Colorectal cancer

From IDWiki

Screening

  • Average-risk men and women ages 50 to 70
    • FIT q2y or flex. sig. q10y
  • High-risk, with 1 or more first-degree relative under 60 years
    • Start at age 40 or 10 years before the age of onset of the index case
    • Colonoscopy

Risk Factors

  • Age
  • Family history
  • Prior polyps: tubular, tubulovillous, and villous
  • History of IBD

Staging

  • Stage 0: carcinoma in situ, no invasion
  • Stage I: invasion into, but not through, muscularis
  • Stage II: invasion through muscularis, but no lymph nodes
  • Stage III: lymph node involvement, but no distant metastases
  • Stage IV: distant metastases

Management

By Stage

Stage 0 to II

  • Treated with primary surgical resection alone
  • Rarely given adjuvant chemotherapy for stage II

Stage III

  • Surgical resection with adjuvant chemotherapy

Stage IV

  • Chemotherapy alone, except in the case of solitary liver metastases
  • For solitary liver metastases, surgical resection with adjuvant chemotherapy can be curative

Chemotherapy

  • FOLFOX or FLOX or XELOX
  • Capecitabine
  • 5-fluorouracil (5-FU) + leucovorin (LV)

Post-treatment Surveillance

  • Stage I: colonoscopy after 1 year; further screening depends on the findings
  • Stage II-III:
    • Clinical assessment every 6 months for 3 years, then annually
      • CEA at each visit for the first 3 years
    • CT chest-abdo-pelvis annually for 3 years
    • Colonoscopy post-operatively, then at 1 year, then every 3-5 years based on findings