Colorectal Cancer

Colorectal cancer is a cancer of the large bowel and the third most common cancer in men and women, representing 13 per cent of all cancers. About 20 per cent of patients have metastatic disease (spreading beyond the large bowel) at the time of diagnosis. In 1990, the World Health Organization reported that more than 780,000 people were diagnosed with colorectal cancer worldwide, and more than 435,000 patients died that year from the disease.

Causes and Risk Factors 

The risk for colorectal cancer increases with age, with more than 90 per cent of cases occurring in patients older than 50. People with a personal history of inflammatory bowel disease such as Crohn's disease, colitis ulcerosa or intestinal polyps are also at greater risk of developing colorectal cancer. In addition, certain genetic syndromes have been identified that dramatically increase a person's risk of developing the disease.

Diagnosis and Screening

Despite its high mortality rate, colorectal cancer is treatable when detected early. Regular screening, involving faecal blood tests and examination of the large bowel (colonoscopies), are recommended to help identify pre-cancerous polyps and colorectal cancers during the early stages of disease. 

Management

A variety of treatment options are available to people who have been diagnosed with colorectal cancer. These therapies range from surgical removal of the cancerous tissue to radiation therapy and the administration of chemotherapy agents.

• Surgery
  Upon diagnosis, a primary tumour may be cured by surgery. In patients with metastatic cancer (spread beyond the large bowel), complete removal of the metastases, often involving removal of entire sections of the liver or lung is associated with prolonged survival. As many patients are diagnosed beyond this stage, however, surgery is not possible.
  

• Radiotherapy
  Radiotherapy is commonly used in the management of rectal cancer. Radiation therapy is also used as a means of reducing the size of a tumor before surgery and may be used in advanced-stage colorectal cancer in conjunction with various chemotherapy measures as a means of preventing relapse to reduce tumor-related symptoms.

• Chemotherapy
  The most common chemotherapy used for patients with metastatic colorectal cancer involves the administration of fluoropyrimidines. Recently approved in this indication, Xeloda (capecitabine) tablets, which is a real breakthrough in oncology.