Current Concepts in the Management of Colorectal Cancer

Colorectal cancer is the fourth commonest malignancy and the second leading cause of cancer related deaths in the United States. In the year 2001, there were an estimated total of 135.400 new cases of colorectal cancer. In terms of cancer deaths, this disease was estimated to account for 56,700 deaths in the United States. The lifetime risk of developing colorectal cancer for the American population is 1 in 17 (6%). When age adjusted incidence and mortality of colorectal cancer is evaluated from the SEER data from 1973-1997, a very pertinent finding is a decrease in incidence and decrease in mortality from this disease beginning at approximately 1985. The most plausible explanation for the decrease in incidence in the past two decades has been the effect of appropriate screening for this disease, with colonoscopic removal of precancerous adenomas, and thus prevention of development of colorectal cancer. The explanation for decrease in mortality is also likely related to screening, with the identification of colorectal cancers at an earlier stage, which are more amenable to cure than more advanced lesions; and secondly, improved multimodality therapies including surgery, radiation therapy and chemotherapy. This corresponds with a progressively improved 5-year survival for colorectal cancer, as evidenced by SEER data from 1974-1996, which showed an overall 5-year survival of 50% for this disease in 1974-1976, with an improvement to over 60% in 1989-1996. Colorectal cancer is a preventable disease by appropriate screening and removal of precursor lesions. Ongoing emphasis for routine screening of both average-risk and high-risk patient populations must be encouraged.