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
- Clinical assessment every 6 months for 3 years, then annually
