In a nutshell
This article reviews the causes and management of colorectal cancer. They specifically focus on improvements that have occurred in the last ten years.
Some background
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth leading cause of cancer-related deaths. Risk factors include age, family history of colorectal cancer, prior colorectal cancer or tissue growths, obesity, tobacco abuse, and high stress.
There has been a gradual decrease in colorectal cancer death rates since 1975. This is partly due to improvements in diagnostic and screening techniques. Currently about 80% of cancers are diagnosed at the early stage and are curable.
Methods & findings
This study summarized results from 127 articles regarding management of colorectal cancer. The cancer stage at diagnosis remains the most important predictor of patient outcome.
Colorectal cancer staging
For patients with stage I cancer, the cancer remains in the innermost layers of the intestine. Patients with stage II cancer have cancer in the outermost layers of the intestine, but the cancer has not spread to the lymph nodes or other organs. Patients with stage III cancer have evidence of cancer spread to the lymph nodes but not to any distant organs. Stage IV colorectal cancer indicates that the cancer has spread to distant organs (secondary tumor; most often to the liver or lung).
After 5 years 80-93% of patients with stage I colorectal cancer are still alive compared to less than 44%-70% of patients with stage II to III colorectal cancer.
Management of colorectal cancer: surgery, chemotherapy and radiation
Surgery remains the main treatment for the majority of patients. The goal of surgery is to remove the tumor and a surrounding segment of bowel. Laparoscopic surgery (involving a small incision to access the bowel) is a new surgical technique which has improved patient recovery. For patients with rectal cancer, radiotherapy before surgery also helps improve patient prognosis.
Recent advances in chemotherapy and radiation have reduced the risk of disease recurrence and increased survival in high risk diseases. Specifically the introduction of oxaliplatin (Eloxatin)-based chemotherapy has improved the treatment of high-risk stage II and stage III colon cancer.
After 5 years, 73% of patients receiving oxaloplatin-based chemotherapy remained cancer free compared to 67% of patients receiving 5-Fluorouracil (Efudex; the original chemotherapy) alone. After 6 years, rate of overall survival in stage III patients was 73% in patients receiving oxaliplatin-based chemotherapy compared to 69% in patients receiving 5-Fluorouracil alone.
Management of Stage IV colorectal cancer
If possible the colon or rectal tumor and the secondary tumor are surgically removed. 5-year survival rates are 24%-58% after liver surgery and 35%-55% for lung surgery combined with colon surgery. Chemotherapy for 6 months after surgery is recommended to reduce the risk of recurrence.
Chemotherapy also improves survival times in patients who are not eligible for surgery. Survival time was originally 10-12 months for these patients, but this has increased to about 24 months due to advances in recent years. Newer treatments combinations for patients not eligible for surgery include oxaliplatin and 5-fluorouracil (FOLFOX) and irinotecan (Camptosar) and 5-fluorouracil (FOLFIRI).
The bottom line
The authors concluded that the last decade has seen substantial progress in the understanding of and in the management of colorectal cancer.
Published By :
International Journal of Colorectal Disease
Date :
Jun 24, 2014