Colon & rectum
The cancer where screening does not merely find disease earlier — it prevents it, by removing the polyp before it ever becomes a cancer.
The figures at a glance
What it is
Colorectal cancer develops in the great majority of cases from polyps — initially benign lesions of the bowel lining that transform gradually, over years.
That slow progression is why screening here does not merely find the disease earlier; it prevents it, by removing the polyp before it ever becomes a cancer.
Symptoms and diagnosis
A persistent change in bowel habit, blood in the stool, unexplained iron-deficiency anaemia, abdominal pain or unexplained weight loss all need investigation — at any age.
Colonoscopy remains the reference test, since it allows diagnosis, biopsy and polyp removal in one procedure.
Biomarkers and heredity
MSI / dMMR testing is performed in nearly all cases: it identifies tumours that respond particularly well to immunotherapy, and simultaneously acts as a gateway to investigating Lynch syndrome. RAS and BRAF status determines targeted drug choice in metastatic disease.
Treatment options
In localised stages treatment is surgical, with post-operative chemotherapy in selected cases. In rectal cancer, radiotherapy or chemoradiotherapy often comes first. In metastatic disease, chemotherapy, targeted agents and — in MSI-high tumours — immunotherapy are combined.
How this is approached at the practice
Every case is discussed in a multidisciplinary team meeting (MDT) — surgeon, radiation oncologist, pathologist, radiologist and, where needed, psycho-oncologist and dietitian. The treatment decision is not made by one doctor alone.
Before any treatment is proposed, the tumour undergoes full molecular and immunohistochemical characterisation, so the choice targets your specific biology rather than a generic protocol. Every alternative is presented with its trade-offs, and a second opinion is treated as an ally.
Biomarkers tested
Molecular and immunohistochemical characterisation is done before treatment is chosen, so the decision rests on this particular tumour’s biology.
Frequently asked questions
Is colonoscopy necessary, or is a stool test enough?
For general-population screening the faecal immunochemical test (FIT) is an adequate first line. A positive result, however, must always be followed by colonoscopy.
At what age should I start screening?
For the general population organised screening begins at 50. With a family history or a known hereditary syndrome it starts earlier and is repeated more often — determined case by case.
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