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13 - Colon and rectum

Published online by Cambridge University Press:  23 December 2009

By
Richard Adams ,
Timothy Maughan  and
Tom Crosby
Edited by
Louise Hanna ,
Tom Crosby  and
Fergus Macbeth
Richard Adams
Affiliation:
Senior Lecturer, Clinical Oncology, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Timothy Maughan
Affiliation:
Professor of Cancer Studies, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Tom Crosby
Affiliation:
Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Cardiff
Louise Hanna
Affiliation:
Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Hospital, Cardiff
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Summary

Introduction

Colorectal cancer (CRC) is second in incidence in Europe only to lung cancer, and it causes around 204,000 deaths each year. The aetiology of CRC is still unclear, but the eight- to ten-fold higher incidence in the developed world compared to that in the developing world suggests environmental causes. Around 15 to 20% of CRCs are of familial origin.

Screening is currently being adopted in the UK with the roll-out of a programme of faecal occult blood (FOB) testing, followed by colonoscopy if FOB testing is positive. Many other countries are also considering such a programme.

Surgery is the only curative treatment and total mesorectal excision (TME) is now well established as the best way of managing rectal carcinoma. But the last 10 years have also seen a rapid increase in the use of preoperative radiotherapy, of neoadjuvant and adjuvant chemotherapy, and of new agents for advanced disease, with small but incremental improvements in outcome.

Targeted therapy such as epithelial growth factor receptor (EGFR) inhibitors and vascular endothelial growth factor inhibitors have been tested in patients with advanced CRC, but the role of these therapies in routine management has not yet been established.

Types of colorectal tumours

The range of tumours that affect the colon and rectum is shown in Table 13.1.

Incidence and epidemiology

The annual incidence of CRC is 54 per 100,000 in the UK, and 35,000 new cases are reported per year (CRUK; http://info.cancerresearchuk.org, accessed September 2006).

Type
Chapter
Information
Practical Clinical Oncology , pp. 159 - 173
Publisher: Cambridge University Press
Print publication year: 2008

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References

Adam, I. J., Mohamdee, M. O., Martin, I. G.et al. (1994). Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet, 344, 707–11.CrossRefGoogle ScholarPubMed
Adam, R., Delvart, V., Pascal, G.et al. (2004). Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann. Surg., 240, 644–57.Google ScholarPubMed
Agrawal, J. and Syngal, S. (2005). Colon cancer screening strategies. Curr. Opin. Gastroenterol., 21, 59–63.Google ScholarPubMed
Andre, T., Boni, C., Mounedji-Boudiaf, L.et al. (2004). Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N. Engl. J. Med., 350, 2343–51.CrossRefGoogle ScholarPubMed
Anonymous. (2000). Comparison of fluorouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. QUASAR Collaborative Group. Lancet, 355, 1588–96.CrossRef
Athreya, S., Moss, J., Urquhart, G.et al. (2006). Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome – 5-year review. Eur. J. Radiol., 60, 91–4.CrossRefGoogle ScholarPubMed
Autier, P., Boyle, P., Buyse, M.et al. (2003). Is faecal occult blood screening really the answer for lowering mortality in colorectal cancer?Recent Results Cancer Res., 163, 254–63.CrossRefGoogle Scholar
Bingham, S. A., Day, N. E., Luben, R.et al. (2003). Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet, 361, 1496–501; Erratum in Lancet, 362, 1000.CrossRefGoogle ScholarPubMed
Birgisson, H., Pahlman, L., Gunnarsson, U.et al. (2005). Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J. Clin. Oncol., 23, 8697–705.CrossRefGoogle ScholarPubMed
Bismuth, H., Adam, R., Levi, F.et al. (1996). Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann. Surg., 224, 509–20.CrossRefGoogle ScholarPubMed
Camma, C., Giunta, M., Fiorica, F.et al. (2000). Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. J.A.M.A., 284, 1008–15.CrossRefGoogle ScholarPubMed
Colorectal Cancer Collaborative Group. (2001). Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet, 358, 1291–304.CrossRef
Cunningham, D., Humblet, Y., Siena, S.et al. (2004). Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N. Engl. J. Med., 351, 337–45.CrossRefGoogle ScholarPubMed
Dube, S., Heyen, F., and Jenicek, M. (1997). Adjuvant chemotherapy in colorectal carcinoma: results of a meta-analysis. Dis. Colon Rectum, 40, 35–41.CrossRefGoogle ScholarPubMed
Fearon, E. R. and Vogelstein, B. (1990). A genetic model for colorectal tumorigenesis. Cell, 61, 759–67.CrossRefGoogle ScholarPubMed
Folkesson, J., Birgisson, H., Pahlman, L.et al. (2005). Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J. Clin. Oncol., 23, 5644–50.CrossRefGoogle ScholarPubMed
Fong, Y. and Salo, J. (1999). Surgical therapy of hepatic colorectal metastasis. Semin. Oncol., 26, 514–23.Google ScholarPubMed
Gray, R. G., Barnwell, J., Hills, R.et al. (2004). QUASAR: a randomised study of adjuvant chemotherapy (computed tomography) vs. observation including 3238 colorectal cancer patients. J. Clin. Oncol., 2004 American Society of Clinical Oncology Annual Meeting Proceedings (Post-Meeting Edition), Vol. 22, No. 14S (July 15 Suppl.), 3501.Google Scholar
Haller, D. G., Catalano, P. J., Macdonald, J. S.et al. (2005). Phase III study of fluorouracil, leucovorin and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J. Clin. Oncol., 23, 8671–8.CrossRefGoogle ScholarPubMed
Hardcastle, J. D., Chamberlain, J. O., Robinson, M. H.et al. (1996). Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet, 348, 1472–7.CrossRefGoogle ScholarPubMed
Hurwitz, H., Fehrenbacher, L., Novotny, W.et al. (2004). Bevacizumab plus irinotecan, fluorouracil and leucovorin for metastatic colorectal cancer. N. Engl. J. Med, 350, 2335–42.CrossRefGoogle ScholarPubMed
Jacobs, D. R. Jr., Marquart, L., Slavin, J.et al. (1998). Whole-grain intake and cancer: an expanded review and meta-analysis. Nutr. Cancer, 30, 85–96.CrossRefGoogle ScholarPubMed
James, R. D., Donaldson, D., Gray, R.et al. (2003). Randomised clinical trial of adjuvant radiotherapy and 5-fluorouracil infusion in colorectal cancer (AXIS). Br. J. Surg. 90, 1200–12.Google Scholar
Kerr, D. J., Gray, R., McConkey, C.et al. (2000). Adjuvant chemotherapy with 5-fluorouracil, L-folinic acid and levamisole for patients with colorectal cancer: non-randomised comparison of weekly versus four-weekly schedules – less pain, same gain. QUASAR Colorectal Cancer Study Group. Ann. Oncol., 11, 947–55.CrossRefGoogle ScholarPubMed
Key, T. J., Allen, N. E., Spencer, E. A.et al. (2002). The effect of diet on risk of cancer. Lancet, 360, 861–8.CrossRefGoogle ScholarPubMed
Lichtman, S. M. (2004). Chemotherapy in the elderly. Semin. Oncol., 31, 160–74.CrossRefGoogle ScholarPubMed
MacFarlane, J. K., Ryall, R. D. and Heald, R. J. (1993). Mesorectal excision for rectal cancer. Lancet, 341, 457–60.CrossRefGoogle ScholarPubMed
Marijnen, C., Peeters, K., Putter, H.et al. (2005). Long term results, toxicity and quality of life in the total mesorectal excision trial. Proc. Am. Soc. Clin. Oncol. Gastrointestinal Cancer Symposium, Abstr. 166.Google Scholar
Maughan, T. S., James, R. D., Kerr, D. J.et al. (2002). Comparison of survival, palliation and quality of life with three chemotherapy regimens in metastatic colorectal cancer: a multicentre randomised trial. Lancet, 359, 1555–63.CrossRefGoogle ScholarPubMed
Maughan, T. (2005). Fluorouracil (FU), oxaliplatin, (OX), CPT-11 (irinotecan, Ir) use and sequencing in advanced colorectal cancer (ACRC): the United Kingdom Medical Research Council FOCUS (complete response08) trial. Proc. Am. Soc. Clin. Oncol. Gastrointestinal Cancers Symposium, Abstr. 165.Google Scholar
MERCURY Study Group. (2006). Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. B.M.J., 333, 779.CrossRef
National Health Service Executive. (1997). Cancer Guidance Sub-group of the Clinical Outcomes Group. Guidance Improving Outcomes in Colorectal Cancer: The Research Evidence. London: Department of Health.
National Health Service Executive. (2000). Referral Guidelines for Suspected Cancer. London: Department of Health.
National Institute for Health and Clinical Excellence. (2005). Technology Appraisal 93. Colorectal Cancer (advanced) Irinotecan, Oxaliplatin and Raltitrexed (Review): Guidance. London: National Institute for Health and Clinical Excellence.
O'Connell, M. J., Laurie, J. A., Kahn, M.et al. (1998). Prospectively randomised trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J. Clin. Oncol., 16, 295–300.CrossRefGoogle Scholar
Renehan, A. G., Egger, M., Saunders, M. P.et al. (2002). Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. B.M.J., 324, 813.CrossRefGoogle ScholarPubMed
Rowan, A., Halford, S., Gaasenbeek, M.et al. (2005). Refining molecular analysis in the pathways of colorectal carcinogenesis. Clin. Gastro. Hepatol., 3, 1115–23.CrossRefGoogle ScholarPubMed
Saltz, L. B., Niedzwiecki, D., Hollis, D.et al. (2004). Irinotecan plus fluorouracil/leucovorin (IFL) versus fluorouracil/leucovorin alone (follicular lymphoma) in stage III colon cancer (intergroup trial Cancer and Leukaemia Group B C89803). J. Clin. Oncol., 2004 American Society of Clinical Oncology Annual Meeting Proceedings (Post-Meeting Edition), Vol. 22, No, 18S (July 15 Suppl.), 3500.Google Scholar
Sauer, R., Becker, H., Hohenberger, W.et al. (2004). Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med., 351, 1731–40.CrossRefGoogle ScholarPubMed
Sebag-Montefiore, D., Steele, R., Quirke, P.et al. (2006). Routine short-course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the Medical Research Council complete response07 randomised trial. J. Clin. Oncol., 2006 American Society of Clinical Oncology Meeting Proceedings Part I, Vol. 24, No. 18S (June 20 Suppl.), 3511.Google Scholar
Thirion, P., Wolmark, N., Haddad, E.et al. (1999). Survival impact of chemotherapy in patients with colorectal metastases confined to the liver: a re-analysis of 1458 non-operable patients randomised in 22 trials and 4 meta-analyses. Meta-Analysis Group in Cancer. Ann. Oncol., 10, 1317–20.CrossRefGoogle Scholar
Tournigand, C., Cervantes, A., Figer, A.et al. (2006). OPTIMOX1: a randomised study of 5-FU, folinic acid, oxaliplatin4 or 5-FU, folinic acid, oxaliplatin7 with oxaliplatin in a stop-and-go fashion in advanced colorectal cancer – a GERCOR study. J. Clin. Oncol., 24, 394–400.CrossRefGoogle Scholar
Twelves, C., Wong, A., Nowacki, M. P.et al. (2005). Capecitabine as adjuvant treatment for stage III colon cancer. N. Engl. J. Med., 352, 2696–704.CrossRefGoogle ScholarPubMed
International Union Against Cancer. (2002). tumour nodes metastases Classification of Malignant Tumours, ed. Sobin, L. H. and Ch., Wittekind, 6th edn. New York: Wiley-Liss, pp. 72–6.Google Scholar
Van, Cutsem E., Labianca, R., Hossfeld, G.et al. (2005). Randomised phase III trial comparing infused irinotecan/5-fluorouracil (5-FU)/folinic acid (IF) versus 5-FU/folinic acid (F) in stage III colon cancer patients (pts). (PETACC 3). J. Clin. Oncol., 2005 American Society of Clinical Oncology Meeting Proceedings, Vol. 23, No. 16S, Part I of II (June 1 Suppl.), 8.Google Scholar
Van, Cutsem E. J. D., Tabernero, J., Dianz-Rubio, E.et al. (2004). An international phase II study of cetuximab in combination with oxaliplatin/5-fluorouracil (5-FU)/folinic acid (folinic acid) (5-FU, folinic acid, oxaliplatin4) in the first-line treatment of patients with metastatic colorectal cancer (colorectal cancer) expressing epidermal growth factor receptor. Ann. Oncol., 15 (Suppl. 3), 339.Google Scholar
Vasen, H. F., Watson, P., Mecklin, J. P.et al. (1999). New clinical criteria for hereditary nonpolyposis colorectal cancer (hereditary non-polyposis colorectal cancer, Lynch syndrome) proposed by the International Collaborative group on hereditary non-polyposis colorectal cancer. Gastroenterology, 116, 1453–6.CrossRefGoogle Scholar
Wade, T. P., Virgo, K. S., Li, M. J.et al. (1996). Outcomes after detection of metastatic carcinoma of the colon and rectum in a national hospital system. J. Am. Coll. Surg., 182, 353–61.Google Scholar
Willett, C. G. (1999). Technical advances in the treatment of patients with rectal cancer. Int. J. Radiat. Oncol. Biol. Phys., 45, 1107–8.CrossRefGoogle ScholarPubMed
Wolmark, N., Wieand, H. S., Kuebler, J. P.et al. (2005). A phase III trial comparing FULV to FULV + oxaliplatin in stage II or III carcinoma of the colon: results of National Surgical Adjuvant Breast and Bowel Project Protocol C-07. J. Clin. Oncol., American Society of Clinical Oncology Annual Meeting Proceedings, 23 (16 Suppl. I), 3500.CrossRefGoogle Scholar
Ychou, M., Raoul, J., Douillard, J.et al. (2005). A phase II randomized trial of LV5FU2+CPT-11 vs. LV5FU2 alone in adjuvant high risk colon cancer (FNCLCC Accord02/FFCD9802). J. Clin. Oncol., American Society of Clinical Oncology Annual Meeting Proceedings, Vol. 23, No. 16S, Part I of II (June 1 Suppl.), 3502.CrossRefGoogle Scholar

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  • Colon and rectum
    • By Richard Adams, Senior Lecturer, Clinical Oncology, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Timothy Maughan, Professor of Cancer Studies, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Tom Crosby, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Cardiff
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.014
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Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Colon and rectum
    • By Richard Adams, Senior Lecturer, Clinical Oncology, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Timothy Maughan, Professor of Cancer Studies, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Tom Crosby, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Cardiff
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.014
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Colon and rectum
    • By Richard Adams, Senior Lecturer, Clinical Oncology, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Timothy Maughan, Professor of Cancer Studies, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Tom Crosby, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Cardiff
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.014
Available formats
×