Overview of the management of primary colon cancer
- Miguel A Rodriguez-Bigas, MD
Miguel A Rodriguez-Bigas, MD
- Professor of Surgery
- MD Anderson Cancer Center
- Axel Grothey, MD
Axel Grothey, MD
- Mayo Clinic College of Medicine
- Section Editors
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Richard M Goldberg, MD
Richard M Goldberg, MD
- Section Editor — Gastrointestinal Cancer
- Director of the West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center
- Professor of Medicine
- Laurence S. & Jean J. DeLynn Chair of Oncology
Colorectal cancer is the third most common cancer affecting both males and females in the United States; approximately 70 percent of cases arise in the colon . Globally, colorectal cancer is the third most commonly diagnosed cancer in males and the second in females; however, the incidence varies markedly . Country-specific incidence rates are available through the World Health Organization (WHO) GLOBOCAN database.
This topic review will provide an overview of the management and prognosis of primary colon cancer. Epidemiology, risk factors, clinical presentation, and diagnosis are addressed in detail elsewhere. (See "Colorectal cancer: Epidemiology, risk factors, and protective factors" and "Clinical presentation, diagnosis, and staging of colorectal cancer".)
The diagnosis of a colon cancer is usually made by colonoscopy. (See "Clinical presentation, diagnosis, and staging of colorectal cancer".)
"Staging" a cancer provides a standard framework for describing disease extent. The stage of a colon cancer has three components, primary tumor (T), status of the regional nodes (N), and distant metastasis (M), which together are combined to form stage groupings, from I to IV. Stage groupings permit the stratification of prognosis, which is useful for the selection of treatment. The T, N, and M categories for colon cancer are assigned based upon:
●Whether there are signs of cancer spread on physical examination or radiographic imaging tests
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
- Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.
- Jessup JM, Goldberg RM, Aware EA, et al.. Colon and Rectum. In: AJCC Cancer Staging Manual, 8th, Amin MB. (Ed), AJCC, Chicago 2017. p.264.
- Stoffel EM, Mangu PB, Gruber SB, et al. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines. J Clin Oncol 2015; 33:209.
- Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Dis Colon Rectum 2014; 57:1025.
- Balmaña J, Balaguer F, Cervantes A, et al. Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 24 Suppl 6:vi73.
- Chautard J, Alves A, Zalinski S, et al. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 2008; 206:255.
- Frasson M, Braga M, Vignali A, et al. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 2008; 51:296.
- Yoh T, Yamamichi K, Oishi M, et al. [A case of effective neoadjuvant chemoradiotherapy with capecitabine for locally advanced sigmoid colon cancer]. Gan To Kagaku Ryoho 2011; 38:1021.
- Kuga Y, Tanaka T, Arita M, et al. [A case of effective chemotherapy using S-1 and CPT-11 following chemoradiotherapy with UFT and Leucovorin for unresectable advanced sigmoid colon cancer]. Gan To Kagaku Ryoho 2010; 37:531.
- Mizukami H, Yoshizawa Y, Sasaya S, et al. [A case of advanced colon cancer invading the rectum effectively treated with chemoradiation therapy before surgery]. Gan To Kagaku Ryoho 2007; 34:953.
- Cukier M, Smith AJ, Milot L, et al. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience. Eur J Surg Oncol 2012; 38:677.
- Taylor WE, Donohue JH, Gunderson LL, et al. The Mayo Clinic experience with multimodality treatment of locally advanced or recurrent colon cancer. Ann Surg Oncol 2002; 9:177.
- Foxtrot Collaborative Group . Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol 2012; 13:1152.
- Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005; 352:2696.
- André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004; 350:2343.
- André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009; 27:3109.
- Schmoll HJ, Cartwright T, Tabernero J, et al. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients. J Clin Oncol 2007; 25:102.
- Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 2014; 15:1065.
- Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009; 27:3379.
- AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th edition, Edge, SB, Byrd, DR, Compton, CC, et al (Eds) (Eds), Springer, New York 2010. p.143.
- O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004; 96:1420.
- Weiser MR, Landmann RG, Kattan MW, et al. Individualized prediction of colon cancer recurrence using a nomogram. J Clin Oncol 2008; 26:380.
- Jessup JM, Goldberg RM, Asare EA, et al.. Colon and Rectum. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), AJCC, Chicago 2017. p.251.
- Sargent D, Sobrero A, Grothey A, et al. Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 2009; 27:872.
- Chang GJ, Hu CY, Eng C, et al. Practical application of a calculator for conditional survival in colon cancer. J Clin Oncol 2009; 27:5938.
- Bouvier AM, Launoy G, Bouvier V, et al. Incidence and patterns of late recurrences in colon cancer patients. Int J Cancer 2015; 137:2133.
- Newton K, Jorgensen NM, Wallace AJ, et al. Tumour MLH1 promoter region methylation testing is an effective prescreen for Lynch Syndrome (HNPCC). J Med Genet 2014; 51:789.
- Parsons MT, Buchanan DD, Thompson B, et al. Correlation of tumour BRAF mutations and MLH1 methylation with germline mismatch repair (MMR) gene mutation status: a literature review assessing utility of tumour features for MMR variant classification. J Med Genet 2012; 49:151.
- O'Connell MJ, Campbell ME, Goldberg RM, et al. Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. J Clin Oncol 2008; 26:2336.
- THE CLINICAL STAGING EVALUATION
- Radiographic imaging
- Tumor markers
- Family history
- MANAGEMENT OF LOCALIZED DISEASE
- Surgical resection
- - Elderly patients
- - Management of carcinoma in a polyp
- - Locally advanced primary lesions
- Neoadjuvant chemoradiotherapy or chemotherapy
- Adjuvant chemotherapy
- - Side effects
- Benefit of postoperative RT
- METASTATIC DISEASE
- POSTTREATMENT SURVEILLANCE
- GENETIC ISSUES
- MANAGEMENT OF LOCALLY RECURRENT DISEASE
- INFORMATION FOR PATIENTS