Quality statement 5: Stage I colorectal cancer treatment

Quality statement

People with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm) are offered further surgery or active monitoring.

Quality measure

Structure: Evidence of local arrangements, including written clinical protocols, to ensure people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm), are offered further surgery or active monitoring.

Process: Proportion of people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm), who receive further surgery or active monitoring.

Numerator – the number of people in the denominator who receive further surgery or active monitoring.

Denominator – the number of people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm).

What the quality statement means for each audience

Service providers ensure systems are in place for people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm) to be offered further surgery or active monitoring.

Healthcare professionals ensure people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm) are offered further surgery or active monitoring.

Commissioners ensure they commission services where people with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm) are offered further surgery or active monitoring.

People with colorectal cancer that has not spread beyond the original tumour (stage I), as confirmed by examining the tumour once it is removed, are offered further surgery or active monitoring if the healthy tissue around the tumour is thought to contain cancer cells.

Source guidance

NICE clinical guideline 131 recommendations 1.2.3.1 (key priority for implementation) and 1.2.3.2.

Data source

Structure: Local data collection.

Process: Local data collection. The National Bowel Cancer Audit reports on whether the circumferential margin was involved, not involved or not known. It also records the distance between the cancer and the circumferential margins.

Definitions

NICE clinical guideline 131 (full version) states that although it is extremely important for patients with involved resection margins to be offered further treatment, there was not enough evidence to recommend specific treatments. Therefore the decision on which further treatment to use should be made locally by the appropriate multidisciplinary team.

NICE clinical guideline 131 states that the colorectal multidisciplinary team should take into account pathological characteristics of the lesion, imaging results and previous treatments when deciding whether to offer further treatment.

The Topic Expert Group who developed the quality standard felt that the choice between surgery and active monitoring would be dependent on clinical judgement on the risks of surgery (taking into account factors such as age and comorbidities) and the risk of disease recurrence.

Involved resection margins (less than 1 mm) refer to the distance from tumour to nearest surgical margin.