# Colorectal Cancer

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Colon Cancer - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK470380/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD26 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Colorectal Cancer - disease-level clinical article (colorectal-cancer-full.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
COLORECTAL CANCER
Sources: Colon Cancer - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK470380/ · ICPC-3 (WONCA
         International Classification of Primary Care, 3rd edition) class DD26 - condition scope
         only, no dose · No dose - referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Colorectal Cancer - disease-level clinical article (colorectal-
               cancer-full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (1)
    - Presenting symptoms include rectal bleeding, abdominal pain, weight loss, and a change in
      bowel habits, which can progress to bowel obstruction in advanced disease  [abdominal pain ·
      rectal bleeding · weight loss]
  SIGNS - what you find (3)
    - Exam may reveal abdominal tenderness, blood in the stool, or, less often, a palpable abdominal
      or pelvic mass  [abdominal mass · abdominal tenderness · bloody diarrhoea · diarrhoea · pelvic
      mass]
    - Physical findings are often unremarkable, and no abnormal finding may be present at all
    - Exam should check for enlarged lymph nodes above the collarbone, in the neck, and in the
      armpit, plus a digital rectal exam and liver size  [lymphadenopathy]
  TESTS (6)
    - Anemia, low ferritin from iron deficiency, and a raised alkaline phosphatase or CEA level can
      raise suspicion for the disease
    - Full colonoscopy is the gold-standard test, allowing biopsy and lesion removal in one
      procedure
    - If colonoscopy cannot be done, CT colonography or a barium enema are alternatives, but a
      positive finding still needs biopsy confirmation
    - Contrast CT of the chest, abdomen, and pelvis is used to stage a newly diagnosed cancer
    - A PET scan can find spread not visible on contrast CT, though infection or healing tissue can
      also raise its signal
    - Tumor testing for microsatellite instability or loss of mismatch-repair proteins screens for
      Lynch syndrome and guides immunotherapy eligibility
  IF NOT THIS - what else fits (3)
    - Solamen syndrome causes segmental overgrowth with vascular malformations and skin lesions, and
      sits within the Cowden syndrome spectrum with PTEN mutations
    - Bannayan-Riley-Ruvalcaba syndrome features intestinal hamartomatous polyps, lipomas, an
      enlarged head, and genital skin pigmentation
    - Proteus syndrome causes progressive overgrowth of the skeleton, skin, and fat with only a few
      hamartomatous polyps, unlike true polyposis syndromes
  Source  StatPearls "A Review of Hereditary Colorectal Cancers" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Colon, rectal, or anal cancer requires colonoscopy and surgical/oncology referral. GP
            recognises red-flag bowel symptoms, gives symptomatic relief, and refers urgently. -
            Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Colon, rectal, or anal cancer requires colonoscopy and surgical/oncology referral. GP
            recognises red-flag bowel symptoms, gives symptomatic relief, and refers urgently.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Where 2 or more first-degree relatives have had colorectal cancer or
            premalignant colon polyps, investigate for an inherited CRC syndrome.
            RED FLAG - Rectal bleeding, unexplained weight loss, a change in bowel habit lasting
            more than 6 weeks, iron-deficiency anaemia, or a palpable abdominal or rectal mass:
            refer urgently.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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