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KMID : 0988920070050020122
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Intestinal Research
2007 Volume.5 No. 2 p.122 ~ p.130
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Multimodality Treatment of Colorectal Cancer
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Park Seun-Ja
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Abstract
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Polyps that contain carcinomatous changes that are confined to the mucosa (carcinoma-in-situ or severe dysplasia) do not have metastatic potential and are adequately treated with complete polypectomy or endoscopic mucosal resection. If deep invasion into the stalk has occurred or if adverse features (such as lymphatic invasion, or positive margins) are present, then en bloc colectomy is indicated. For lesions in the mid to upper rectum, a low anterior resection is the treatment of choice. To decrease the risk of local recurrence, patients should undergo optimal pelvic dissection with sharp mesorectal excision. Patients with pathologic lymph node-negative T3 or T4 lesions or any lymph node-positive cancer should receive preoperative or postoperative combined modality therapy. A major goal of preoperative therapy is to decrease the volume of the primary tumor and thus enhance sphincter preservation. For resectable colon cancer, the surgical procedure of choice is colectomy with en bloc removal of the regional lymph nodes. Laparoscopic colectomy has been advanced as an approach to the surgical management of colon cancer. Recently, the outcomes of cancer from a randomized trial comparing laparoscopically assisted and open surgery for curable colon cancer was reported. After a median of 4.4 years follow-up, similar cancer recurrence rates were observed in the two groups. The current management of disseminated metastatic colon cancer uses various active drugs, both in combination and as single agents: 5-FU/leucovorin, irinotecan, oxaliplatin, capecitabine, bevacizumab, and cetuximab. The choice of therapy is based on consideration of the type and timing of the prior therapy that has been administered and the differing toxicity profiles of the constituent drugs. As primary therapy for metastatic disease in a patient with good tolerance to intensive therapy, combination therapy consisting of fluoropyrimidines: FOLFOX (oxaliplatin, infusional fluorouracil, and leucovorin) or FOLFIRI (irinotecan, infusional fluorouracil, and leucovorin), with or without bevacizumab; bolus 5-FU/leucovorin/irinotecan with bevacizumab; 5-FU/leucovorin with bevacizumab were recommened.
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KEYWORD
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Colonic Neoplasms, Endoscopic Mucosal Resection, Laparoscopy, Radiotherapy, Drug Therapy
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