Advertisement

Colon and Rectum Carcinoma Surveillance Counterpoint: Canada

  • Marko SimunovicEmail author
Chapter
Part of the Current Clinical Oncology book series (CCO)

Abstract

In Canada, approximately 20,000 people are diagnosed annually with colon or rectal cancer, and cancer in these two related sites is the second leading cause of cancer deaths [1]. A similar pattern is present in other jurisdictions around the world [2, 3]. Surgical removal of the appropriate bowel segment and attached lymphatic basin is the cornerstone of curative therapy. Unfortunately, many patients do not undergo such resections due to the presence of advanced unresectable disease or underlying patient comorbidities. Population-based data from Ontario, Canada (population 13 million) show that 18 % and 24 % of patients with colon and rectal cancer, respectively, do not undergo a resection of their tumor [4]. Other data, also from Ontario, suggest that 10 % of patients undergoing resection of their primary colon or rectal tumor have stage IV or metastatic disease [5] (see Table 36.1). Rarely is stage IV disease curable. Patients who present with metastatic disease do not enter surveillance regimens, but may enter testing regimens that monitor response to therapy. One may estimate then that, in Ontario and likely in many other large populations, approximately 70 % of patients with colon or rectal cancer undergo resective surgery for cure. This chapter addresses surveillance for these patients.

Keywords

Cancer Care Ontario Computed tomography Carcinoembryonic antigen Magnetic resonance imaging Position emissions tomography Program in Evidence Based Care 

References

  1. 1.
    Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2008, Toronto, Canada, 2008. ISSN 0835-2976. http://www.cancer.ca/canada-wide/about%20cancer/cancer%20statistics/∼/media/CCS/Canada%20wide/Files%20List/English%20files%20heading/pdf%20not%20in%20publications%20section/Canadian%20Cancer%20Society%20Statistics%20PDF%202008_614137951.ashx (Accessed November 19, 2009).
  2. 2.
    Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol. 2005;16:481–8. http://coloncancer.about.com/gi/dynamic/offsite.htm?zi  =  1/XJ&sdn  =  coloncancer&cdn  =  health&tm  =  12&gps  =  86_189_931_562&f  =  10&su  =  p284.9.336.ip_p736.8.336.ip_&tt  =  2&bt  =  0&bts  =  0&zu  =  http%3A//dx.doi.org/ 10.1093/annonc/mdi098.PubMedCrossRefGoogle Scholar
  3. 3.
    Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, et al., editors. SEER cancer statistics review, 1975–2006. Bethesda, MD: National Cancer Institute; 200. http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site.Google Scholar
  4. 4.
    Nenshi R, Baxter N, Kennedy E, Schultz SE, Gunraj N, Wilton AS, et al. Cancer surgery in Ontario: surgery for colorectal cancer; ICES atlas. Toronto: Institute for Clinical Evaluative Sciences; 2008. Chapter 4, p. 53–96.Google Scholar
  5. 5.
    Simunovic M, Coates A, Goldsmith C, Thabane L, Reeson D, Smith A, et al. The cluster-randomized Quality Initiative in Rectal Cancer (QIRC) trial: evaluating a quality improvement strategy in surgery. CMAJ. 2010;182(12):1301–1306 [ISRCTN 78363167].PubMedCrossRefGoogle Scholar
  6. 6.
    Enblad P, Adami HO, Glimelius B, Krusemo U, Påhlman L. The risk of subsequent primary malignant diseases after cancers of the colon and rectum. A nationwide cohort study. Cancer. 1990;65:2091–100.PubMedCrossRefGoogle Scholar
  7. 7.
    Bülow S, Svendsen LB, Mellemgaard A. Metachronous colorectal carcinoma. Br J Surg. 1990;77:502–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Winawer S, Zauber A, Ho M, O’Brien M, Gottlieb L, Sternberg S, et al. The National Polyp Study Workgroup. Prevention of colorectal cancer by colonscopic polypectomy. N Engl J Med. 1993;329:1977–81.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Connell MJ, Campbell ME, Goldberg RM, Grothey A, Seitz JF, Benedetti JK, et al. Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. J Clin Oncol. 2008;26:2336–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Heriot AG, Tekkis PP, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis. 2006;8:733–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Moriya Y. Treatment strategy for locally recurrent rectal cancer. Jpn J Clin Oncol. 2006;36:127–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Gastrointestinal Cancer Disease Site Group. Figueredo A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R, Zuraw L, Zwaal C. Follow-up of patients with curatively resected colorectal cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 [online update]. 30 p. (Practice guideline report; no. 2–9).Google Scholar
  13. 13.
    Shah SA, Bromberg R, Coates A, Rempel R, Simunovic M, Gallinger S. Survival after liver resection for metastatic colorectal carcinoma in a large population. J Am Coll Surg. 2007;205:676–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer. 2007;109:718–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Takagawa R, Fujii S, Ohta M, et al. Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol. 2008;15:3433–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest. 2005;23:338–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med. 2008;359:1218–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Simunovic M, Stewart L, Zwaal C, Johnston M. Diagnostic Imaging Guidelines Panel. Cross-sectional imaging in colorectal cancer: recommendations report. Toronto, ON: Cancer Care Ontario (CCO); 2006. p.20.Google Scholar
  19. 19.
    Lennon T, Houghton J, Northover J. What is the value of clinical follow-up for colorectal cancer patients? The experience of the CRC/NIH CEA second-look trial. In the proceedings of the Nottingham International Colorectal Cancer Symposium, Nottingham; 1995.Google Scholar
  20. 20.
    Ohlsson B, Breland U, Ekberg H, Graffner H, Tranberg KG. Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum. 1995;38:619–26.PubMedCrossRefGoogle Scholar
  21. 21.
    Mäkelä JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg. 1995;130:1062–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology. 1998;114:7–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg. 1997;84:666–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum. 1998;41:1127–33.PubMedCrossRefGoogle Scholar
  25. 25.
    Secco GB, Fardelli R, Gianquinto D, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol. 2002;28:418–23.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosen M, Chan L, Beart Jr RW, Vucasin P, Anthone G. Follow-up of colorectal cancer. A meta-analysis. Dis Colon Rectum. 1998;41:1116–26.PubMedCrossRefGoogle Scholar
  27. 27.
    Bruinvels DJ, Stiggelbout AM, Kievit J, van Houwelingen HC, Habbema DF, van de Velde CJ. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg. 1994;219:174–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Blomqvist L, Holm T, Göranson H, Jacobsson H, Ohlsén H, Larsson SA. MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence or rectal carcinoma. Acta Radiol. 1996;37:779–84.PubMedCrossRefGoogle Scholar
  29. 29.
    Simunovic M, Rempel E, Thériault ME, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg. 2006;49:251–8.PubMedGoogle Scholar
  30. 30.
    Desch CE, Benson 3rd AB, Somerfield MR, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;20(23):8512–9.CrossRefGoogle Scholar
  31. 31.
    Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer. CA Cancer J Clin. 2006;56:160–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Anthony T, Simmang C, Hyman N, et al. American Society of Colon and Rectal Surgeons Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum. 2004;47:807–17.PubMedCrossRefGoogle Scholar
  33. 33.
    Association of Coloproctology of Great Britain and Ireland. Guidelines for the management of colorectal cancer. London, UK: Association of Coloproctology of Great Britain and Ireland; 2007. 117 p.Google Scholar
  34. 34.
    Scottish Intercollegiate Guidelines Network (SIGN). Management of colorectal cancer. A national clinical guideline. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network (SIGN); 2003. 47 p. (SIGN publication; No. 67).Google Scholar
  35. 35.
    New Zealand Guidelines Group (NZGG). Surveillance and management of groups at increased risk of colorectal cancer. Wellington, NZ: New Zealand Guidelines Group (NZGG); 2004. 84 p.Google Scholar

Copyright information

© Humana Press 2013

Authors and Affiliations

  1. 1.Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Surgical OncologistJuravinski Cancer Centre, Hamilton Health SciencesHamiltonCanada

Personalised recommendations