Colorectal Cancer: Metastatic: Past Decade ? Colon And Rectal ...

May 31st | Colon And Rectal Surgery

Michael D?Angelica, Kamran Idrees, Philip B. Paty, and Leslie H. Blumgart Approximately 20% of patients with colorectal cancer present with established distant metastases.1 In most cases, the metastases are detectable with noninvasive imaging, and patients can be assigned to AJCC Stage IV before any surgical intervention. Among these patients there is enormous heterogeneity with respect to sites of disease, extent of disease, symptoms, performance status, and comorbidities. The clinical spectrum at the time of diagnosis ranges from the asymptomatic patient with a single metastatic lesion to the rapidly deteriorating patient with colon obstruction and advanced, multiorgan metastases. It is therefore difficult to define rigid treatment algorithms that can be widely applied to all clinical settings. Despite considerable progress in the treatment of advanced colorectal cancer, the vast majority of Stage IV patients are not curable by current treatment protocols. A recent analysis of data from the SEER population-based database estimates that the 5-year survival rate for Stage IV patients diagnosed between 1991 and 2000 was 8%.2 However, despite a low overall cure rate, aggressive treatment is indicated for most patients to extend survival and enhance quality of life. Systemic chemotherapy, endoscopic treatments to palliate obstruction, surgical diversion, and surgical resection all have important roles in treatment of Stage IV patients. Treatment approaches must be individualized based on the extent and resectability of local and distant disease, the presence or absence of bowel obstruction, performance status, and comorbidities. For patients with good performance status and minimal symptoms from their primary cancers, standard treatment is systemic chemotherapy, which is well documented to increase survival and quality of life.3,4 Surgical resection of the primary tumor and, when feasible, of the metastatic lesions can provide excellent palliation and can, in some cases, provide lasting cure.

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Tags: cancer, Colorectal, Decade, Metastatic, past

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