Colorectal cancer

David Cunningham, Wendy Atkin, Heinz Josef Lenz, Henry T. Lynch, Bruce Minsky, Bernard Nordlinger, Naureen Starling

Research output: Contribution to journalReview article

1063 Scopus citations

Abstract

Substantial progress has been made in colorectal cancer in the past decade. Screening, used to identify individuals at an early stage, has improved outcome. There is greater understanding of the genetic basis of inherited colorectal cancer and identification of patients at risk. Optimisation of surgery for patients with localised disease has had a major effect on survival at 5 years and 10 years. For rectal cancer, identification of patients at greatest risk of local failure is important in the selection of patients for preoperative chemoradiation, a strategy proven to improve outcomes in these patients. Stringent postoperative follow-up helps the early identification of potentially radically treatable oligometastatic disease and improves long-term survival. Treatment with adjuvant fluoropyrimidine for colon and rectal cancers further improves survival, more so in stage III than in stage II disease, and oxaliplatin-based combination chemotherapy is now routinely used for stage III disease, although efficacy must be carefully balanced against toxicity. In stage II disease, molecular markers such as microsatellite instability might help select patients for treatment. The integration of targeted treatments with conventional cytotoxic drugs has expanded the treatment of metastatic disease resulting in incremental survival gains. However, biomarker development is essential to aid selection of patients likely to respond to therapy, thereby rationalising treatments and improving outcomes.

Original languageEnglish
Pages (from-to)1030-1047
Number of pages18
JournalThe Lancet
Volume375
Issue number9719
DOIs
StatePublished - 2010

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All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Cunningham, D., Atkin, W., Lenz, H. J., Lynch, H. T., Minsky, B., Nordlinger, B., & Starling, N. (2010). Colorectal cancer. The Lancet, 375(9719), 1030-1047. https://doi.org/10.1016/S0140-6736(10)60353-4