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Colorectal Cancer – Current Status

Colorectal Cancer – Current Status. Professor Paul Horgan Head of Academic Surgery University of Glasgow. Magnitude of the Problem. Second most common cause of cancer death 900,000 new cases worldwide in 2007 20-fold difference Western countries and India 52,180 deaths in the US in 2007.

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Colorectal Cancer – Current Status

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  1. Colorectal Cancer – Current Status Professor Paul Horgan Head of Academic Surgery University of Glasgow

  2. Magnitude of the Problem • Second most common cause of cancer death • 900,000 new cases worldwide in 2007 • 20-fold difference Western countries and India • 52,180 deaths in the US in 2007

  3. Surgery • Best for cure • Optimised/standardised technique and care • Aggressive treatment of stage 4 disease • Adjuvant chemotherapy for stage 3 disease • Personalisation of chemotherapy

  4. Node-negative Disease • Treated with surgery alone • >75% 5 yr survival Stage 2 • >90% Stage 1 • 25-33% recurrent or metastatic disease • How do we improve these poor results?

  5. Adjuvant Chemotherapy • Direct evidence of benefit Stage 3 • 10% increased survival • No direct evidence for stage 2 • 2 – 3%

  6. Negatives • 6-8 months chemotherapy – QUALY • Cost • Mortality 1-4% • Aborted treatment • Morbidity

  7. Sub-populations • Poor prognosis • Perforation, T4, Obstruction, Poor differentiation, Lympho-vascular invasion, margin involvement. • Low lymph node harvest • K-Ras • MSI – H and 5FU resistance • Does this imply use of adjuvant chemo?

  8. Opportunities • Screening and stage • Primary prevention – block, retard or abort • Secondary prevention – risk assessment, screening and early detection • Tertiary prevention – reduce recurrence

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