The Indian Council of Medical Research (ICMR) has issued a 'consensus document' for the management of colorectal cancer, which is a formidable health problem worldwide. It is the third most common cancer in men and the second most common in woman.

According to senior ICMR officials, this consensus document represents the current thinking of experts on the topic based on available evidence. This has been developed by national experts in the field and does not in any way bind a clinician to follow this guideline verbatim. One can use an alternate mode of therapy based on discussions with the patient and institution, national or international guidelines. The mention of pharmaceutical drugs for therapy does not constitute endorsement or recommendation for use but is a guidance for clinicians in complex decision-making.

Officials said that this consensus document can be used as framework for more focused and planned research programmes to carry forward the process. The aim of the consensus document is to assist oncologists in making major clinical decisions encountered in managing their patients, well realizing the fact that some patients may require treatment strategies other than that suggested in these guidelines.

According to the draft consensus document issued by the ICMR, the pattern of genomic alterations in colon and rectal tumours are similar, hence can be grouped as one. Histological confirmation is mandatory prior to commencing definitive treatment and all patients should be staged with TNM staging system and risk-assessed at diagnosis. A baseline contrast-enhanced CT scan of chest, abdomen, and pelvis should be considered.

As per the document, patients should receive multidisciplinary care under the care of a surgical oncologist, medical and radiation oncologist. Colon cancer (tumours lying above the peritoneal reflection)-- primary surgery remains the standard of care. Adjuvant chemotherapy should be decided on an individual basis.

The document further says that regarding rectal cancer, strong consideration to neoadjuvant chemo-radiotherapy should be given in locally advanced but resectable tumours to downstage the disease and for organ preservation consideration. K-ras mutation testing may be done in all patients with metastatic disease and patients with liver-limited colorectal metastases should be referred early to hepato-biliary surgeon to assess resectability.

Colorectal cancer is a formidable health problem worldwide. Almost 60 per cent cases occur in the developed regions. About 608 000 deaths from colorectal cancer are estimated worldwide, accounting for eight per cent of all cancer deaths, making it the fourth most common cause of death from cancer.

In India colon cancer ranks ninth & rectal cancer ranks 10th amongst men. For women, rectal cancer does not figure in the top 10 cancers while colon cancer ranks ninth. The AAR for colon cancer & rectal cancer in men is 4.4 & 4.1 per 100000 respectively. The AAR for colon cancer in woman is 3.9 per 100000.

In a recently conducted study of 224 colo-rectal tumours by the Cancer Genomic Atlas (TCGA) Network, the pattern of genomic alterations in colon and rectal tissues was found to be similar, regardless of the anatomic location and origin.