Screening for Colorectal Cancer: Which Test can we Afford?

Introduction

In recent years, treatment of colorectal cancer has improved significantly. Laparoscopic surgery has been demonstrated to be at least equivalent to traditional laparotomy in terms of adequacy of resection, disease recurrence, and long-term survival. In addition, laparoscopic resection for cancer has considerable short-term benefits over laparotomy, including shorter hospital stay, shorter time to recovery of bowel function, and decreased analgesic requirements [1]. Recent advances in treatment of metastatic disease such as portal vein embolization have made liver resection a possibility for more patients. The criteria for resectability are also less rigid than in the past and the tendency to adopt a more aggressive treatment of metastatic lesions is the rule [2] [3]. This approach is associated with prolonged survival for patients with liver metastases [4]. The acceptance of the principle of total mesorectal excision for rectal cancers has ensured significant improvements in the quality of surgical resection [5], and radiotherapy for these tumours has allowed the possibility of down-staging, making more rectal cancers suitable for total mesorectal excision with a reduced local recurrence rate during long-term follow-up [6].

In terms of systemic management, 5-fluorouracil (5-FU) with leucovorin has been the mainstay of chemotherapy for colorectal cancer in both the adjuvant and metastatic settings for a long time. This chemotherapy increased median survival with metastatic disease from 5 months with best supportive care to 14 months. In the late 1990 s, the introduction of irinotecan and oxaliplatin as combination treatment with 5-FU/leucovorin increased the median survival of patients with disseminated colorectal cancer to 16 months. Sequential chemotherapy of both irinotecan and oxaliplatin with 5-FU/leucovorin further increased this survival to 21 months. More recently, several biopharmaceuticals, in particular the monoclonal antibodies bevacuzimab and cetuximab, have shown promise in clinical studies [7] [8] and are rapidly being implemented in regular treatment protocols.

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