Lower gastrointestinal

Lower gastrointestinal cancers include colon cancer, rectal cancer and anal cancer.

Accurate diagnosis and staging is central to the appropriate management of patients with lower gastrointestinal cancers. Diagnostic and radiological tests available at The Royal Marsden include:


  • flexible sigmoidoscopy
  • colonoscopy
  • CT pneumocolon examination


  • CT
  • MRI

Our colorectal diagnostic service aims for all referrals to be screened by a clinical nurse specialist to help determine whether they should be examined in our consultant-led outpatient clinic or, if suitable, sent directly for endoscopy. This allows for rapid direct access to specialist investigations.


The management of lower gastrointestinal cancers depends on the presenting stage of disease and patient fitness.

Patients with anal cancer are usually treated with a combination of chemotherapy and radiotherapy. Patients with colorectal cancer that has not spread are considered for surgery. Radiotherapy and chemotherapy before surgery is sometimes advised for patients with rectal cancer. Chemotherapy given after surgery may also be of benefit.

Patients with inoperable or metastatic disease will be considered for chemotherapy and maybe radiotherapy. Patients with operable liver or lung metastases will be will be considered for surgical resection or radiofrequency ablation.

We also offer specialist treatment and advice to deal with long-term pelvic radiotherapy side effects.

Colorectal surgery

A range of minimally invasive colorectal surgery is available at The Royal Marsden to confirm diagnoses and treat lower gastrointestinal cancers.

Clinical trials

We believe that research is essential in order to raise standards of cancer care, and to improve the prognosis of patients with gastrointestinal cancers. Not all patients are suitable or willing to participate in a clinical trial, however our philosophy is to give patients the option of a research trial if one is available.