© Borgis - New Medicine 4/2005, s. 57-59
Eryk Chrapowicki, Grzegorz Krasowski
Follow-up of patients with curatively resected colorectal cancer – a literature review
General Surgery Department Wolski Hospital Warsaw, Poland
Head of Department: Marek Kruk, MD, PhD
Follow-up of patients with curatively resected colorectal cancer is an integral part of the total long-term treatment of this group of patients. In this review current recommendations of oncologists and surgeons concerning postoperative management and controversial opinions of specialists interested in the therapy of patients with colorectal cancer published in the literature are described.
Colorectal cancer is one of the most frequent cancers in Poland, but it is often discovered relatively late. During the past 60 years colon cancer incidence in Poland has increased threefold. According to the latest figures of the Oncology Institute in Warsaw, it takes the third position among neoplasm-connected mortality causes both in males and in females. Approximately 11 thousand new cases are diagnosed in Poland annually (in EU countries approx. 220 thousand.). The morbidity increases with age (above 50 years old). The number of deaths due to this disease reaches 8 thousand in Poland (in the EU approx. 112 thousand) . Recurrence of the disease is estimated to occur in 40% of operated patients. This index reveals the low efficacy of treatment, especially as the number of operated subjects surviving more than 5 years is 25% maximum . The problem of proper monitoring after colorectal cancer resection has been widely discussed in recent years. Firstly, properly performed post-operative monitoring allows a recurrence of the disease to be discovered and treated early enough or the chemotherapy treatment to be changed. It also enables patients in advanced stages of the disease to be selected and palliative care to be started. What is also important, such postoperative monitoring allows metachronous cancer foci to be discovered and any residual or new polyps in the colon to be observed. It also plays an important role in discovering other types of cancer, which has been proved to occur more frequently in patients with colon cancer. However, the high costs connected with carrying out many specialist procedures and the limited usefulness of some of them are obvious. Consequently, the determination of standards based on EBM rules that might be used in daily clinical practice has become essential.
The aim of this work is to describe current ASCO (American Society of Clinical Oncology) and ESMO (European Society for Medical Oncology) recommendations with modifications and opinions published in the literature of experts and clinicians interested in the subject.
Material and method
Cochrane, Medline and Medscape 2000-2005 data were searched using such terms as colon cancer, follow-up, monitoring, clinical recommendation; and metaanalysis and prospective clinical trials were chosen.
Results and discussion
According to the ASCO expert panel recommendations, the ideal test should be:
1) sensitive enough to detect a neoplasmatic change that could be treated radically,
2) reliable and credible,
4) easy to perform.
The basic question is still the frequency and intensiveness of the recommended examinations.
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