NICE publish new quality standards on colorectal cancer and stable angina

NICE has today (13 August) published new quality standards on colorectal cancer (commonly known as colon cancer, rectal cancer or bowel cancer) and stable angina.

Colorectal cancer is the third most common type of cancer in England. Around 83% of cases occur in people over 60. Two-thirds of colorectal cancers develop in the colon, with the remaining third developing in the rectum. An estimated 16,000 people die from the disease each year in Englandi.

The initial symptoms of colorectal cancer may include:

  • blood in stools or bleeding from the rectum
  • a change to normal bowel habits that persists for more than six weeks, such as diarrhoea, constipation or passing stools more frequently than usual
  • abdominal pain
  • unexplained weight loss

The new quality standard for colorectal cancer includes eight statements designed to drive and measure priority quality improvements in this area. The standard states that people with suspected colorectal cancer are offered a contrast-enhanced computed tomography (CT) scan of the chest, abdomen and pelvis to determine the stage of the disease. It also states that people with rectal cancer are offered pelvic magnetic resonance imaging (MRI) to assess the risk of local recurrence. People free from disease after treatment should be offered regular surveillance.

Angina is a common condition among older adults in England; it is estimated that 1 in every 12 men and 1 in every 30 women between 55 and 64 years of age have angina. This figure rises to 1 in every 7 men and 1 in every 12 women who are over 65 years of ageii.

Angina is the main symptom of coronary artery disease and occurs when the blood supply to the muscles of the heart is restricted, usually when the arteries that supply the heart become hardened and narrowed. There are two main types of angina - stable and unstable. The symptoms of stable angina develop gradually over time and follow a predictable pattern. With unstable angina, the symptoms develop rapidly, can persist even at rest and can last up to 30 minutes. The main symptom of angina is a dull, heavy or tight pain in the chest that can sometimes spread to the left arm, neck, jaw or back. The pain is usually triggered by physical activity or stress and usually only lasts for a few minutes. This is known as an angina attack.

The new quality standard for stable angina consists of five statements, which include: people with features of typicaliii or atypicaliv angina and an estimated likelihood of coronary artery disease of 10-90% should be offered diagnostic investigation according to that likelihood, and that people with stable angina whose symptoms have not responded to treatment are offered re-evaluation of their diagnosis and treatment.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Colorectal cancer and stable angina are both common in people over 60, and these new quality standards will help drive improvements in the diagnosis, care and treatment of these diseases. Both sets of standards are concise, easy to read documents that will, I'm sure, be a useful aid to all those working in these areas.”

Richard Evans, Chief Executive Officer at the Society and College of Radiographers said: “The Society and College of Radiographers welcomes the publication of the quality standards for colorectal cancer. The importance of early and accurate diagnosis cannot be stressed highly enough as early diagnosis improves the possibility of achieving effective treatment outcomes. Responding to the challenges of delivering diagnostic imaging and effective radiotherapy in busy clinical departments will require not only the professional commitment of radiographers but also the support of provider organisations and commissioners to ensure the necessary resources are in place.”

Peter Weissberg, Medical Director at the British Heart Foundation said: “These quality standards for stable angina are both timely and important. Angina, usually experienced as discomfort in the chest on exertion, can be the first and only warning that someone has coronary artery disease and is at risk of a heart attack. Through medical research we have developed a range of tests and treatments to effectively identify and care for patients with angina, but it is essential that robust standards and guidelines are followed to confirm or refute the presence of coronary artery disease in someone experiencing chest pain.”

For more information, please call the NICE press office on 0845 003 7782, or out of hours on 07775 583 813, or email


Notes to Editors

References and explanation of terms

  1. NHS Choices.
  2. NHS Choices.
  3. People with typical angina experience classic symptoms of the condition such as dull, heavy or tight chest pains.
  4. People with atypical angina experience less common symptoms of the condition, such as weakness, faintness, sweating, and nausea.

About the quality standards

  1. The new quality standards are available on the NICE website from Monday 13 August at:

2. NICE quality standards (QS) are a set of specific, concise statements and measures that act as markers of high-quality, clinical and cost-effective patient care. They apply nationally in health and social care, and are developed from the very best available evidence, such as NICE guidance or other NHS Evidence-accredited sources. Quality standards are produced with the NHS and social care, along with their partners, service users and carers. They are a pivotal part of the new NHS Outcomes Framework, an overview of aims and objectives in improving patient outcomes in the NHS.

  1. Quality standard topics are referred to NICE by ministers on the advice of the National Quality Board, a group of representatives from health and social care, committed to improving quality in the NHS and overseeing the reforms aimed at improving care. Further information on the National Quality Board can be found at:

4. There is more information on NICE quality standards at:

5. For more information on the Society of and College of Radiographers, go to:

6. For more information on the British Heart Foundation, go to:

Related NICE quality standards

7. Patient experience in adult NHS services. NICE quality standard (2012).

8. End of life care for adults. NICE quality standard (2011).

About NICE

7. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

8. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

9. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
  • Commissioning Outcomes Framework - NICE develops the potential indicators for the COF, the scheme starting in 2013, which will help measure the health outcomes and quality of care commissioned by Clinical Commissioning Groups.

10. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 14 August 2012

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Selected, reliable information for health and social care in one place

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.