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.
KeywordsRectal Cancer Lynch Syndrome KRAS Mutation Comprehensive Geriatric Assessment Polyposis Syndrome
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.
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 examines how long after diagnosis people live. Cancer survival is measured in a number of different ways depending on the intended purpose.
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 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.
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.
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. (http://seer.cancer.gov/statfacts/html/colorect.html) (Accessed May 23, 2011).
- 1.http://www.census.gov/population/www/projections/files/nation/summary/np2008-t2.xls. Accessed 23 May 2011.
- 2.Altekruse SF, Kosary CL, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site; 2010.
- 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
- 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.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
- 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
- 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.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.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
- 20.https://www.adjuvantonline.com/index.jsp. Accessed 23 May 2011.
- 28.National Comprehensive Cancer Network. (2011). http://www.nccn.org/professionals/physician_gls/PDF/colon.pdf. Accessed 23 May 2011.