RCS England responds to National Bowel Cancer Audit State of the Nation report 2026

New figures from the National Bowel Cancer Audit (NBOCA), published today by the National Cancer Audit Collaborating Centre (NATCAN), show that the two-year survival following major bowel cancer surgery has improved in recent years, yet significant differences remain in how people are diagnosed and treated in England and Wales.

Over 48,000 people are diagnosed with bowel cancer every year in the UK, with nine out of ten new cases diagnosed in people over the age of 50 but also 2,900 new cases in people under 50, a figure that has been steadily rising over recent years.

The latest audit highlights that better survival likely reflects improvements in care across the whole patient journey, including care before and after surgery, cancer treatment, and multidisciplinary decision-making.

The main findings:

• Delays following routine GP referral: People diagnosed following a routine GP referral waited over a week longer for a treatment decision in secondary care than those referred urgently when cancer was suspected.
• Emergency diagnosis remains common: 18.7% of people were diagnosed following an emergency presentation when bowel cancer was not yet suspected. People who present as an emergency often experience poorer outcomes and may require urgent surgery instead of planned treatment.
• Higher mortality following emergency surgery: People undergoing emergency bowel cancer surgery are still six times more likely to die within 90 days than those having planned operations, highlighting a persistent and concerning disparity in outcomes.

Recommendations include:

• Ileostomy closure: Patients with rectal cancer often require a temporary ileostomy to protect a join made low in the bowel. Around 4 in 10 of these patients still have the ‘temporary’ ileostomy 18 months after their cancer surgery, which has significant impact on their long-term health and quality of life. The audit recommends reducing delays in reversing temporary stomas after bowel cancer surgery, enabling patients to return to normal bowel function sooner, and is encouraging participation in the national quality improvement collaborative Close It Quick, run by RCS England.
  
  
• Rectal cancer treatment: The audit recommends tailoring preoperative treatment planning for people with rectal cancer, based on high quality radiological imaging, to ensure they receive the most appropriate and streamlined care at the right time.

Miss Nicola Fearnheard, Council member at the Royal College of Surgeons of England (RCS England) and Clinical Co-Lead of the National Bowel Cancer Audit, said:

“These latest results show encouraging progress in bowel cancer care, with more people surviving following major surgery than in recent years.

“However, significant differences remain in how people are diagnosed and treated. Everyone should benefit from high-quality care throughout their cancer journey, and continued efforts are needed to reduce variation and improve outcomes across the country.”

ENDS

Notes to editors:

1. The National Bowel Cancer Audit (NBOCA) can be found on the NATCAN website: NBOCA State of the Nation Report 2026 - National Cancer Audit Collaborating Centre

2. What is bowel cancer? | Bowel Cancer UK | Bowel Cancer UK

3. The National Cancer Audit Collaborating Centre (NATCAN) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England and the Welsh Government as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). NATCAN delivers national audits in bowel, breast (primary and metastatic), kidney, lung, non-Hodgkin lymphoma, oesophago-gastric, ovarian, pancreatic and prostate cancers.

4. The Clinical Effectiveness Unit (CEU) is a collaboration between the Royal College of Surgeons of England and the Department of Health Services Research and Policy at the London School of Hygiene & Tropical Medicine. Since its inception in 1998, the CEU has become a national centre of expertise in the methods, organisation and logistics of large-scale studies of the quality of surgical care. It has fostered collaborative links with professional organisations, the Department of Health and Social Care, and other relevant bodies within the NHS.

5. The Royal College of Surgeons of England provides world-class education, assessment and development to 30,000 surgeons, dental professionals and members of the wider surgical and dental care teams, at all stages of their careers. Our vision is to see excellent surgical care for everyone. We do this by setting professional standards, facilitating research and championing the best outcomes for patients.

6. For more information, please contact the RCS England press office: telephone: 020 7869 6054/6053; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 0207 869 6056.