This guideline covers managing colorectal (bowel) cancer in people aged 18 and over. It aims to improve quality of life and survival for adults with colorectal cancer through management of local disease and secondary tumours (metastatic disease).

The recommendations in this guideline were developed before the COVID-19 pandemic.

In December 2021, we updated guidance on transanal total mesorectal excision to recommend that it is used only in research, in line with NICE's interventional procedures guidance on transanal total mesorectal excision for rectal cancer.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Cancer Alliances Commissioners of colorectal cancer preventative and treatment services (including Clinical Commissioning Groups and NHS England Specialised Commissioning)
  • People with colorectal cancer and their families and carers

Is this guideline up to date?

December 2020: We have found no new evidence that affects the recommendations. For more information, see the surveillance decision

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces NICE guideline CG131 (November 2011) and NICE guideline CSG5 (June 2004)

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.