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Malignant Neoplasm of the Colorectum B066

Last amended 
4 May 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
37 of 2013
Balance of Probabilities SOP
38 of 2013
Changes from previous Instruments:

SOP Bulletin 166

ICD Coding:
  • ICD-9-CM Codes: 153,154.0,154.1
  • ICD-10-AM Codes: C18, C19, C20

Brief description

This is a primary cancer of the lining of the large intestine (colon or rectum).  Primary means that the cancer arose in the colon or rectum and did not arrive secondarily from another body site.

Confirming the diagnosis

Information on histology (from biopsy, surgery, or autopsy) is required to confirm the diagnosis and apply the SOP.  There are SOP factors specific to MN of the colon only, so information on tumour location will be required to apply those factors.

The relevant medical specialist is a general surgeon, colorectal surgeon or gastroenterologist.

Additional diagnoses covered by these SOPs
  • adenocarcinoma of the colon or rectum
  • adenosquamous carcinoma of the colon or rectum
  • carcinoma of the colon or rectum
  • medullary carcinoma of the colon or rectum
  • mucinous (colloid) adenocarcinoma of the colon or rectum
  • signet ring carcinoma of colon or rectum
  • small cell (oat cell) carcinoma of the colon or rectum
  • squamous cell (epidermoid) carcinoma of the colon or rectum
  • undifferentiated carcinoma of the colon or rectum
Related conditions that may be covered by SOP (further information required)
  • colon cancer
  • cancer of the colon
  • cancer of the rectum
  • rectal cancer
Conditions excluded from SOP
  • adenoma of the colon or rectum*
  • carcinoid of the colon or rectum#
  • carcinoma in situ of the colon or rectum# - ICD code 230.4
  • Hodgkin’s lymphoma* of the colon or rectum
  • non-Hodgkin’s lymphoma* of the colon or rectum
  • secondary/metastatic cancer/carcinoma involving the colon or rectum (code to primary site)
  • soft tissue sarcoma* of the colon or rectum

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will generally be at the time of diagnosis.  Symptoms are non-specific, but it may be possible to back-date onset on the basis of symptoms such as rectal bleeding, change in bowel habit or loss of weight.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Colorectal cancer has a very variable course and prognosis.  It is particularly amenable to treatment if found early.  A delay in appropriate treatment could result in worsening of the condition.  Establishing whether worsening beyond the normal course of the disease has occurred will generally require expert medical opinion. 


Further information – dietary factors

This SOP has factors for the consumption of red meat and processed meat. Previous similar dietary factors required an increase in food intake, whereas these factors specify a minimum threshold level of intake. In the previous factors the increase could be weighed with respect to its relationship with military service.  For these factors, since every person whether military or civilian eats and drinks, it is difficult to conceptually weigh the relationship of these necessary activities and military service.


If the client was consuming a certain amount of a certain food substance during military service, that does not necessarily make this consumption due to military service:

  • The client still had a personal choice with respect to the type of food eaten. Note that foods are generally not considered addictive in themselves.
  • The client still had a personal choice with respect to the quantity of food eaten. Note that foods are generally not considered addictive in themselves.
  • Note that on operational service, the military provided the food and as a result there would have been some restrictions in the type of food choices. There also may be some limitation of the military provision of the quantity of food choices in operational service.
  • Canteens and military messes do not restrict the client’s freedom of choice of the quantity of food products.
  • The client may have been consuming the food type at or in excess of the required threshold level prior to military service.  If this circumstance did not change during service (food intake could have increased, decreased, or stayed the same, but remained above the threshold) then a relationship to service for consumption of the food type will be difficult to establish.

A further issue is whether the Defence department had a duty to inform their members of the need to eat less meat and less fat and more fruit and vegetables.

  • It could be argued that diet falls outside the normal medical scope unless that client suffers from a disease for which a special diet is required.
  • Secondly, dietary recommendations for health have changed over time, and hence the relevant Australian dietary standards would have to be used to assess whether there was any breach in the duty of care to the military members during each phase change of dietary standards.
  • Thirdly and importantly, as noted in the 2013 Australian Dietary Guidelines, “adherence to dietary recommendations in Australia is poor”.