STEP 4: Treatment

Establish intent of treatment

  • Curative
  • Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
  • Symptom palliation


  • Surgery is recommended for many patients with colorectal cancer.
  • Surgeons should have adequate qualifications and expertise, especially those undertaking rectal surgery.

Radiation therapy

  • Neoadjuvant radiation therapy is recommended for those with high-risk rectal cancer.
  • Radiation therapy may be given with palliative intent in symptomatic, non-resectable, locally advanced colorectal cancer.
  • Radiation therapy may be suitable for patients with colon cancer where the tumour has penetrated a fixed structure.

Systemic therapy

Systemic therapy may be beneficial for patients with:

  • a high risk of relapse and who may benefit from adjuvant therapy
  • locally advanced (high-risk) rectal cancer, treated with chemoradiation therapy
  • non-resectable, locally advanced or metastatic disease.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.


The lead clinician and team’s responsibilities include:

  • discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
  • discussing advance care planning with the patient and/or carer where appropriate
  • communicating the treatment plan to the patient’s GP
  • helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.



Surgery conducted within 5 weeks of investigations and MDM if no neoadjuvant therapy is required for patients with colorectal cancer.

Surgery conducted 8–12 weeks after neoadjuvant therapy for patients with rectal cancer.

Neoadjuvant radiation and neoadjuvant chemotherapy should begin within 3 weeks of the MDM.

Adjuvant chemotherapy should begin within 8 weeks of surgery.