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Colorectal (bowel) cancer in the UK and the NHS
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.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
A kit through the letterbox
12.2% of diagnoses (England and Wales, 2023)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: 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) (2026-03-17); NBOCA State of the Nation report 2025, full report (PDF) (2025-10); GOV.UK: bowel cancer screening pathway requirements specification (colonoscopy for an abnormal result, CT colonography where colonoscopy is unsuitable) (2026-03-06); 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 (2026-04-07)
Symptoms, then a stool test at the GP surgery
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, 20 micrograms per gram.
Sources: 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 (2026-04-15); NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023) (2023-08-24); 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) (2025-08-06)
An emergency admission
19.2% of diagnoses (England and Wales, 2023)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: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); 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 (2026-09-24)
Under 50, and told it is something else
8.0% of diagnoses (England and Wales, 2023)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: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); Bowel Cancer UK: Never Too Young, the campaign for younger patients launched in 2013, with the findings of its 2020 report (2026-09-24); 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 (2026-04-15)
- 1Before any symptoms: the screening kitA faecal immunochemical test by post every two years from 50 (60 in Northern Ireland) to 74Target Uptake: England acceptable 52%, achievable 60%; Scotland minimum 60%
England's programme started in 2006 for people aged 60 to 69, widened to 74 in 2010, and began lowering the age to 50 in April 2021, a process completed in 2025; depending on when you turned 50 the first kit comes at 50, 52 or 54. Scotland has invited people aged 50 to 74 since before the switch to the faecal immunochemical test in November 2017. Wales extended down to 50 from October 2024. Northern Ireland still starts at 60. 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: 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) (2026-03-17); 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) (2026-07-11); NHS: bowel cancer screening (the home test kit, the 0800 707 6060 helpline, results in about two weeks) (2024-10-11); 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) (2026-04-07); Public Health Wales: bowel screening (people aged 50 to 74 registered with a doctor in Wales, every two years) (2026-09-24); nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years) (2026-09-24); Bowel Cancer UK: screening (the four nations' age ranges and the over-75 self-referral helplines) (2026-09-24); 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) (2026-09-24)
- 2Day 0: the stool test decides the referralQuantitative faecal immunochemical test in primary care; refer on a suspected cancer pathway at 10 micrograms of haemoglobin per gram or more
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.
Sources: NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023) (2023-08-24); 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 (2026-04-15); 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 (2026-02-04); 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) (2025-08-06)
- 328 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of the referralTarget 75%, with 80% in the 2025/26 planning guidance and by March 2029
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: 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) (2026-09-10); 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 (2026-02-04); 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 (2026-04-07); NHS England: changes to cancer waiting times standards from 1 October 2023 (HTTP 202 with an empty body to OnCo)
- 4The colorectal multidisciplinary team and the rectal MRIStaging CT of chest, abdomen and pelvis for everyone; high-resolution pelvic MRI for every rectal cancer, read by a specialist team
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, 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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); MERCURY Study Group, Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study, BMJ 2006 (2006-09-19); NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
- 5Mismatch repair testing for every new diagnosisImmunohistochemistry or microsatellite instability testing on every colorectal cancer at diagnosis; RAS and BRAF on every stage 4 tumour
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: NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017) (2017-02-22); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); GeNotes: patient with colorectal cancer and a constitutional (germline) variant causing Lynch syndrome (reviewed 22 September 2024) (2024-09-22); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14); NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
- 6The clinical nurse specialistA colorectal clinical nurse specialist as the named contact from diagnosisTarget More than 95% seen by a clinical nurse specialist
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: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NBOCA State of the Nation 2025 infographic (PDF) (2025-10); Bowel Cancer UK: Never Too Young, the campaign for younger patients launched in 2013, with the findings of its 2020 report (2026-09-24)
- 731 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96% (England); 95% (Scotland); 98% (Northern Ireland)
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: 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) (2026-09-10); 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 (2026-02-04); Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral (2026-06-30); Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026-07-02)
- 862 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85% (England, by March 2029); 95% (Scotland); 75% (Wales); 95% (Northern Ireland)
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: 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 (2026-02-04); 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) (2026-09-10); Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral (2026-06-30); Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target) (2026-09-17); Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026) (2026-09-11)
- 9SurgeryMajor resection at a unit doing at least 20 rectal cancer operations a year; laparoscopic resection offered
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), 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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NBOCA State of the Nation 2025 infographic (PDF) (2025-10); NICE TA105: laparoscopic surgery for colorectal cancer (23 August 2006); its recommendations are carried in NG151 (2006-08-23)
- 10The stoma, and getting rid of itA trained stoma professional to give information and support; the diverting ileostomy closed within 18 monthsTarget Fewer than 35% still unclosed at 18 months
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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NATCAN: National Bowel Cancer Audit (NBOCA) (2026-09-24); 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 (2026-04)
- 11Life after a low resectionInformation about low anterior resection syndrome before sphincter-preserving surgery, and treatment in primary care if it happens
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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29)
- 12Chemotherapy and the drugsThree months of CAPOX for stage 3; RAS and BRAF results before any targeted treatment in stage 4Target More than 55% of people with stage 3 colon cancer to receive adjuvant chemotherapy
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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); NBOCA State of the Nation report 2025, full report (PDF) (2025-10); Iveson TJ, Kerr RS et al, 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT), Lancet Oncology 2018 (2018-04); NICE TA100: capecitabine and oxaliplatin in the adjuvant treatment of stage 3 (Dukes' C) colon cancer (26 April 2006) (2006-04-26)
Where you would be treated
29 centre entries across 4 nations, with what each offers for this cancer. The service model note below says what happens only at a specialist centre and what can be given closer to home under its MDT.
England
- 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
- 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
Service pageSecond opinionListed by 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, ISRCTN83842641, ISRCTN11118663
- Colorectal surgery
- Birmingham Clinical Trials Unit sponsors STAR-TREC and the ROSSINI surgical site infection trials
- FOxTROT and ARIEL site
- 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
- Colorectal oncology and radiotherapy
- FOxTROT, ARIEL, BICCC and PRIME-RT site
- TRACC site
- Colorectal surgery and oncology
- FOxTROT, ARIEL, OrigAMI-2 and TRACC site
- Pilot of a microchip blood and stool test for bowel cancer markers
- Colorectal cancer service
- ARIEL, OrigAMI-2 and OrigAMI-3 site
- FORTRESS: an anti-CD40 adenoviral vector with chemoradiotherapy in rectal cancer
- Colorectal oncology for North East London
- OrigAMI-2 and OrigAMI-3 site
- FOxTROT site
- 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
- Colorectal surgery and oncology
- Imperial College London ran the UK Flexible Sigmoidoscopy Screening Trial
- FOxTROT and PICCOS site
- Colorectal oncology
- FOxTROT and ARIEL site
- Colorectal surgery and oncology
- ARIEL site; the GIRFT lower gastrointestinal surgical advisor is at the University of Southampton
- Colorectal oncology
- ARIEL, OrigAMI-2 and OrigAMI-3 site
- Colorectal oncology and radiotherapy
- OrigAMI-2 and OrigAMI-3 site
- Colorectal oncology for Cheshire and Merseyside
- FOxTROT site
- ACRE study of the supportive care needs of people with advanced bowel cancer
Leicester Royal Infirmary and Leicester General Hospital
University Hospitals of Leicester NHS Trust
Leicester
- Colorectal surgery and oncology
- The University of Leicester sponsors COLO-PREVENT, the polyp prevention platform run inside the screening programme
- Colorectal oncology
- FOxTROT and TRACC site
- Colorectal surgery and oncology for Devon and Cornwall
- FOxTROT site; the GIRFT lower gastrointestinal radiology advisor is at Plymouth
- Colorectal surgery and oncology
- FOxTROT and TRACC site
- Colorectal surgery and oncology for South East London
- ARIEL and TRACC site
- Colorectal surgery
- FOxTROT site
Scotland
- Colorectal oncology for the West of Scotland
- NHS Greater Glasgow and Clyde sponsored SCOT and PRIME-RT
- FOxTROT, ARIEL, BICCC and TRACC site
- Colorectal oncology for South East Scotland
- ARIEL and OrigAMI-2 site
- Colorectal surgery and oncology for Tayside
- FOxTROT site
- TAYCAN: a liquid biopsy study in colorectal and pancreatic cancer
- Colorectal surgery and oncology for the North of Scotland
- ARIEL, PRIME-RT and TRACC site
Service pageSecond opinionListed by ISRCTN11061442, ISRCTN18138369, 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
Wales
- Colorectal oncology and radiotherapy for South East Wales
- FOxTROT, ARIEL and BICCC site
- Colorectal surgery
- Cardiff University sponsors BICCC; Cardiff and Vale sponsors PICCOS, the aerosolised intraperitoneal chemotherapy trial
- Colorectal surgery and oncology for South West Wales
- FOxTROT and PICCOS site
Northern Ireland
- Colorectal oncology for Northern Ireland
- ARIEL and PICCOS list Northern Ireland among their recruiting countries
The service model
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: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); 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) (2026-09-24); 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) (2026-09-24); GIRFT: lower gastrointestinal cancer workstream (clinical lead Alastair Simpson, Nottingham University Hospitals; no national report published, guidance and academy resources only) (2026-09-24)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| After surgery (adjuvant), stage 3 colon or rectal cancer | Capecitabine with oxaliplatin (CAPOX) for three months; FOLFOX for three to six months; or a single fluoropyrimidine for six months 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. | NICE TA1002006-04-26 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 | SMC2011-08-08 Capecitabine with oxaliplatin accepted for use within NHS Scotland for adjuvant stage 3 (Dukes' C) colon cancer (SMC 716/11, 8 August 2011) | Wales: As England, under NICE TA100 and NG151. NI: As England. |
| Before surgery (neoadjuvant), locally advanced colon cancer | Six weeks of preoperative oxaliplatin with a fluoropyrimidine 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. | NHS England2020-01-29 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 | SMC Not appraised (generic medicines); given under regional protocols | Wales: As England. NI: As England. |
| Before surgery, rectal cancer | Short-course radiotherapy (25 Gy in five fractions) or long-course chemoradiotherapy with capecitabine 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. | NHS England2020-01-29 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 | SMC Not appraised (radiotherapy and generic capecitabine) | Wales: As England. NI: As England. |
| Metastatic, first line, MSI-high or mismatch repair deficient | Nivolumab with ipilimumab; or pembrolizumab alone 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. | NICE TA10652025-05-28 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 | SMC SMC28202026-01-19 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) | Wales: Follows NICE TA1065 and TA709 (both marked as meeting the AWMSG exclusion criteria because NICE has appraised them). NI: Follows NICE TA1065 and TA709. |
| Metastatic, first line, RAS wild-type | Cetuximab or panitumumab with FOLFOX or FOLFIRI CetuximabPanitumumabFOLFOX (5-FU, leucovorin, oxaliplatin)FOLFIRI (5-FU, leucovorin, irinotecan)MRC COINPARADIGM 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. | NICE TA4392017-03-29 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 | SMC2015-01-12 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) | Wales: Follows NICE TA439; Blueteq list entries exist for both cetuximab and panitumumab. NI: Follows NICE TA439. |
| Metastatic, first and second line, when targeted treatment and immunotherapy are unsuitable | Bevacizumab (originator or biosimilar) with fluoropyrimidine-based chemotherapy 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. | NICE TA11362026-02-25 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 | SMC2006-06-05 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) | Wales: Follows NICE TA1136 (listed as meeting the AWMSG exclusion criteria). NI: Follows NICE TA1136. |
| Metastatic, first line, chemotherapy | Capecitabine with or without oxaliplatin or irinotecan (FOLFOX, FOLFIRI, CAPOX) CapecitabineFOLFOX (5-FU, leucovorin, oxaliplatin)FOLFIRI (5-FU, leucovorin, irinotecan)CAPOX (capecitabine, oxaliplatin)Irinotecan (and liposomal irinotecan) 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. | NICE TA612003-05-27 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 | SMC2008-10-13 Capecitabine accepted for use within NHS Scotland for metastatic colorectal cancer (SMC 507/08, 13 October 2008) | Wales: As England. NI: As England. |
| Previously treated, MSI-high or mismatch repair deficient | Nivolumab with ipilimumab; pembrolizumab only if that combination cannot be used Both are on the Cancer Drugs Fund list as routinely funded: form NIV10 from 26 October 2021, form PEMB24 from 19 December 2023. | NICE TA7162021-07-28 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 | SMC SMC23942021-12-13 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) | Wales: Follows NICE TA716 and TA914. NI: Follows NICE TA716 and TA914. |
| Previously treated, BRAF V600E mutation-positive | Encorafenib with cetuximab 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. | NICE TA6682021-01-06 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 | SMC SMC23122021-05-10 Accepted for use within NHSScotland after a full submission under the end of life and orphan equivalent process with PACE (10 May 2021) | Wales: Follows NICE TA668. NI: Follows NICE TA668. |
| Third line and beyond | Trifluridine-tipiracil with bevacizumab; then fruquintinib if that is unsuitable; regorafenib; trifluridine-tipiracil alone 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. | NICE TA10082024-09-25 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 | SMC SMC26542024-08-12 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) | Wales: Follows NICE TA1008, TA1079, TA866 and TA405; Blueteq entries exist for fruquintinib and regorafenib. NI: Follows the same NICE appraisals. |
| NTRK fusion-positive disease, any line | Larotrectinib 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. | NICE TA630 · CDF2020-05-27 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 | SMC Not listed among the colorectal cancer advice; search the register by medicine name | Wales: Follows NICE TA630. NI: Follows NICE TA630. |
| Previously treated, after oxaliplatin (aflibercept) | Aflibercept with irinotecan and fluorouracil-based therapy The clearest border on this page. A Scottish patient can be offered aflibercept after oxaliplatin; an English or Welsh patient cannot. | NICE TA3072014-03-25 Not recommended within its marketing authorisation; people already having it could continue until they and their clinician chose to stop | SMC2014-03-10 Accepted for use within NHS Scotland on resubmission, contingent on the patient access scheme (SMC 878/13, 10 March 2014) | Wales: Not recommended: AWMSG advice 0315 says the case for cost-effectiveness has not been proven (ratified 8 June 2015). NI: Not available (follows NICE TA307). |
| Rechallenge with an anti-EGFR antibody (Wales only) | Panitumumab after a previous anti-EGFR antibody and at least one other treatment, in left-sided disease with RAS wild-type circulating tumour DNA 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. | NICE TA2422012-01-25 Not recommended: cetuximab monotherapy or with chemotherapy, and panitumumab monotherapy, remain unrecommended after first-line chemotherapy; no rechallenge appraisal exists | SMC No rechallenge advice; the panitumumab records are non-submissions | 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. NI: Not available. |
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: NICE: all products on colorectal cancer (65 products on the check date) (2026-09-24); 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) (2026-02-25); 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 (2026-01-07); NICE TA307: aflibercept with irinotecan and fluorouracil-based therapy after oxaliplatin-based chemotherapy, not recommended (25 March 2014) (2014-03-25); NICE TA242: cetuximab, bevacizumab and panitumumab after first-line chemotherapy (25 January 2012; cetuximab and panitumumab not recommended, the bevacizumab recommendation replaced by TA1136) (2012-01-25); NICE TA334: regorafenib for metastatic colorectal cancer, terminated 25 February 2015 because Bayer did not provide an evidence submission (superseded in practice by TA866) (2015-02-25); NICE TA240: panitumumab with chemotherapy for metastatic colorectal cancer, terminated 14 December 2011 because Amgen did not provide an evidence submission (2011-12-14); Scottish Medicines Consortium: medicines advice, keyword colorectal (21 matches on the check date) (2026-09-24); 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) (2026-09-24); 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 (2025-05-12); 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 (2025-06-06); NHS England: national Cancer Drugs Fund list (the page answered HTTP 202 with an empty body to OnCo on 24 September 2026)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2) or microsatellite instability | pathology (HTG430 strategy) | Four-panel immunohistochemistry on the tumour block, or a microsatellite instability test | 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 | 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: NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017) (2017-02-22); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14); NICE TA1065: nivolumab plus ipilimumab for untreated unresectable or metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency (28 May 2025) (2025-05-28) |
| BRAF V600E and MLH1 promoter hypermethylation, as a reflex test | pathology (HTG430 steps 2 to 4) | Sequential BRAF V600E testing then MLH1 promoter hypermethylation testing, done only when the MLH1 immunohistochemistry is abnormal or the microsatellite instability test is positive | 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 | 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: NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017) (2017-02-22); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14) |
| Germline MLH1, MSH2, MSH6, PMS2 and EPCAM (Lynch syndrome) | germline panel | 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 | 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 | 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: NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017) (2017-02-22); GeNotes: patient with colorectal cancer and a constitutional (germline) variant causing Lynch syndrome (reviewed 22 September 2024) (2024-09-22); 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) (2026-07-11); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29) |
| RAS (KRAS and NRAS) | somatic panel | Next-generation sequencing of KRAS exons 2, 3 and 4 and NRAS exons 2 to 4 on the tumour | 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 | 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: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); GeNotes: patient with colorectal cancer and a somatic (tumour) KRAS variant (reviewed 16 May 2024) (2024-05-16); NICE TA439: cetuximab and panitumumab for previously untreated metastatic colorectal cancer (29 March 2017, last updated 25 September 2017) (2017-03-29) |
| BRAF V600E in the tumour | somatic panel | Next-generation sequencing on the tumour block, usually on the same panel as RAS | Encorafenib with cetuximab after previous systemic treatment (TA668); it also carries a poor prognosis, which changes the conversation about how hard to treat | Same request as RAS under NG151 1.4.1. Around 10 to 15 percent of colorectal cancers carry a BRAF variant, most commonly V600E Sources: NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14); NICE TA668: encorafenib plus cetuximab for previously treated BRAF V600E mutation-positive metastatic colorectal cancer (6 January 2021) (2021-01-06) |
| NTRK1, NTRK2 and NTRK3 rearrangement | somatic panel | Multi-target next-generation sequencing for structural variants on the tumour block | 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 | Requested by the oncologist through the Genomic Laboratory Hub, usually on an existing specimen; NTRK fusions are rare in colorectal cancer Sources: NICE TA630: larotrectinib for NTRK fusion-positive solid tumours (27 May 2020, Cancer Drugs Fund) (2020-05-27); 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 (2026-01-07); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29) |
| Inherited polyposis and early-onset colorectal cancer (APC, MUTYH and others) | R211 | The R211 panel, tested in people presenting with colorectal cancer and polyposis | 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 | 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: GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14) |
| Blood in the stool, before any of this | primary care | Quantitative faecal immunochemical test using HM-JACKarc or OC-Sensor | 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 | 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: NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023) (2023-08-24); 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 (2026-04-15); 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) (2025-08-06) |
| Circulating tumour DNA | not in the directory | A blood test for tumour DNA left behind after surgery, or for RAS status at progression | 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 | 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: 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 (2025-05-12); 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 (2024-08); TRACC: a protocol for circulating tumour DNA-guided adjuvant chemotherapy in resected colorectal cancer, BMC Cancer 2023 (2023-03); NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026) |
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: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NICE HTG430 (formerly DG27): molecular testing strategies for Lynch syndrome in people with colorectal cancer, recommendations (published 22 February 2017) (2017-02-22); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14); GeNotes: genomic testing in the devolved nations (2026-09-24)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
ISRCTN83842641Recruiting, 7 February 2022 to 1 April 2027 (platform runs to August 2029)
Operable colon cancer; the continuing phase 2/3 platform, target 1,703
77 centres, including St James's University Hospital (Leeds)Addenbrooke's, The Christie, the Royal Marsden and Churchill HospitalBeatson West of Scotland, Ninewells, Velindre, Singleton and Ysbyty Gwynedd
Sponsor University of Leeds; also open in Australia, France, India, the Netherlands and Sweden.
Registry or sponsor page →ISRCTN11061442Recruiting, 25 April 2022 to 1 October 2027
ARIEL: a biomarker enrichment trial of anti-EGFR agents in right-sided RAS wild-type advanced colorectal cancer
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
43 centres across all four nations, including St James's (Leeds), The Christie, UCLH and Southampton GeneralNHS Greater Glasgow and Clyde, NHS Grampian and NHS LothianVelindre, Withybush, Bronglais, Prince Philip and Betsi Cadwaladr
Sponsor University of Leeds; phase 4.
Registry or sponsor page →ISRCTN14240288Closed to recruitment 31 December 2023; follow-up to December 2027, 12-month results published 2026
Early and intermediate rectal cancer: chemoradiotherapy or short-course radiotherapy, each with response-adapted watch and wait or local excision, against surgery
34 centres in England, Scotland, Wales, Denmark and the Netherlands
Sponsor University of Birmingham. No UK rectal organ-preservation trial is recruiting on ISRCTN at present.
Registry or sponsor page →NCT04050345Recruiting
Resected stage II and III colorectal cancer: does a blood test for residual tumour DNA after surgery say who needs chemotherapy?
71 UK sites led by The Royal Marsden, including Guy's and St Thomas', The Christie, Addenbrooke's, Aberdeen Royal Infirmary and the BeatsonDistrict general hospitals from Carlisle and Milton Keynes to Glangwili and Withybush
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.
Registry or sponsor page →ISRCTN13526628Recruiting, 30 September 2022 to 31 January 2028
COLO-PREVENT: aspirin, aspirin with metformin, or resveratrol to prevent colorectal polyps
People under polyp surveillance within the bowel cancer screening programme; phase 2/3 randomised platform
Sponsor University of Leicester; the registry record does not list centres
Registry or sponsor page →ISRCTN11118663Recruiting, 21 October 2024 to 23 December 2026
OrigAMI-2: amivantamab with chemotherapy against cetuximab with chemotherapy, first line
Untreated RAS and BRAF wild-type metastatic colorectal cancer; phase 3
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)
Sponsor Janssen-Cilag International.
Registry or sponsor page →ISRCTN39913423Recruiting, 26 November 2024 to 13 October 2026
OrigAMI-3: amivantamab with FOLFIRI against cetuximab or bevacizumab with FOLFIRI
KRAS, NRAS and BRAF wild-type metastatic colorectal cancer; phase 3
St Bartholomew's, University College Hospital, Castle Hill (Cottingham)The Royal Marsden, Mount Vernon, Birmingham Heartlands, St James's (Leeds)
Sponsor Janssen-Cilag International.
Registry or sponsor page →ISRCTN12508004Recruiting, 13 September 2024 to 12 March 2028
BICCC: a brief course of cyclophosphamide after completing treatment for bowel cancer
People who have completed standard colorectal cancer treatment; phase 2 randomised
University Hospital of Wales and Velindre (Cardiff)Beatson West of Scotland, The Christie, Churchill Hospital (Oxford)Royal Liverpool University Hospital, Lincoln County Hospital
Sponsor Cardiff University.
Registry or sponsor page →ISRCTN12595783Recruiting, 15 February 2025 to 30 November 2026
NG-350A with chemoradiotherapy for locally advanced rectal cancer
Locally advanced rectal cancer: a tumour-selective anti-CD40-expressing adenoviral vector added to neoadjuvant chemoradiotherapy; phase 1b
University College London HospitalsThe Royal Marsden
Sponsor Akamis Bio.
Registry or sponsor page →ISRCTN17575409Recruiting, 22 January 2024 to 31 October 2027
PICCOS: pressurised intraperitoneal aerosolised chemotherapy for peritoneal metastases
Peritoneal metastases from bowel, ovarian and stomach cancers; randomised phase 2
Cardiff and Vale University Health BoardImperial College HealthcareSwansea BayRoyal United Hospitals Bath
Open in all four nations.
Registry or sponsor page →ISRCTN18133394Recruiting, 28 July 2023 to 28 February 2027
EPiC: exercise prehabilitation before curative colorectal surgery
People awaiting curative colorectal surgery: high-intensity interval training with or without resistance training
Royal Derby HospitalUniversity of Nottingham Medical School at Derby
Registry or sponsor page →ISRCTN16126290Recruiting, 1 January 2025 to 31 December 2026
ColoCap: colon capsule endoscopy against standard colonoscopy
People at risk of colorectal disease: diagnostic accuracy of a swallowed camera capsule against colonoscopy
Sponsor York and Scarborough Teaching Hospitals; the registry record does not list centres
Registry or sponsor page →ISRCTN12706992Recruiting, 1 October 2024 to 1 October 2026
PACES: machine-learning algorithms in the colorectal cancer pathway
Artificial intelligence applied from histopathology through to the multidisciplinary team
Oxford University Hospitals
Registry or sponsor page →ISRCTN93548632Recruiting, 1 May 2025 to 1 May 2027
TAYCAN: a liquid biopsy blood test in colorectal and pancreatic cancer
Observational: circulating tumour DNA as a marker of progression or recurrence in NHS Tayside
NHS Tayside (Ninewells Hospital, Dundee)
Registry or sponsor page →ISRCTN80318573Recruiting from 1 September 2026 to 1 February 2028
ACRE: the supportive care needs of people with advanced bowel cancer and their carers
Observational cross-sectional study of unmet supportive care needs
Clatterbridge Cancer Centre (Wirral)Liverpool University Hospitals, Warrington, Arrowe Park, Countess of Chester, Mersey and West Lancashire
Sponsor University of Liverpool, funded by North West Cancer Research.
Registry or sponsor page →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: ISRCTN registry search: colorectal cancer (2026-09-24); 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) (2026-09-24); 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) (2026-09-24); 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) (2026-09-24); NIHR Be Part of Research: bowel cancer
The UK trial legacy
The adjuvant question (1994 to 2018): QUASAR and SCOT, or how much chemotherapy is enough
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: QUASAR Collaborative Group, Adjuvant chemotherapy versus observation in patients with colorectal cancer, Lancet 2007 (2007-12-15); Kerr RS et al, Adjuvant capecitabine plus bevacizumab versus capecitabine alone in patients with colorectal cancer (QUASAR 2), Lancet Oncology 2016 (2016-11); Iveson TJ, Kerr RS et al, 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT), Lancet Oncology 2018 (2018-04); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29); ISRCTN82375386: QUASAR, adjuvant chemotherapy against observation after curative resection of colorectal cancer (2026-09-24); ISRCTN59757862: SCOT, short course oncology therapy (NHS Greater Glasgow and Clyde with the University of Glasgow; recruitment 9 May 2008 to 29 November 2013) (2026-09-24)
The rectum (2002 to 2026): MERCURY, CR07 and STAR-TREC
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: MERCURY Study Group, Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study, BMJ 2006 (2006-09-19); Sebag-Montefiore D et al, Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Lancet 2009 (2009-03-07); 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 (2026); ISRCTN28785842: MRC CR07, pathology-guided treatment of rectal cancer (2026-09-24); 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) (2026-09-24); NICE NG151: colorectal cancer, recommendations (published 29 January 2020, last updated 15 December 2021; links to the technology appraisals refreshed April 2026) (2020-01-29)
The screening programme (1981 to 2021): Nottingham and the flexible sigmoidoscopy trial
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: Hardcastle JD et al, Randomised controlled trial of faecal-occult-blood screening for colorectal cancer, Lancet 1996 (1996-11-30); Atkin WS et al, Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial, Lancet 2010 (2010-05-08); Atkin W et al, Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up, Lancet 2017 (2017-04-01); 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) (2026-03-17); 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) (2026-07-11); ISRCTN11631712: the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer (Medical Research Council) (2026-09-24); ISRCTN28352761: the UK Flexible Sigmoidoscopy Screening Trial (Imperial College London; recruitment 1 July 1995 to 28 February 2014, 167,882 people) (2026-09-24)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
New cases a year
48,213
UK · 2019, 2021-2022 average
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.
Sources: Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares) (2026-09-24)
Deaths a year
17,700
UK · 2022-2024 average
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.
Sources: Cancer Research UK: bowel cancer mortality (2026-09-24)
Ten-year survival
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 54.3% colon, 53.9% rectal ten-year survival (UK, 2018 (predicted)).
- In the 1970s it was 22.4 percent for colon and 24.6 percent for rectal cancer. Population averages, not a personal prognosis.
UK · 2018 (predicted)
Sources: Cancer Research UK: bowel cancer survival (2026-09-24)
Five-year survival by deprivation
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 55% most deprived, 62.9% least deprived five-year survival by deprivation (England, 2018-2022).
England · 2018-2022
Sources: Cancer Research UK: bowel cancer survival (2026-09-24)
Diagnosed at an early stage (I or II)
47%
England · 2022, cases with a known stage
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).
Sources: Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares) (2026-09-24)
Routes to diagnosis
38% urgent referral, 22% emergency, 12% screening
England · 2019
Northern Ireland 2019: 35 percent red flag referral, 26 percent emergency, 11 percent screening.
Sources: Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares) (2026-09-24)
Treatment in the first course
60% surgery, 34% systemic therapy, 12% radiotherapy
England · 2022
In 2024 there were around 4,400 curative and 2,800 palliative radiotherapy episodes for bowel cancer in England.
Sources: Cancer Research UK: bowel cancer statistics (key stats, stage and routes to diagnosis by nation, treatment shares) (2026-09-24)
Preventable cases
54%
UK · current estimate
Lifetime risk is 1 in 17 for males and 1 in 20 for females born in 1961.
Sources: Cancer Research UK: bowel cancer risk (lifetime risk and the preventable fraction) (2026-09-24)
Change in incidence rate since the early 1990s
+6%
UK · to 2019, 2021-2022
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.
Sources: Cancer Research UK: bowel cancer incidence (2026-09-24)
People diagnosed, in the audit
37,730
England and Wales · 2023
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.
Sources: NBOCA State of the Nation 2025 infographic (PDF) (2025-10)
Diagnosed at stage 1 or 2
41.5%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Diagnosed through screening
12.2%
England and Wales · 2023
Up from 10.9 percent in 2019, with the emergency share falling from 21.4 percent to 19.2 percent over the same period.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Diagnosed under the age of 50
8.0%
England and Wales · 2023
3,023 people, up from 6.4 percent in 2021 and 2022. The audit has made this group a focus of further study.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Died within 90 days of major resection
2.5%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Alive two years after major resection
84.9%
England and Wales · surgery April 2021 to March 2022
Up from 82.3 percent for surgery in the previous year. Every unit met the 70 percent local target.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Major resections done by keyhole or robot
75%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Still had a diverting ileostomy 18 months after anterior resection
38%
England and Wales · surgery April 2018 to March 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Units doing at least 20 rectal cancer resections a year
78%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Stage 3 colon cancer given adjuvant chemotherapy
66%
England and Wales · surgery April 2021 to October 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Rectal cancer given neoadjuvant radiotherapy
33%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Seen by a clinical nurse specialist, where recorded
93%
England and Wales · 2023
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Stage 4 disease with a record of RAS or BRAF testing
66.2%
England · 2021, in the 44 of 119 trusts with usable data
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.
Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10)
Screening uptake
65.2%
England · 2024-2025
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.
Sources: 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) (2026-07-11)
Screening uptake
65.2%
Scotland · May 2023 to April 2025
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.
Sources: 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 (2026-04-07)
Screening uptake
65.5%
Wales · April 2023 to March 2024
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.
Colonoscopy within four weeks of a positive screening test
41.5%
Scotland · May 2023 to April 2025
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.
Sources: 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 (2026-04-07)
62 days from urgent referral to first treatment, colorectal
79.0% non-screening, 57.6% screening
Scotland · quarter ending 31 March 2026
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.
Sources: Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral (2026-06-30)
31 days from decision to treat, colorectal
96.7% non-screening, 91.0% screening
Scotland · quarter ending 31 March 2026
Against a 95 percent standard; colorectal was among the cancer types that met the 31-day standard overall.
Sources: Public Health Scotland: cancer waiting times report, quarter ending 31 March 2026 (PDF), with the colorectal split by screening and non-screening referral (2026-06-30)
31 days from decision to treat, lower gastrointestinal
90.1%
Northern Ireland · quarter ending 31 March 2026
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.
Sources: Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026-07-02)
62 days from urgent GP referral to first treatment, all cancers
29.6%
Northern Ireland · quarter ending 31 March 2026
Against a 95 percent target; the revised series has run between 25.0 and 30.9 percent since December 2023.
Sources: Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026) (2026-09-11)
62 days from suspicion to first treatment, all cancers
60.1%
Wales · July 2026
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.
Sources: Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target) (2026-09-17)
New cases (C18 to C20)
4,275
Scotland · 2024
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.
Sources: Public Health Scotland open data: annual cancer incidence, Scotland-level file (opendata_inc0024_scotland.csv; site Colorectal cancer, ICD-10 C18 to C20) (2026-09-24)
New cases (C18 to C20)
2,714
Wales · 2022
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.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026), summed over C18 to C20 (2026-02)
Deaths (C18 to C20)
1,061
Wales · 2025 (year of registration)
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.
Sources: Public Health Wales, WCISU: cancer mortality in Wales 2002-2025, counts by ICD-10 code (xlsx, March 2026), summed over C18 to C20 (2026-03)
Stage at diagnosis (colorectal)
I 16%, II 23%, III 29%, IV 25%, unknown 8%
Wales · 2020-2022 (7,559 cases)
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.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2011-2022, stage data table (xlsx), colorectal three-year rolling period 2020 to 2022 (2026-02)
New cases (C18 to C20)
1,340
Northern Ireland · 2023
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.
Sources: Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25) (2026-09-24)
Stage at diagnosis (colorectal)
I 18%, II 23%, III 27%, IV 22%, unknown 11%
Northern Ireland · 2019-2023 (6,557 cases)
Of the 5,832 cases with a known stage: I 20 percent, II 26 percent, III 30 percent, IV 25 percent.
Sources: Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25) (2026-09-24)
Deaths (C18 to C20)
496
Northern Ireland · 2023
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.
Sources: Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25) (2026-09-24)
Net survival by stage
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Stage I 93%, stage II 88%, stage III 68%, stage IV 7% at five years net survival by stage (Northern Ireland, diagnosed 2014-2018).
- 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.
Northern Ireland · diagnosed 2014-2018
Sources: Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25) (2026-09-24)
Support in the UK
Charities focused on this cancer, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
Charity
- 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
Charity
- Research grants and PhD funding in bowel cancer and other bowel disease
- Take PaRT: patient and public involvement in reviewing and shaping research
Charity
- Support line and online community
- Macmillan colorectal clinical nurse specialists in many centres
- Grants and benefits advice
Charity
- Drop-in centres beside major cancer hospitals
- Benefits advice, psychological support and courses, free and without an appointment
Charity
- Nurse helpline and the Cancer Chat forum
- Plain-English information on bowel cancer and a trial database
- The UK statistics quoted on this page
- Research funding set up in Dame Deborah James's name, held at Cancer Research UK
NHS bowel cancer information and the screening helplines
NHS- 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
Free NHS prescriptions in England (medical exemption certificate)
Cost and benefit- 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
Prescriptions in Scotland, Wales and Northern Ireland
Cost and benefit- Scotland: free for everyone
- Wales: free for anyone registered with a Welsh GP
- Northern Ireland: all prescriptions dispensed there are free
Special rules for end of life (SR1)
Cost and benefit- 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
Personal Independence Payment and Attendance Allowance
Cost and benefit- 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
Healthcare Travel Costs Scheme
Cost and benefit- 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
Macmillan Grants
Cost and benefit- 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
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
| Topic | England | Scotland | Wales | Northern Ireland |
|---|---|---|---|---|
| Who is screened, and from what age Sources: 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) (2026-03-17); 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) (2026-07-11); 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) (2026-04-07); 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 (2026-01); nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years) (2026-09-24); 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) (2026-09-24); Bowel Cancer UK: screening (the four nations' age ranges and the over-75 self-referral helplines) (2026-09-24) | 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. | 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. | 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. | 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. No self-referral for over-75s. |
| The screening test threshold Sources: 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 (2026-02-04); 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 (2026-01); 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 (2026-04-07); NHS inform: bowel screening in Scotland (a free test kit sent to people aged 50 to 74) (2026-09-24); nidirect: bowel cancer screening (offered to people aged 60 to 74 in Northern Ireland, every two years) (2026-09-24) | Not published on any page that could be read. The National Cancer Plan for England commits to increasing the test's sensitivity to 80 micrograms of haemoglobin per gram and rolling that out nationally by 2028, which implies the current threshold is higher. | Not published on the Public Health Scotland report or NHS inform; both describe it only as the screening limit. | 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. | Not published on nidirect or the Public Health Agency page; described only as above the screening range. |
| The referral threshold for someone with symptoms Sources: 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 (2026-04-15); NICE HTG690 (formerly DG56): quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care, recommendations (published 24 August 2023) (2023-08-24); 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) (2025-08-06) | 10 micrograms of haemoglobin per gram or more on a quantitative faecal immunochemical test, under NICE NG12 1.3.2 and HTG690. | 20 micrograms per gram or more, under the Scottish referral guidelines for suspected cancer 2025: twice England's threshold. | Follows NICE NG12 and HTG690. | Follows NICE NG12 and HTG690. |
| Waiting-time standards Sources: 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) (2026-09-10); 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 (2026-02-04); Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (published 30 June 2026) (2026-06-30); Welsh Government: NHS activity and performance summary, July and August 2026 (the single suspected cancer pathway and its 75 per cent target) (2026-09-17); Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026-07-02); Department of Health (Northern Ireland): revised 62-day cancer waiting time figures (PDF, published 11 September 2026) (2026-09-11) | 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. | 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. | 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. | 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. |
| Who decides drug funding Sources: NICE: all products on colorectal cancer (65 products on the check date) (2026-09-24); Scottish Medicines Consortium: medicines advice, keyword colorectal (21 matches on the check date) (2026-09-24); 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) (2026-09-24); 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 (2025-05-12); 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 (2025-06-06) | NICE technology appraisals, with the Cancer Drugs Fund for managed access; NHS England commissions and publishes the funded list with Blueteq forms. | 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. | 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). | NICE appraisals are applied through the Department of Health. |
| The national audit Sources: NBOCA State of the Nation report 2025, full report (PDF) (2025-10); NBOCA State of the Nation 2025 methodology supplement (PDF) (2025-10); 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) (2026-04-07); Northern Ireland Cancer Registry: colorectal cancer (ICD-10 C18 to C20), official statistics 1993-2023 (2026-09-24) | 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. | Not in the audit. Public Health Scotland publishes bowel screening and cancer waiting times statistics separately. | 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. | Not in the audit. The Northern Ireland Cancer Registry publishes incidence, stage, survival and mortality by tumour site. |
| Cancer statistics Sources: NDRS: cancer registration statistics, England (the publication page answered HTTP 403 to OnCo on 24 September 2026); Public Health Scotland open data: annual cancer incidence, Scotland-level file (opendata_inc0024_scotland.csv; site Colorectal cancer, ICD-10 C18 to C20) (2026-09-24); Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026), summed over C18 to C20 (2026-02); Northern Ireland Cancer Registry: colorectal cancer data tables 1993-2023 (xlsx, Tables 1, 3, 6, 12, 16 and 25) (2026-09-24) | 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. | Public Health Scotland's open data files give counts and rates by ICD-10 code to 2024. | The Welsh Cancer Intelligence and Surveillance Unit publishes count, stage and mortality workbooks; incidence runs to 2022 and mortality to 2025. | The Northern Ireland Cancer Registry at Queen's University Belfast publishes data tables and a factsheet for colorectal cancer covering 1993 to 2023. |
| Genomic testing route Sources: NHS England: National Genomic Test Directory (HTTP 202 with an empty body to OnCo on 24 September 2026); GeNotes: genomic testing in the devolved nations (2026-09-24); 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 (2025-05-12); GeNotes knowledge hub: colorectal cancer (the R211 inherited polyposis and early onset colorectal cancer panel; reviewed 14 October 2024) (2024-10-14) | 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. | The Scottish Genomic Test Directory, through four regional laboratories. | 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. | The Northern Ireland Regional Genetics Centre in Belfast. |
| Prescription charges Sources: NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment) (2026-09-24); NHS inform: prescription charges and exemptions (prescriptions in Scotland are free) (2026-01-07); Welsh Government: free prescriptions (2020-09-18); nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge) (2026-09-24) | 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. | Free for everyone; no certificate needed. | Free for anyone registered with a Welsh GP. | Free: all prescriptions dispensed in Northern Ireland are free of charge. |
| Benefits under the special rules for end of life Sources: GOV.UK: get benefits if you're nearing the end of life (special rules) (2026-09-24); DWP: the Special Rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians) (2026-09-24); GOV.UK: Personal Independence Payment (2026-09-24); nidirect: benefits if you are nearing the end of life (2026-09-24) | 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. | Adult Disability Payment and Pension Age Disability Payment replace them, with equivalent fast-track rules. | As England. | As England, administered by the Department for Communities. |
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- The faecal immunochemical test threshold used by the screening programme could not be found for England, Scotland or Northern Ireland. The GOV.UK programme overview, the pathway requirements specification, the programme standards and the 2024 to 2025 standards data report all describe it only as the screening threshold; Public Health Scotland's April 2026 publication and its full report PDF, and NHS inform, describe it only as the screening limit; nidirect and the Public Health Agency say only above the screening range. Only Wales publishes a number with a date. The National Cancer Plan for England's commitment to reach 80 micrograms of haemoglobin per gram by 2028 implies England is currently above that, but the current figure is not stated on any page that could be read. The widely repeated figure of 120 for England is not quoted here because no readable source carries it.
- 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 specialty 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.
- 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.
How to read this page. Every figure and decision links to the page it was read from (162 sources, checked 2026-09-24); the drug and trial pills open OnCo records with their own sources. Standards and funding change: confirm with your team and the linked pages. Machine-readable copy at /api/v1/cancers/colorectal/uk.json. OnCo is orientation, not medical advice.