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Colon Cancer or Colorectal Cancer (CRC) is a common and potentially lethal disease. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, with 1.65 million new cases and almost 835,000 deaths in 2015. As per GLOBOCON (2012) data, the incidence of CRC in India is very low (Age Standardise rate per 1,00,000,6.09) as compared to Australia (38), New Zealand (37), Europe (30), North America (25), Canada (31) and other countries of Southeast Asia. However, with an increase in urbanization, there is a steady increase in the incidence of CRC in India.
Risk factors can be broadly divided into genetic and environmental reasons. Genetic syndromes include familial adenomatous polyposis (FAP), Hereditary Nonpolyposis Colon Cancer (HNPCC) or Lynch syndrome, Turcot, Gardner, and MyH-associated polyposis. Environmental factors include consumption of alcohol, fresh red meat, processed meat, obesity, smoking, ulcerative colitis, old age, male gender, and diabetes mellitus with insulin resistance.
Patients with symptoms such as;
A multi-disciplinary team (MDT) approach is necessary for the effective treatment of CRC. MDT consists of CRC Surgeon, Gastroenterologist, Medical Oncologist, Radiation specialist, Pathologist, Radiologist & nurse.
Broadly options include the following
Early or Operable Disease - Primary surgery with or without adjuvant chemotherapy or radiotherapy (for rectal cancer).
Locally Advanced Disease - Primary surgery unlikely: Consider preoperative chemotherapy/radiotherapy
Isolated Metastatic Disease - Consider resection of primary disease followed by metastasectomy with or without neoadjuvant and/or adjuvant chemotherapy
Widespread Metastatic Disease - Palliative chemotherapy, supportive care
Surgery forms the mainstay in the curative treatment of colorectal cancer. Principles of surgery for the primary tumor are as follows;
Commonly used chemotherapy 5-Fluorouracil with Oxaliplatin (FOLFOX) or Capecitabine with Oxaliplatin (CapeOx) as adjuvant treatment for stage III, IV, and selected stage II CRC. Patients with stage II and above rectal cancer require preoperative or postoperative CTRT (combination chemoradiotherapy).
Amongst all digestive cancers, this cancer carries the best prognosis largely due to the multidisciplinary treatment options that have dramatically improved over the last decade. Overall, 5-year survival rate of CRC for Stage I is 88-92%, Stage II is 60-85%, Stage III is 50-80%, and Stage IV is 12-13%.