Indian Council of Medical Research consensus document for the management of colorectal cancer

This document is based on consensus among the experts and best available evidence pertaining to the Indian population and is meant for practice in India. Evaluation of a patient with newly diagnosed colorectal cancer (CRC) should include essential tests: A complete colonoscopy with biopsy, imaging (for colon cancer: Contrast-enhanced computed tomography (CECT) scan of the chest, abdomen and pelvis and for rectal cancer: Magnetic resonance imaging (MRI) of the pelvis, or an endoscopic ultrasound (EUS), with a chest and abdomen CECT), complete blood counts, liver and kidney function tests, carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA19.9). For patients with localized colon cancer, resection is the treatment of choice, with consideration given to adjuvant chemotherapy for the patient with stage III and high-risk Stage II cancers. In patients with early rectal cancer (T1/T2, N0) surgery is the treatment of choice. Patients with locally advanced rectal cancer (T3/T4, N1, circumferential resection margin (CRM) threatened or involved) benefit from neoadjuvant therapy. Short course radiotherapy can be given if the CRM is not threatened. Others should undergo long course chemoradiotherapy. Adjuvant therapy is given to all patients receiving neoadjuvant therapy. Patients with potentially resectable metastatic liver limited disease should undergo synchronous or staged metastatectomy, along with neoadjuvant and adjuvant chemotherapy. Nonresectable metastatic disease must be assessed for chemotherapy versus best supportive care on an individual basis. Clinical examination and serum tumor markers are recommended at each followup visit, with imaging only done when either is abnormal or rising. Colonoscopic surveillance is also recommended for these patients.