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Enter where the cancer was, the stage on your pathology report, what was given before the operation and whether oxaliplatin is suitable for you, and read the statements that apply, quoted word for word from NICE NG151. An educational aid to prepare for the conversation with your team, not advice. Nothing you enter leaves this page.
Answer the 4 questions and the statement that applies to that combination appears here, quoted word for word from NICE NG151: colorectal cancer, recommendations (January 2020, last updated December 2021) and the sources listed below, with a plain line on what it means and the questions to take to your surgeon.
Without JavaScript, every statement the aid can show is listed further down the page. This is an educational aid, not advice.
The aid picks from these 14 cards; each quotes its source word for word. Read them all here, with or without the questions above.
“For people with stage 3 colon cancer (pT1-4, pN1-2, M0), offer: capecitabine in combination with oxaliplatin (CAPOX) for 3 months, or if this is not suitable either: oxaliplatin in combination with 5-fluorouracil and folinic acid (FOLFOX) for 3 to 6 months, or single-agent fluoropyrimidine (for example, capecitabine) for 6 months.”
“Stage III colon, pMMR: Resection then adjuvant CAPOX for 3 months (T1-3 N1, low risk) or FOLFOX/CAPOX for 6 months (T4 or N2), per IDEA.”
What this means: Cancer in the lymph nodes is where chemotherapy after surgery has the clearest benefit, and NICE names CAPOX for three months as the first option. Three months of the two-drug combination and six months of the single tablet are both in the guideline, so the length and the number of drugs are genuinely open to discussion.
“For people with stage 3 rectal cancer (pT1-4, pN1-2, M0) treated with short-course radiotherapy or no preoperative treatment, offer: capecitabine in combination with oxaliplatin (CAPOX) for 3 months, or if this is not suitable either: oxaliplatin in combination with 5-fluorouracil and folinic acid (FOLFOX) for 3 to 6 months, or single-agent fluoropyrimidine (for example, capecitabine) for 6 months.”
What this means: For rectal cancer the guideline attaches its adjuvant recommendation to what happened before the operation. Where the preoperative treatment was short-course radiotherapy, or there was none, the offer is the same as for colon cancer.
“For people with stage 3 rectal cancer (pT1-4, pN1-2, M0) treated with short-course radiotherapy or no preoperative treatment, offer: capecitabine in combination with oxaliplatin (CAPOX) for 3 months, or if this is not suitable either: oxaliplatin in combination with 5-fluorouracil and folinic acid (FOLFOX) for 3 to 6 months, or single-agent fluoropyrimidine (for example, capecitabine) for 6 months.”
“Give people information on all treatment options for colorectal cancer available to them, including: surgery, radiotherapy, systemic anticancer therapy or palliative care, the potential benefits, risks, side effects and implications of treatments, for example, possible effects on bowel and sexual function, quality of life and independence.”
What this means: NICE wrote its adjuvant recommendation for rectal cancer treated with short-course radiotherapy or with nothing before the operation, so if you had long-course chemoradiotherapy the recommendation does not literally cover you. Chemotherapy afterwards is still commonly given, and UK practice has moved towards giving the chemotherapy before the operation instead, so this is a decision for your team to explain rather than a rule to look up.
“capecitabine in combination with oxaliplatin (CAPOX) for 3 months, or if this is not suitable either: oxaliplatin in combination with 5-fluorouracil and folinic acid (FOLFOX) for 3 to 6 months, or single-agent fluoropyrimidine (for example, capecitabine) for 6 months.”
“Emphasise to people the importance of monitoring and managing side effects during non-surgical treatment to try to prevent permanent damage (for example, monitoring prolonged sensory symptoms after platinum-based chemotherapy treatment, which can be a sign that the dose needs to be reduced to minimise future permanent peripheral neuropathy).”
What this means: The guideline builds in an alternative for people who should not have oxaliplatin, whether because of existing nerve damage, age, other illnesses or preference: a single fluoropyrimidine, usually capecitabine tablets, for six months. It also asks teams to watch sensory symptoms during treatment, because a dose reduction at the right moment is what prevents permanent neuropathy.
“Base the choice on the person's histopathology (for example pT1-T3 and pN1, and pT4 and/or pN2), performance status, personal preferences, any comorbidities and age.”
What this means: NICE names your preferences in the same sentence as the pathology report, which is unusual and worth using. Lower-risk node-positive disease (pT1 to T3 with pN1) tends towards the shorter course, higher-risk disease (pT4 or pN2) towards the longer one, and how much neuropathy you are willing to risk is a legitimate part of the answer.
“In August 2025, the use of some treatments was off label: capecitabine in combination with oxaliplatin (though CAPOX is common in UK clinical practice) capecitabine for 3 months' duration of adjuvant treatment.”
What this means: Off-label means the licence was written before the evidence caught up, not that the treatment is experimental. NICE flags it so the conversation about consent is an honest one, and notes in the same breath that CAPOX is common UK practice.
“Give people information on all treatment options for colorectal cancer available to them, including: surgery, radiotherapy, systemic anticancer therapy or palliative care, the potential benefits, risks, side effects and implications of treatments, for example, possible effects on bowel and sexual function, quality of life and independence.”
“Stage I-II colon: Surgical resection; observation for stage I and low-risk stage II. High-risk stage II (T4, obstruction, <12 nodes, LVI): consider 3-6 months fluoropyrimidine ± oxaliplatin; ctDNA-negative patients can safely omit (DYNAMIC). dMMR stage II derives no benefit from 5-FU alone.”
What this means: NG151's adjuvant recommendations are written for stage 3 only. For node-negative disease the guideline is silent, so the decision runs on the risk features in your pathology report (a T4 tumour, a blocked or perforated bowel, fewer than 12 nodes examined, invasion of lymphatic or blood vessels), on the mismatch repair result, and increasingly on whether tumour DNA can still be found in your blood after the operation. Ask for the absolute numbers rather than percentages of a percentage.
“Laparoscopic resection is recommended as an alternative to open resection for treating colon cancer when both techniques are considered suitable.”
“Stage I-II colon: Surgical resection; observation for stage I and low-risk stage II. High-risk stage II (T4, obstruction, <12 nodes, LVI): consider 3-6 months fluoropyrimidine ± oxaliplatin; ctDNA-negative patients can safely omit (DYNAMIC). dMMR stage II derives no benefit from 5-FU alone.”
What this means: For a stage 1 colon cancer removed with clear margins, NICE makes no recommendation for chemotherapy afterwards, and the OnCo record describes observation. What follows the operation is surveillance rather than treatment.
“Offer one of the treatments shown in table 1 to people with early rectal cancer (cT1-T2, cN0, M0) after discussing the implications of each treatment and reaching a shared decision with the person about the best option.”
“Do not offer preoperative radiotherapy to people with early rectal cancer (cT1-T2 cN0, M0), unless as part of a clinical trial.”
What this means: For early rectal cancer NICE puts three operations side by side (transanal excision, endoscopic submucosal dissection and total mesorectal excision) and compares them in a table on the points patients actually ask about: whether bowel is removed, whether a stoma may be needed, the hospital stay, scarring and the complications of each. Radiotherapy before the operation is only for a trial.
“Give information on low anterior resection syndrome (LARS) to people who will potentially have sphincter-preserving surgery. Advise them to seek help from primary care if they think they have symptoms of LARS, such as: increased frequency of stool, urgency with or without incontinence of stool, feeling of incomplete emptying of the bowels, fragmentation of stool (passing small amounts little and often), difficulty in differentiating between gas and stool.”
“Offer treatment (such as dietary management, laxatives, anti-bulking agents, anti-diarrhoeal agents, or anti-spasmodic agents) in primary care to people with bowel dysfunction symptoms associated with LARS. Seek advice from secondary care if the treatment is not successful.”
What this means: Bowel function after rectal surgery is the effect people most often say they were not warned about. NICE requires the warning in advance, asks for the LARS score to be used to measure it, and names the treatments a GP can start, so it is neither inevitable nor untreatable.
“Advise people with colorectal cancer of possible reasons why their treatment plan might need to change during their care, including: changes from laparoscopic to open surgery or curative to non-curative treatment, and why this change may be the most suitable option for them, the likelihood of having a stoma, why it might be necessary and for how long it might be needed.”
“Ensure that appropriate specialists discuss possible side effects with people who have had surgery for colorectal cancer, including: altered bowel, urinary and sexual function, physical changes, including anal discharge or bleeding. If relevant, have a trained stoma professional provide information on the care and management of stomas and on learning to live with a stoma.”
What this means: NICE puts three things in writing: that you should be told how likely a stoma is and for how long, that the plan can change during the operation, and that a trained stoma professional should teach you to live with it. Meeting the stoma nurse before the operation is part of the standard, not a favour.
“Emphasise to people the importance of monitoring and managing side effects during non-surgical treatment to try to prevent permanent damage (for example, monitoring prolonged sensory symptoms after platinum-based chemotherapy treatment, which can be a sign that the dose needs to be reduced to minimise future permanent peripheral neuropathy).”
“Give people who have had treatments for colorectal cancer information about possible short-term, long-term, permanent and late side effects which can affect quality of life, including: pain, altered bowel, urinary or sexual function, nerve damage and neuropathy, mental and emotional changes, including anxiety, depression, chemotherapy-related cognitive impairment, and changes to self-perception and social identity.”
What this means: Every one of these options contains a fluoropyrimidine, so a DPD blood test comes first: low DPD has no symptoms of its own and raises the risk of severe toxicity. During treatment, tingling in the fingers and toes is the symptom to report at every visit rather than at the end, because that is when the dose can still be changed.
“For people who have had potentially curative surgical treatment for non-metastatic colorectal cancer, offer follow-up for detection of local recurrence and distant metastases for the first 3 years. Follow-up should include serum carcinoembryonic antigen (CEA) and CT scan of the chest, abdomen and pelvis.”
“Help people prepare for discharge after treatment for colorectal cancer by giving them advice on: adapting physical activity to maintain their quality of life, diet, including advice on foods that can cause or contribute to bowel problems such as diarrhoea, flatulence, incontinence and difficulty in emptying the bowels, stopping smoking, how long their recovery might take, how, when and where to seek help if side effects become problematic.”
What this means: Follow-up is a named part of the plan for the first three years, not something to chase. The same recommendation covers what you should be told at discharge: activity, diet, recovery time and where to go when something goes wrong.
“Give people information on all treatment options for colorectal cancer available to them, including: surgery, radiotherapy, systemic anticancer therapy or palliative care, the potential benefits, risks, side effects and implications of treatments, for example, possible effects on bowel and sexual function, quality of life and independence.”
What this means: This aid quotes a guideline; it does not know your pathology report, your other illnesses or what matters to you. Take the statements above to the appointment and ask which apply, and what your team would do differently and why.
Each combination of answers maps to a fixed set of cards, and every card quotes the statement it implements with the page it was read from; nothing is scored or inferred. Where the sources disagree, both are quoted. The mapping is data in the OnCo repository and is tested against every combination of answers. Checked 2026-09-24.
This is an educational aid to prepare for a conversation with your surgical team. It is not medical advice, and it cannot see your scans or your history. OnCo is orientation, not medical advice.