","url":"https://www.bowelcanceruk.org.uk/","date":"2026-09-24"}},{"institutionId":"bowel-research-uk","name":"Bowel Research UK","kind":"charity","provides":["Research grants and PhD funding in bowel cancer and other bowel disease","Take PaRT: patient and public involvement in reviewing and shaping research"],"url":"https://bowelresearchuk.org/","source":{"label":"Bowel Research UK (registered charity 1186061), the medical research charity for bowel cancer and other bowel disease","url":"https://bowelresearchuk.org/","date":"2026-09-24"}},{"institutionId":"macmillan-cancer-support","name":"Macmillan Cancer Support","kind":"charity","provides":["Support line and online community","Macmillan colorectal clinical nurse specialists in many centres","Grants and benefits advice"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer","source":{"label":"Macmillan Cancer Support: bowel cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer","date":"2026-09-24"}},{"institutionId":"maggies-centres","name":"Maggie's","kind":"charity","provides":["Drop-in centres beside major cancer hospitals","Benefits advice, psychological support and courses, free and without an appointment"],"url":"https://www.maggies.org/","source":{"label":"Maggie's","url":"https://www.maggies.org/","date":"2026-09-24"}},{"institutionId":"cruk","name":"Cancer Research UK","kind":"charity","provides":["Nurse helpline and the Cancer Chat forum","Plain-English information on bowel cancer and a trial database","The UK statistics quoted on this page"],"url":"https://www.cancerresearchuk.org/","source":{"label":"Cancer Research UK","url":"https://www.cancerresearchuk.org/","date":"2026-09-24"}},{"institutionId":"bowelbabe-fund","name":"Bowelbabe Fund for Cancer Research UK","kind":"charity","provides":["Research funding set up in Dame Deborah James's name, held at Cancer Research UK"],"url":"https://www.cancerresearchuk.org/get-involved/donate","source":{"label":"Cancer Research UK","url":"https://www.cancerresearchuk.org/","date":"2026-09-24"}},{"name":"NHS bowel cancer information and the screening helplines","kind":"nhs","provides":["Symptoms, tests and treatment on nhs.uk","England: the bowel cancer screening helpline on 0800 707 60 60, for questions, a replacement kit, or to ask for a kit if you are 75 or over","Scotland: the bowel screening centre helpline on 0800 0121 833"],"url":"https://www.nhs.uk/conditions/bowel-cancer/","source":{"label":"Bowel Cancer UK: screening (the four nations' age ranges and the over-75 self-referral helplines)","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/screening/","date":"2026-09-24"}},{"name":"Free NHS prescriptions in England (medical exemption certificate)","kind":"benefit","provides":["Anyone being treated for cancer, the effects of cancer or the effects of cancer treatment is entitled to a five-year medical exemption certificate; ask the hospital or GP for the FP92A form"],"url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","source":{"label":"NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment)","url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","date":"2026-09-24"}},{"name":"Prescriptions in Scotland, Wales and Northern Ireland","kind":"benefit","provides":["Scotland: free for everyone","Wales: free for anyone registered with a Welsh GP","Northern Ireland: all prescriptions dispensed there are free"],"url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","source":{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2020-09-18"}},{"name":"Special rules for end of life (SR1)","kind":"benefit","provides":["If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for Personal Independence Payment, Universal Credit, Employment and Support Allowance, Attendance Allowance and Disability Living Allowance for children are fast-tracked at the higher rate with no assessment"],"url":"https://www.gov.uk/benefits-end-of-life","source":{"label":"DWP: the Special Rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians)","url":"https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","date":"2026-09-24"}},{"name":"Personal Independence Payment and Attendance Allowance","kind":"benefit","provides":["Non-means-tested payments for people whose illness or treatment affects daily living or mobility (Personal Independence Payment under State Pension age, Attendance Allowance over it). A stoma, incontinence and low anterior resection syndrome are the kinds of daily-living difficulty these are meant for"],"url":"https://www.gov.uk/pip","source":{"label":"GOV.UK: Attendance Allowance","url":"https://www.gov.uk/attendance-allowance","date":"2026-09-24"}},{"name":"Healthcare Travel Costs Scheme","kind":"benefit","provides":["Help with fares to hospital for people on qualifying benefits or a low income; it matters during six months of fortnightly chemotherapy or five weeks of daily radiotherapy"],"url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","source":{"label":"NHS: Healthcare Travel Costs Scheme","url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","date":"2026-09-24"}},{"name":"Macmillan Grants","kind":"benefit","provides":["One-off payments for costs such as heating, travel or clothing, including clothing that fits around a stoma; a nurse or social worker applies with you"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work/macmillan-grants","source":{"label":"Macmillan Grants","url":"https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work/macmillan-grants","date":"2026-09-24"}}],"nations":[{"topic":"Who is screened, and from what age","england":"50 to 74, a faecal immunochemical test kit by post every two years. The extension from 60 down to 50 began in April 2021 and was completed in 2025; depending on when you turned 50 the first kit arrives at 50, 52 or 54. Over-75s can request one on 0800 707 60 60.","scotland":"50 to 74 every two years, and has been since before the switch to the faecal immunochemical test in November 2017. Over-75s can request a kit on 0800 0121 833.","wales":"50 to 74 every two years; the range was 55 to 74 until October 2023, then 51 to 74, reaching 50 from October 2024 as part of a four-year plan. No self-referral for over-75s.","northernIreland":"60 to 74 every two years, unchanged since the programme began in 2010. The widest gap between the nations on this page: a 55-year-old in Belfast is not invited, although the UK National Screening Committee recommends screening from 50 across the UK. No self-referral for over-75s.","sources":[{"label":"GOV.UK: bowel cancer screening programme overview (age 50 to 74 every two years; the 50, 52 and 54 transition cohorts; faecal immunochemical test since June 2019; last updated 17 March 2026)","url":"https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview","date":"2026-03-17"},{"label":"GOV.UK: bowel cancer screening standards data report 2024 to 2025 (the programme history, the age extension completed in 2025, uptake and outcomes; published 11 July 2026)","url":"https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","date":"2026-07-11"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics (age 50 to 74 every two years; May 2023 to April 2025 uptake; published 7 April 2026)","url":"https://publichealthscotland.scot/publications/scottish-bowel-screening-programme-statistics/scottish-bowel-screening-programme-statistics-for-the-period-of-invitations-from-may-2023-to-april-2025/","date":"2026-04-07"},{"label":"Bowel Screening Wales annual statistical report 2023-24 (PDF, January 2026): the threshold moved from 150 to 120 micrograms of haemoglobin per gram in October 2023, with a plan to move to 80, and the age range extended towards 50","url":"https://phw.nhs.wales/app/uploads/sites/2/2026/01/Bowel-Screening-Wales-Annual-Statistical-Report-2023-24.pdf","date":"2026-01"},{"label":"nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years)","url":"https://www.nidirect.gov.uk/articles/bowel-cancer-screening","date":"2026-09-24"},{"label":"Public Health Agency: bowel cancer screening in Northern Ireland (started in 2010; all people aged 60 to 74 registered with a GP are sent a kit every two years)","url":"https://www.publichealth.hscni.net/directorate-public-health/service-development-and-screening/bowel-cancer-screening","date":"2026-09-24"},{"label":"Bowel Cancer UK: screening (the four nations' age ranges and the over-75 self-referral helplines)","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/screening/","date":"2026-09-24"},{"label":"UK National Screening Committee: bowel cancer recommendation (screening every two years for men and women aged 50 to 74 in the UK using the faecal immunochemical test; last reviewed August 2018)","url":"https://view-health-screening-recommendations.service.gov.uk/bowel-cancer/","date":"2026-09-25"}]},{"topic":"The screening test threshold","england":"120 micrograms of haemoglobin per gram. No programme publication states it; the figure comes from the modelling of the English pilot in the British Journal of Cancer (2022), which calls it the current threshold. The National Cancer Plan for England commits to increasing the test's sensitivity to 80 micrograms per gram and rolling that out nationally by 2028.","scotland":"Not published. The Public Health Scotland report, its key performance indicator workbook and NHS inform describe the test only as measuring the amount of blood.","wales":"Published and dated: the threshold moved from 150 to 120 micrograms of haemoglobin per gram in October 2023, with a stated plan to move to 80 from October 2024.","northernIreland":"120 micrograms of haemoglobin per gram, for the screened ages 60 to 74. Neither nidirect nor the Public Health Agency publishes it; the number comes from the Northern Ireland Cancer Network's lower gastrointestinal referral pathway, which tells GPs that a result sent without symptoms is only processed above 120 in that age band.","sources":[{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Bowel Screening Wales annual statistical report 2023-24 (PDF, January 2026): the threshold moved from 150 to 120 micrograms of haemoglobin per gram in October 2023, with a plan to move to 80, and the age range extended towards 50","url":"https://phw.nhs.wales/app/uploads/sites/2/2026/01/Bowel-Screening-Wales-Annual-Statistical-Report-2023-24.pdf","date":"2026-01"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics, full report (PDF, 7 April 2026): uptake by sex and deprivation, positivity, colonoscopy waits and cancers found","url":"https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","date":"2026-04-07"},{"label":"NHS inform: bowel screening in Scotland (a free test kit sent to people aged 50 to 74)","url":"https://www.nhsinform.scot/healthy-living/screening/bowel-screening/","date":"2026-09-24"},{"label":"nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years)","url":"https://www.nidirect.gov.uk/articles/bowel-cancer-screening","date":"2026-09-24"},{"label":"Northern Ireland Cancer Network: Lower GI suspected cancer pathway, primary care (June 2024, PDF). The host's firewall rejects a request without a referer from the qFIT page above, which is what a checker should send","url":"https://nican.hscni.net/wp-content/uploads/2025/09/NICaN-Primary-Care-Pathway-for-Lower-GI-Suspected-Cancer-Pathway-June-2024.pdf","date":"2026-09-25"}]},{"topic":"The referral threshold for someone with symptoms","england":"10 micrograms of haemoglobin per gram or more on a quantitative faecal immunochemical test, under NICE NG12 1.3.2 and HTG690.","scotland":"20 micrograms per gram or more, under the Scottish referral guidelines for suspected cancer 2025: twice England's threshold.","wales":"No Welsh threshold could be sourced. NICE NG12 and HTG690 name no nation, and the Wales Cancer Network document library has been lost in a move between NHS Wales sites, so the assumption that Wales follows the English figure is not quoted here as fact.","northernIreland":"10 micrograms of haemoglobin per gram or more, the same number as England but set by the Northern Ireland Cancer Network rather than by NICE, and with a rule England does not have: two results below 10 taken two months apart still justify a red-flag referral where clinical concern persists.","sources":[{"label":"NICE NG12: suspected cancer, recommendations by site (colorectal 1.3.1 to 1.3.5, anal 1.3.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023)","url":"https://www.nice.org.uk/guidance/htg690/chapter/1-Recommendations","date":"2023-08-24"},{"label":"Scottish Government: Scottish referral guidelines for suspected cancer 2025, lower gastrointestinal (an urgent suspicion of cancer referral at a quantitative faecal immunochemical test result of 20 micrograms of haemoglobin per gram or more)","url":"https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/pages/5/","date":"2025-08-06"},{"label":"Northern Ireland Cancer Network: qFIT for lower gastrointestinal symptoms in primary care","url":"https://nican.hscni.net/info-for-professionals/primary-care/qfit/","date":"2026-09-25"},{"label":"Northern Ireland Cancer Network: Lower GI suspected cancer pathway, primary care (June 2024, PDF). The host's firewall rejects a request without a referer from the qFIT page above, which is what a checker should send","url":"https://nican.hscni.net/wp-content/uploads/2025/09/NICaN-Primary-Care-Pathway-for-Lower-GI-Suspected-Cancer-Pathway-June-2024.pdf","date":"2026-09-25"}]},{"topic":"Waiting-time standards","england":"28-day Faster Diagnosis Standard, 31 days from decision to treat and 62 days from referral to first treatment; the National Cancer Plan sets 80 percent, 96 percent and 85 percent respectively by March 2029, and notes the 62-day standard has not been met nationally since late 2015.","scotland":"31 days from decision to treat and 62 days from an urgent suspicion of cancer referral, both at 95 percent; 94.5 percent and 72.2 percent in the quarter to March 2026.","wales":"A single suspected cancer pathway measured from the point of suspicion, not referral, with a 75 percent target at 62 days; 60.1 percent in July 2026.","northernIreland":"31 days at 98 percent and 62 days at 95 percent, plus a 14-day breast target; 87.3 percent and 29.6 percent in the quarter to March 2026.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026): the 2029 waiting-time targets, the commitment to a more sensitive screening test at 80 micrograms of haemoglobin per gram by 2028, and what the faecal immunochemical test has already done to lower gastrointestinal referrals","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (published 30 June 2026)","url":"https://publichealthscotland.scot/publications/cancer-waiting-times/cancer-waiting-times-1-january-to-31-march-2026/","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target)","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026","url":"https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-cancer-waiting-times-january-march-2026","date":"2026-07-02"},{"label":"Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026)","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"}]},{"topic":"Who decides drug funding","england":"NICE technology appraisals, with the Cancer Drugs Fund for managed access; NHS England commissions and publishes the funded list with Blueteq forms.","scotland":"The Scottish Medicines Consortium, with the Patient and Clinician Engagement (PACE) process for end of life and orphan equivalent medicines. It accepted aflibercept that NICE refused, and has not revisited its 2006 refusal of bevacizumab.","wales":"NICE appraisals apply; the All Wales Medicines Strategy Group appraises only what NICE has not, and the One Wales process funds a handful of things beyond both, including panitumumab rechallenge (OW29).","northernIreland":"NICE appraisals are applied through the Department of Health.","sources":[{"label":"NICE: all products on colorectal cancer (65 products on the check date)","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/colorectal-cancer/products","date":"2026-09-24"},{"label":"Scottish Medicines Consortium: medicines advice, keyword colorectal (21 matches on the check date)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal","date":"2026-09-24"},{"label":"All Wales Therapeutics and Toxicology Centre: medicine recommendations, keyword colorectal (24 matches on the check date; most marked as meeting the AWMSG exclusion criteria because NICE has appraised the medicine)","url":"https://awttc.nhs.wales/accessing-medicines/medicine-recommendations/","date":"2026-09-24"},{"label":"One Wales OW29: panitumumab rechallenge for metastatic colorectal cancer, supported for use via the One Wales Medicines process (OWMAG meeting 12 May 2025); a Wales-only option with no NICE or SMC equivalent","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/panitumumab-rechallenge-for-metastatic-colorectal-cancer/","date":"2025-05-12"},{"label":"NHS England: national Cancer Drugs Fund list, version 1.365 (6 June 2025), read in full: nine colorectal medicines in the routinely funded section, nivolumab with ipilimumab first line in the Cancer Drugs Fund section from 22 April 2025","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-version-1.365.pdf","date":"2025-06-06"}]},{"topic":"The national audit","england":"The National Bowel Cancer Audit covers every NHS trust; the 2025 State of the Nation report, published October 2025, covers 35,243 people diagnosed in England in 2023, with unit-level results.","scotland":"Not in the audit. Public Health Scotland publishes bowel screening and cancer waiting times statistics separately.","wales":"In the audit: 2,487 people in 2023. Welsh data quality is affected by an ongoing cancer informatics implementation, with quarterly Welsh data expected from 2027.","northernIreland":"Not in the audit. The Northern Ireland Cancer Registry publishes incidence, stage, survival and mortality by tumour site.","sources":[{"label":"NBOCA State of the Nation report 2025, full report (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","date":"2025-10"},{"label":"NBOCA State of the Nation 2025 methodology supplement (PDF)","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Methodology-Supplement.pdf","date":"2025-10"},{"label":"Public Health Scotland: Scottish bowel screening programme statistics (age 50 to 74 every two years; May 2023 to April 2025 uptake; published 7 April 2026)","url":"https://publichealthscotland.scot/publications/scottish-bowel-screening-programme-statistics/scottish-bowel-screening-programme-statistics-for-the-period-of-invitations-from-may-2023-to-april-2025/","date":"2026-04-07"},{"label":"Northern Ireland Cancer Registry: colorectal cancer (ICD-10 C18 to C20), official statistics 1993-2023","url":"https://www.qub.ac.uk/research-centres/nicr/cancer-information/cancer-data-by-tumour-type/colorectal-cancer/","date":"2026-09-24"}]},{"topic":"Cancer statistics","england":"The National Disease Registration Service publishes cancer registration statistics with stage and routes to diagnosis; its pages returned HTTP 403 to OnCo, so England figures here come from Cancer Research UK and the audit.","scotland":"Public Health Scotland's open data files give counts and rates by ICD-10 code to 2024.","wales":"The Welsh Cancer Intelligence and Surveillance Unit publishes count, stage and mortality workbooks; incidence runs to 2022 and mortality to 2025.","northernIreland":"The Northern Ireland Cancer Registry at Queen's University Belfast publishes data tables and a factsheet for colorectal cancer covering 1993 to 2023.","sources":[{"label":"NDRS: cancer registration statistics, England (the publication page answered HTTP 403 to OnCo on 24 September 2026)","url":"https://digital.nhs.uk/data-and-information/publications/statistical/cancer-registration-statistics/england-2023"},{"label":"Public Health Scotland open data: annual cancer incidence, Scotland-level file (opendata_inc0024_scotland.csv; site Colorectal cancer, ICD-10 C18 to C20)","url":"https://www.opendata.nhs.scot/dataset/annual-cancer-incidence","date":"2026-09-24"},{"label":"Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026), summed over C18 to C20","url":"https://phw.nhs.wales/data/cancer-incidence-in-wales-data/","date":"2026-02"},{"label":"Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","date":"2026-09-24"}]},{"topic":"Genomic testing route","england":"The National Genomic Test Directory through seven Genomic Laboratory Hubs; the directory page answered HTTP 202, so no test codes are quoted except R211, which comes from GeNotes.","scotland":"The Scottish Genomic Test Directory, through four regional laboratories.","wales":"The All Wales Medical Genomics Service. Circulating tumour DNA RAS testing, which One Wales OW29 requires, is not on the test directory and is not routinely commissioned, so health boards must fund it.","northernIreland":"The Northern Ireland Regional Genetics Centre in Belfast.","sources":[{"label":"NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026)","url":"https://www.england.nhs.uk/publication/national-genomic-test-directories/"},{"label":"GeNotes: genomic testing in the devolved nations","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/genomic-testing-in-the-devolved-nations/","date":"2026-09-24"},{"label":"One Wales OW29: panitumumab rechallenge for metastatic colorectal cancer, supported for use via the One Wales Medicines process (OWMAG meeting 12 May 2025); a Wales-only option with no NICE or SMC equivalent","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/panitumumab-rechallenge-for-metastatic-colorectal-cancer/","date":"2025-05-12"},{"label":"GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024)","url":"https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","date":"2024-10-14"}]},{"topic":"Prescription charges","england":"9.90 pounds an item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate, and everyone over 60 is exempt.","scotland":"Free for everyone; no certificate needed.","wales":"Free for anyone registered with a Welsh GP.","northernIreland":"Free: all prescriptions dispensed in Northern Ireland are free of charge.","sources":[{"label":"NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment)","url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","date":"2026-09-24"},{"label":"NHS inform: prescription charges and exemptions (prescriptions in Scotland are free)","url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","date":"2026-01-07"},{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2020-09-18"},{"label":"nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge)","url":"https://www.nidirect.gov.uk/articles/help-health-costs","date":"2026-09-24"}]},{"topic":"Benefits under the special rules for end of life","england":"Personal Independence Payment (under State Pension age) or Attendance Allowance (over it) fast-tracked at the higher rate with no assessment when a clinician says 12 months or less, using the SR1 form.","scotland":"Adult Disability Payment and Pension Age Disability Payment replace them, with equivalent fast-track rules.","wales":"As England.","northernIreland":"As England, administered by the Department for Communities.","sources":[{"label":"GOV.UK: get benefits if you're nearing the end of life (special rules)","url":"https://www.gov.uk/benefits-end-of-life","date":"2026-09-24"},{"label":"DWP: the Special Rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians)","url":"https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","date":"2026-09-24"},{"label":"GOV.UK: Personal Independence Payment","url":"https://www.gov.uk/pip","date":"2026-09-24"},{"label":"nidirect: benefits if you are nearing the end of life","url":"https://www.nidirect.gov.uk/articles/benefits-if-you-are-nearing-end-life","date":"2026-09-24"}]}],"gaps":["No screening programme in England or Scotland publishes its own faecal immunochemical test threshold. For England the GOV.UK programme overview, the pathway requirements specification, the programme standards, the 2024 to 2025 standards data report, the care pathway, the professional guidance collection and the UK National Screening Committee page all describe it only as the screening threshold, and the specific operating model address answers 404; the figure of 120 micrograms of haemoglobin per gram used on this record comes instead from the peer-reviewed modelling of the English pilot, which states it as the current threshold (British Journal of Cancer 2022). For Scotland nothing carries a number: NHS inform answers and says only that the test measures the amount of blood, and Public Health Scotland's April 2026 report, its key performance indicator workbook and its screening-standards pages have no figure or glossary entry for it. Wales and Northern Ireland both publish theirs. The National Cancer Plan for England commits to reaching 80 micrograms per gram by 2028.","No Welsh threshold for referring a symptomatic patient could be sourced. NICE NG12 and HTG690 name no nation; the Wales Cancer Network document library redirected into a 404 on the NHS Wales Performance and Improvement site, whose cancer page carries one line and whose search and sitemap return nothing usable; gov.wales renders its search in the browser only. The table above says so rather than assuming Wales follows England.","The Scottish Government's 2025 referral guidelines link twice to national qFIT guidance at nhscfsd.co.uk, and that PDF answers 404; the Centre for Sustainable Delivery's site search answers 404 too, so the guidance the Scottish referral rule depends on is currently unreachable. The Scottish threshold of 20 micrograms per gram is quoted from the referral guidelines themselves, which do resolve.","NHS England's pages answered HTTP 202 with an empty body: the National Genomic Test Directory (so no colorectal test codes are quoted; the R211 code comes from GeNotes), the Cancer Drugs Fund list page, the cancer waiting times statistics pages and the 2023 changes to the waiting-time standards. The standards themselves are quoted from the GOV.UK statistical release and the National Cancer Plan instead, and the Cancer Drugs Fund content from version 1.365 of the list PDF, which does resolve.","The latest England cancer waiting times performance percentages, and any colorectal breakdown of them, could not be obtained: england.nhs.uk is the only publisher and it answers 202 to scripted requests. The GOV.UK release carries the definitions but links out to that host for the figures. Only Scotland publishes a colorectal-specific waiting-time split.","NDRS cancer registration statistics for England answered HTTP 403 to OnCo on 24 September 2026, so no England-only count for ICD-10 C18 to C20, stage split or routes-to-diagnosis table is quoted from the registry itself; the England figures come from Cancer Research UK and from the National Bowel Cancer Audit.","There is no 2026 National Bowel Cancer Audit State of the Nation report. The 2025 report, published October 2025 and covering people diagnosed or operated on in 2023, is the latest; the NATCAN reports list shows 2026 reports for eight other audits but not for bowel. The audit publishes no time-to-treatment indicator, and its own commentary names timeliness of care as a future priority.","GIRFT has no colorectal surgery speciality page and no national colorectal report: the address for one answered 403 to a plain user agent and 404 with full browser headers, because the path does not exist. The lower gastrointestinal cancer workstream page carries guidance and webinars only. The colorectal priorities quoted here come from the general surgery follow-up report of April 2026, whose full text is on the FutureNHS platform behind a login; only the executive summary was read.","Northern Ireland publishes no bowel screening uptake figure that could be found: the Department of Health statistics index and publications search returned nothing, and the Public Health Agency's publications address answered 404. The Public Health Agency's own page also carries stale text describing the programme as aimed at people aged 60 to 71 alongside the current 60 to 74, still describes the guaiac faecal occult blood test as the programme's primary test while a later section on the same page says the test has changed to the faecal immunochemical test, and still carries text from the 2020 pause.","ISRCTN record pages answer HTTP 200 but serve a JavaScript cookie challenge of about 1,200 bytes rather than the record, so every trial was read through the registry's public API. The API ignores its own offset parameter, so the search had to be done with a large limit and several keyword queries rather than by paging.","TRACC, the UK circulating tumour DNA trial, is registered on ClinicalTrials.gov and not on ISRCTN. Because this page cites UK public sources only, its row links to the NIHR Be Part of Research search rather than to the registry record; the status and sites come from the ClinicalTrials.gov record and the published papers.","The All Wales Therapeutics and Toxicology Centre's search returned 24 colorectal matches but its pagination is session-bound and answered with zero matches on every attempt, so 14 of the 24 could not be enumerated; per-medicine searches were used instead. The AWMSG appraisals address redirects to the centre's home page with no appraisal listing.","Cardiff University blocks automated readers: three candidate staff pages for Richard Adams, first author of FOCUS4-N and second author of COIN, all answered HTTP 403, so he has no record here despite verified authorship. Jenny Seligmann, first author of the FOxTROT biomarker analysis and of FOCUS4-C, has no Leeds staff page that could be found (the obvious address answered 404 and the site search answered 404). Kai-Keen Shiu's UCL profile answered 200 but renders in the browser only.","St Mark's Hospital, the specialist bowel hospital, is not listed as a centre: London North West University Healthcare NHS Trust's page confirms only that St Mark's has locations at Central Middlesex and Northwick Park hospitals, and the trust's service pages render in the browser only, with every guessed service address answering 404.","NICE's colorectal products list answered HTTP 403 when asked for 100 results per page, though it answered 200 and returned all 65 products with the default page size. The BSG and ACPGBI joint guideline page on faecal immunochemical testing carries no date, and the full text in Gut answered 403, so no threshold is quoted from it."],"route":"/cancers/colorectal/uk/","sources":["https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview","https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-State-of-the-Nation-Report-2025.pdf","https://www.gov.uk/government/publications/bowel-cancer-screening-pathway-requirements-specification/bowel-cancer-screening-pathway-requirements-specification","https://publichealthscotland.scot/media/38236/2026-04-07-bowel-screening-publication_report_final.pdf","https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","https://www.nice.org.uk/guidance/htg690/chapter/1-Recommendations","https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/pages/5/","https://www.nice.org.uk/guidance/ng151/chapter/Recommendations","https://www.bowelcanceruk.org.uk/campaigning/policy-reports-and-consultations/","https://www.bowelcanceruk.org.uk/campaigning/never-too-young/","https://www.gov.uk/government/statistics/bowel-cancer-screening-annual-report-2024-to-2025/bowel-cancer-screening-standards-data-report-2024-25","https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/","https://publichealthscotland.scot/publications/scottish-bowel-screening-programme-statistics/scottish-bowel-screening-programme-statistics-for-the-period-of-invitations-from-may-2023-to-april-2025/","https://phw.nhs.wales/topic/screening/bowel-screening/","https://www.nidirect.gov.uk/articles/bowel-cancer-screening","https://www.bowelcanceruk.org.uk/about-bowel-cancer/screening/","https://view-health-screening-recommendations.service.gov.uk/bowel-cancer/","https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","https://www.england.nhs.uk/long-read/changes-to-cancer-waiting-times-standards-from-1-october-2023/","https://europepmc.org/article/MED/16984925","https://www.nice.org.uk/guidance/htg430/chapter/1-Recommendations","https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/results-patient-with-colorectal-cancer-constitutional-germline-variant-causing-lynch-syndrome-identified/","https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/colorectal-cancer/","https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Infographic.pdf","https://publichealthscotland.scot/media/39233/2026-06-30_cwt-report_final.pdf","https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-cancer-waiting-times-january-march-2026","https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","https://www.nice.org.uk/guidance/ta105","https://www.natcan.org.uk/audits/bowel/","https://gettingitrightfirsttime.co.uk/wp-content/uploads/2026/04/GIRFT-General-Surgery-Follow-Up-Report-FINAL-April-2026-exec-summary.pdf","https://europepmc.org/article/MED/29611518","https://www.nice.org.uk/guidance/ta100","https://www.leedsth.nhs.uk/","https://www.isrctn.com/ISRCTN83842641","https://www.isrctn.com/ISRCTN11061442","https://www.isrctn.com/ISRCTN28785842","https://www.royalmarsden.nhs.uk/","https://europepmc.org/article/MED/38864835","https://www.isrctn.com/ISRCTN11118663","https://www.uhb.nhs.uk/","https://www.isrctn.com/ISRCTN14240288","https://www.ouh.nhs.uk/","https://www.isrctn.com/ISRCTN12706992","https://www.isrctn.com/ISRCTN12508004","https://www.oncology.ox.ac.uk/team/rachel-kerr","https://www.christie.nhs.uk/","https://www.cuh.nhs.uk/","https://www.uclh.nhs.uk/","https://www.isrctn.com/ISRCTN12595783","https://www.bartshealth.nhs.uk/","https://www.isrctn.com/ISRCTN39913423","https://www.nuh.nhs.uk/","https://europepmc.org/article/MED/8942775","https://gettingitrightfirsttime.co.uk/surgical_specialties/lower-gi-cancer/","https://www.isrctn.com/ISRCTN18133394","https://www.imperial.nhs.uk/","https://europepmc.org/article/MED/20430429","https://www.isrctn.com/ISRCTN17575409","https://www.sth.nhs.uk/","https://www.uhs.nhs.uk/","https://www.hull.nhs.uk/","https://www.enherts-tr.nhs.uk/hospitals/mount-vernon/","https://www.clatterbridgecc.nhs.uk/","https://www.isrctn.com/ISRCTN80318573","https://www.uhleicester.nhs.uk/","https://www.isrctn.com/ISRCTN13526628","https://www.uhbw.nhs.uk/","https://www.plymouthhospitals.nhs.uk/","https://www.uhcw.nhs.uk/","https://www.guysandstthomas.nhs.uk/","https://www.royalfree.nhs.uk/","https://www.nhsggc.scot/","https://www.isrctn.com/ISRCTN59757862","https://www.isrctn.com/ISRCTN18138369","https://www.nhslothian.scot/","https://www.nhstayside.scot.nhs.uk/index.htm","https://www.isrctn.com/ISRCTN93548632","https://www.nhsgrampian.org/","https://velindre.nhs.wales/","https://cavuhb.nhs.wales/","https://sbuhb.nhs.wales/","https://belfasttrust.hscni.net/","https://scottishmedicines.org.uk/medicines-advice/capecitabine-xeloda-fullsubmission-71611/","https://scottishmedicines.org.uk/medicines-advice/?keywords=colorectal","https://www.nice.org.uk/guidance/ta1065","https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-full-smc2820/","https://www.nice.org.uk/guidance/ta439","https://scottishmedicines.org.uk/medicines-advice/cetuximab-erbitux-fullsubmission-101214/","https://www.nice.org.uk/guidance/ta1136","https://scottishmedicines.org.uk/medicines-advice/bevacizumab-avastin-resubmission-22105/","https://www.nice.org.uk/guidance/ta61","https://www.nice.org.uk/guidance/ta716","https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-full-smc2394/","https://www.nice.org.uk/guidance/ta668","https://scottishmedicines.org.uk/medicines-advice/encorafenib-braftovi-full-smc2312/","https://www.nice.org.uk/guidance/ta1008","https://scottishmedicines.org.uk/medicines-advice/trifluridine-tipiracil-lonsurf-full-smc2654/","https://www.nice.org.uk/guidance/ta630","https://www.nice.org.uk/guidance/ta307","https://scottishmedicines.org.uk/medicines-advice/aflibercept-zaltrap-resubmission-87813/","https://www.nice.org.uk/guidance/ta242","https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/colorectal-cancer/products","https://www.nice.org.uk/guidance/terminated/ta1118","https://www.nice.org.uk/guidance/terminated/ta334","https://www.nice.org.uk/guidance/terminated/ta240","https://awttc.nhs.wales/accessing-medicines/medicine-recommendations/","https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/panitumumab-rechallenge-for-metastatic-colorectal-cancer/","https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-version-1.365.pdf","https://www.england.nhs.uk/cancer/cdf/cancer-drugs-fund-list/","https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/results-patient-with-colorectal-cancer-somatic-tumour-kras-variant-identified/","https://europepmc.org/article/MED/36941575","https://www.england.nhs.uk/publication/national-genomic-test-directories/","https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/genomic-testing-in-the-devolved-nations/","https://bepartofresearch.nihr.ac.uk/results/search-results?query=TRACC%20colorectal","https://www.isrctn.com/ISRCTN16126290","https://www.isrctn.com/search?q=colorectal+cancer","https://bepartofresearch.nihr.ac.uk/results/search-results?query=bowel%20cancer","https://europepmc.org/article/MED/18083404","https://europepmc.org/article/MED/27660192","https://www.isrctn.com/ISRCTN82375386","https://europepmc.org/article/MED/19269519","https://europepmc.org/article/MED/42633754","https://europepmc.org/article/MED/28236467","https://www.isrctn.com/ISRCTN11631712","https://www.isrctn.com/ISRCTN28352761","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/mortality","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/risk-factors","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence","https://phw.nhs.wales/app/uploads/sites/2/2026/01/Bowel-Screening-Wales-Annual-Statistical-Report-2023-24.pdf","https://www.opendata.nhs.scot/dataset/annual-cancer-incidence","https://phw.nhs.wales/data/cancer-incidence-in-wales-data/","https://phw.nhs.wales/data/cancer-mortality-in-wales-data/","https://phw.nhs.wales/app/uploads/sites/2/2026/02/CancerIncidenceWales_DataTables_2011-2022_Stage.xlsx","https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Colorectal%20cancer%20data%20tables.xlsx","https://www.bowelcanceruk.org.uk/","https://bowelresearchuk.org/","https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer","https://www.maggies.org/","https://www.cancerresearchuk.org/","https://www.cancerresearchuk.org/get-involved/donate","https://www.nhs.uk/conditions/bowel-cancer/","https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","https://www.gov.wales/free-prescriptions","https://www.gov.uk/benefits-end-of-life","https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","https://www.gov.uk/pip","https://www.gov.uk/attendance-allowance","https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work/macmillan-grants","https://www.publichealth.hscni.net/directorate-public-health/service-development-and-screening/bowel-cancer-screening","https://www.nhsinform.scot/healthy-living/screening/bowel-screening/","https://nican.hscni.net/wp-content/uploads/2025/09/NICaN-Primary-Care-Pathway-for-Lower-GI-Suspected-Cancer-Pathway-June-2024.pdf","https://nican.hscni.net/info-for-professionals/primary-care/qfit/","https://publichealthscotland.scot/publications/cancer-waiting-times/cancer-waiting-times-1-january-to-31-march-2026/","https://www.natcan.org.uk/wp-content/uploads/2025/10/NBOCA-SotN-2025-Methodology-Supplement.pdf","https://www.qub.ac.uk/research-centres/nicr/cancer-information/cancer-data-by-tumour-type/colorectal-cancer/","https://digital.nhs.uk/data-and-information/publications/statistical/cancer-registration-statistics/england-2023","https://www.nidirect.gov.uk/articles/help-health-costs","https://www.nidirect.gov.uk/articles/benefits-if-you-are-nearing-end-life"]}