Trials and papersRectal cancer

For mismatch repair-deficient rectal cancer, six months of a single antibody now replaces chemotherapy, radiotherapy and an operation, and the same appears to be true for early-stage mismatch repair-deficient cancers of other organs.

The numbers behind the argument that the screening programme is working for the people it covers and failing everyone below its start age; the stage shift going into reverse is the most uncomfortable figure on this roadmap.

Selected patients with intermediate-risk rectal cancer can avoid radiotherapy altogether, with chemotherapy alone before surgery, trading neuropathy for better long-term bowel and sexual function.

Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.

The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.

The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.

The paper that turned early-onset colorectal cancer from an anecdote into a policy problem, and the direct evidence behind lowering the screening start age from 50 to 45 in the United States.

The document behind the MRI-first rectal cancer pathway used across Europe and the UK; the total neoadjuvant therapy trials (RAPIDO, PRODIGE 23, OPRA) that came after it are the main reason an update was needed.