Colorectal Cancer



Colorectal cancer (CRC) is predominantly a disease of older adults with median age of 70 years at diagnosis. Several risk factors, disease associations, and potential protective factors are known. Chemoprevention is of no proven benefit. Utilization of screening strategies has resulted in decreased incidence and mortality from CRC. Current evidence suggests that select older adults derive benefit with chemotherapy comparable to younger individuals both in adjuvant and metastatic settings. Treatment is best tailored incorporating comorbidities and other contributors of frailty. Molecular markers are increasingly useful in the diagnosis and treatment of CRC.


Rectal Cancer Lynch Syndrome KRAS Mutation Comprehensive Geriatric Assessment Polyposis Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Annual percent change (APC)

The average annual percent change over several years. The APC is used to measure trends or the change in rates over time. For information on how this is calculated, go to Trend Algortihms in the SEER*Stat Help system. The calculation involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year.

Joinpoint analyses

A statistical model for characterizing cancer trends which uses statistical criteria to determine how many times and when the trends in incidence or mortality rates have changed. The results of joinpoint are given as calendar year ranges and the annual percent change (APC) in the rates over each period.

Survival rates

Survival examines how long after diagnosis people live. Cancer survival is measured in a number of different ways depending on the intended purpose.

Relative survival rate

A measure of net survival that is calculated by comparing observed (overall) survival with expected survival from a comparable set of people who do not have cancer to measure the excess mortality that is associated with a cancer diagnosis.

Stage distribution

Stage provides a measure of disease progression, detailing the degree to which the cancer has advanced. Two methods commonly used to determine stage are AJCC and SEER Summary Stage. The AJCC method (see Collaborative Staging Method) is more commonly used in the clinical settings, while SEER has strived to provide consistent definitions over time with their Local/Regional/Distant staging.

Lifetime risk

The probability of developing cancer in the course of one’s lifespan. Lifetime risk may also be discussed in terms of the probability of developing or of dying from cancer. Based on cancer rates from 2004 to 2006, it was estimated that men had about a 44% chance of developing cancer in their lifetimes, while women had about a 38% chance.

Probability of developing cancer

The chance that a person will develop cancer in his/her lifetime.


The number of people who have received a ­diagnosis of cancer during a defined time period, and who are alive on the last day of that period. Most prevalence data in SEER is for limited duration because information on cases diagnosed before 1973 is not generally available. ( (Accessed May 23, 2011).


  1. 1.
  2. 2.
    Altekruse SF, Kosary CL, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute., based on November 2009 SEER data submission, posted to the SEER web site; 2010.
  3. 3.
    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Souglakos J. Genetic alterations in sporadic and hereditary colorectal cancer: implementations for screening and follow-up. Dig Dis. 2007;25(1):9–19.PubMedCrossRefGoogle Scholar
  5. 5.
    Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993;88(6):825.PubMedGoogle Scholar
  6. 6.
    Markowitz SD, Bertagnolli MM. Molecular basis of colorectal cancer. N Engl J Med. 2009;361:2449–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Lines LM, Lang K, Lee DW, et al. Trends in stage distribution and survival among elderly colorectal cancer patients in the U.S. J Clin Oncol (Meeting Abstracts). 2008;26(15S):4043.Google Scholar
  8. 8.
    Onozato W, Yamashita K, Yamashita K, et al. Genetic alterations of K-ras may reflect prognosis in stage III colon cancer patients below 60 years of age. J Surg Oncol. 2011;103(1):25–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 2005;104(9): 1998–2005.PubMedCrossRefGoogle Scholar
  10. 10.
    Simmonds PD, Best L, George S, et al., Colorectal Cancer Collaborative Group. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet. 2000;356(9234):956.Google Scholar
  11. 11.
    Faiz O, Haji A, Bottle A, et al. Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007. Colorectal Dis. 2011;13(7):779–85.Google Scholar
  12. 12.
    Pallis AG, Papamichael D, Audisio R, et al. EORTC Elderly Task Force experts’ opinion for the treatment of colon cancer in older patients. Cancer Treat Rev. 2010;36(1):83–90. Epub 2009 Nov 26.PubMedCrossRefGoogle Scholar
  13. 13.
    Kahn KL, Adams JL, Weeks JC, et al. Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer. JAMA. 2010;303(11):1037–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Patwardhan MB, Samsa GP, McCrory DC, et al. Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer. Evidence Report/Technology Assessment No. 138. Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025. AHRQ Publication No. 06-E002. Rockville, MD: Agency for Healthcare Research and Quality; May 2006.Google Scholar
  15. 15.
    Blinman P, Duric V, Nowak AK, et al. Adjuvant chemotherapy for early colon cancer: what survival benefits make it worthwhile? Eur J Cancer. 2010;46(10):1800–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Des Guetz G, Uzzan B, Morere JF, Perret G, Nicolas P. Duration of adjuvant chemotherapy for patients with non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2010;(1):CD007046. doi: 10.1002/14651858.CD007046.pub2.
  17. 17.
    Ades S. Adjuvant chemotherapy for colon cancer in the elderly: moving from evidence to practice. Oncology (Williston Park). 2009;23(2):162–7.Google Scholar
  18. 18.
    McCleary J, Meyerhardt E, Green G, et al. Impact of older age on the efficacy of newer adjuvant therapies in > 12,500 patients (pts) with stage II/III colon cancer: findings from the accent database. J Clin Oncol. 2009;27(Suppl):15s (Abstract 4010).Google Scholar
  19. 19.
    Marshall JL. Risk assessment in stage II colorectal cancer. Oncology. 2010;24 Suppl 1:9–13.PubMedGoogle Scholar
  20. 20.
  21. 21.
    Sargent DJ, Marsoni S, Monges G, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol. 2010;28(20): 3219–26. Epub 2010 May 24.PubMedCrossRefGoogle Scholar
  22. 22.
    Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in ­metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27(22): 3677–83. Epub 2009 May 26.PubMedCrossRefGoogle Scholar
  23. 23.
    Van Cutsem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best ­supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007;25(13):1658–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Raftery L, Sanoff HK, Goldberg R. Colon cancer in older adults. Semin Oncol. 2008;35(6):561–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Pasetto LM, Basso U, Friso ML, et al. Determining therapeutic approaches in the elderly with rectal cancer. Drugs Aging. 2007; 24(9):781–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Chang GJ, Skibber JM, Feig BW, et al. Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg. 2007; 246(2):215–21.PubMedCrossRefGoogle Scholar
  27. 27.
    Endreseth BH, Romundstad P, Myrvold HE, et al. Rectal cancer treatment of the elderly. Colorectal Dis. 2006;8(6):471–9.PubMedCrossRefGoogle Scholar
  28. 28.
    National Comprehensive Cancer Network. (2011). Accessed 23 May 2011.
  29. 29.
    Lichtman SM, Boparai MK. Anticancer drug therapy in the older cancer patient: pharmacology and polypharmacy. Curr Treat Options Oncol. 2008;9:191–203.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Medical OncologyEphrata Cancer CenterEphrataUSA
  2. 2.Division of Hematology/Oncology, Department of MedicineContinuum Cancer Centers, St. Luke’s Roosevelt Hospital CenterNew YorkUSA

Personalised recommendations