Colorectal cancer: prevention and early diagnosis

Colorectal cancer (CRC) is a curable disease; over 90% of patients who have surgical resection of a Dukes’ A tumour will still be alive after 5 years. This is direct evidence that an early diagnosis will reduce mortality from CRC. Despite this, CRC is the second most common cause of cancer-related death in the UK. The discrepancy suggests that outcomes can be improved by a better understanding of the causes of the disease and its early detection and treatment. In this article, prevention and early diagnosis are discussed. The important associations of CRC with diet, obesity and exercise are considered, as well as the benefits of patient education and continued academic research into these areas. Screening for CRC using faecal occult blood test (FOBT) and flexible sigmoidoscopy are examined, and surveillance programmes for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis and other high-risk patients are reviewed. Finally, the impact of the ‘two-week wait’ rule introduced by the ‘NHS Cancer Plan 2000’ is analyzed, and proposals made on how to maximize its purpose to detect CRC as early as possible.