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Chapter 9: Colorectal Cancer

Julia Lee Close; Carmen Joseph Allegra

INTRODUCTION

Epidemiology

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Epidemiology

Incidence

Colon cancer:

96,830 (male: 48,450; female: 48,380. Estimated new cases for 2014 in the United States)

Rectum cancer:

40,000 (male: 23,380; female: 16,620. Estimated new cases for 2014 in the United States) 52.2 per 100,000 male, 39.3 per 100,000 female for colon and rectum cancer

Deaths:

Estimated 50,310 in 2014 for colon and rectum cancer (male: 26,270; female: 24,040)

Median age at diagnosis:

69 years

Male to female ratio:

1.7:1

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Stage at presentation:

Stage I:

15%

Stage II:

20–30%

Stage III:

30–40%

Stage IV:

20–25%

Skibber JM et al. Cancer of the colon. In: Devita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2001:1216–1270

Five-Year Survival

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Five-Year Survival

Colon

Rectal

>90%

75-85%

70-85%

IIIA

59%

55%

IIIB

42%

35%

IIIC

27%

24%

<5%

A large proportion of colorectal cancer patients are potential candidates for adjuvant therapies for stage II or III disease.

AJCC Cancer Staging Manual, 6th ed. New York: Springer-Verlag, 2002:113–123

Greene FL et al. Ann Surg 2002;236:416–421

Greene FL et al. Proc Am Soc Clin Oncol 2003;22:251 [abstract 1007]

Work-up

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Work-up

In situ and Stage I

H&P, carcinoembryonic antigen and (CEA), full colonoscopy, and pathology review

Stage II

H&P, CBC, serum electrolytes, LFTs, serum creatinine, BUN, and CEA. Full colonoscopy, CT scan of thorax and abdomen, and pelvis, pathology review

Rectal lesions: MRI. Determine whether there is a loss of heterozygosity at chromosome 18q and ascertain the presence of microsatellite instability (MSI). Patient at high risk based on loss of heterozygosity at 18q and MSI status can be recommended for adjuvant treatment

Stage III

As above for stages I–II. If patient has potentially resectable disease, additional studies may be needed before laparotomy to confirm resectability, including spiral CT scan, contrast MRI, PET scan, angiography, and laparoscopy

Stage IV

As above plus KRAS status

de Gramont A et al. Gastrointest Cancer Res 2008,2: S2–S6

Pathology

World Health Organization Classification