Management of colorectal cancer

Abstract

Colorectal cancer is one of the most frequent solid tumors in the Western world. Treatment options are dependent on the stage of the disease, the performance status of the patient, and increasingly the molecular makeup of the tumor. In countries with surveillance programs, the incidence rate as well as the mortality rate has gone down because of the earlier stages at which the tumors are detected. For rectal cancer, standard of care differs from that of colon cancer with regard to perioperative treatment. In the metastatic setting, treatment options are uniform for colorectal cancer. Over the years, treatment options have emerged from single-agent 5-fluorouracil (5-FU) treatment to combination regimens using 5-FU and oxaliplatin or irinotecan or both. Treatment efficacy in the metastatic setting has been increased with the introduction of targeted substances. These include (a) the anti-vascular endothelial growth factor-A (anti-VEGF-A) antibody bevacizumab, (b) the anti-epidermal growth factor receptor (anti-EGFR) antibodies cetuximab and panitumumab, (c) the anti-angiogenic multi-kinase inhibitor regorafenib, and (d) the anti-angiogenic compound aflibercept. Anti-EGFR antibodies have shown efficacy only in the subpopulations of tumors that do not have any mutation in KRAS and NRAS exon 2, 3, 4. Physicians have the choice in the first line to use anti-EGFR or anti-VEGF inhibitors in combination with chemotherapy based on treatment goals and patient performance. In recent years, tumor location has been shown to be prognostic and predictive for clinical outcome. Right-sided sporadic colon cancers differ significantly in molecular characteristics and, with the exception of microsatellite instability (MSI-H) tumors, are associated with poor prognosis. Tumors based on hereditary non-polyposis colorectal cancer, on the other hand, have excellent prognosis in stage II and III disease. Recent efforts have focused on the molecular classification of colorectal cancer with the purpose of establishing molecularly defined subgroups.

Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival

“…[6] Stage IV disease treated with chemotherapy alone has a median overall survival of 12 months. [7] Various treatment algorithms have been incorporated into international guidelines, but common to most is that, when possible, surgical resection of the primary lesion and its metastases offers the best survival benefit for patients. [8] So far, a specific treatment algorithm tailored to SA patients has not been published.…”

Cancer, Benign Gynecology, and Sexual Function—Issues and Answers

“…Transanal excision is applied for low-risk cancer. 151,152 An epochal advance in the surgical technique for CRC is total mesorectal excision. This procedure allows preservation of pelvic autonomic nerves located just outside the mesorectal fascia.…”

EGFR and β1-integrin targeting differentially affect colorectal carcinoma cell radiosensitivity and invasion

“…Colorectal cancer (CRC) is one of the most frequent solid tumors treated with multimodal treatment regimens leading to 5-year overall survival rates of over 60% [1]. Challenging remains the metastatic clinical setting [2].…”

“…The serine/threonine protein kinase BRAF is located downstream of RAS as part of the same pathway. Contrary to KRAS, small molecular inhibitors are available for BRAF, which failed to provide survival benefit for CRC patients [1].…”

“…The serine/threonine protein kinase BRAF is located downstream of RAS as part of the same pathway. Contrary to KRAS, small molecular inhibitors are available for BRAF, which failed to provide survival benefit for CRC patients [1].Mutually and cooperatively interacting with EGFR are integrins [7,8]. Of the 24 integrin receptors, the b1 integrin subunit is most widely distributed [9].…”