Survival and Follow-up of Colorectal Cancer
Despite the undoubted advances in early diagnosis, screening procedures and surgical treatment, the prognosis of colorectal cancer has not shown over the last 3–4 decades the remarkable improvements that could be expected [1]. Moreover, rather unexpectedl
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Introduction
Despite the undoubted advances in early diagnosis, screening procedures and surgical treatment, the prognosis of colorectal cancer has not shown over the last 3 - 4 decades the remarkable improvements that could be expected [1]. Moreover, rather unexpectedly, impressive intercountry differences in survival have recently been reported [2] - even within Europe - which are difficult to explain and interpret when taking into account the well standardized therapeutic approaches [3]. These findings, however, should not obscure the fact that colorectal neoplasms remain the most treatable and probably the most preventable tumor of the digestive organs [4]. Several clinical, biological, histological and subsequently molecular variables have been investigated in survival studies, with the objective of identifying useful indicators of the clinical outcome. Although many of these have been shown to be related to prognosis, the results have often been intriguing and conflicting. Thus, nearly 60 years after its original publication [5], Dukes' staging - together with more recent staging procedures [6] - continues to represent the most reliable prognostic indicator in colonic and rectal cancer. Indeed, in terms of prognosis, no other neoplasms appear so closely related to pathological stage at diagnosis as tumors of the large bowel. After apparently curative resection for colorectal cancer, both the patient and physician are faced with the problem of follow-up. In most instances, surgeons tend to review their patients at regular intervals. However, recent studies cast some doubts on the real value of follow-up and showed a frequent lack of consensus among surgeons about the type and intensity of follow-up [7,8], with a consequent tendency among clinicians to devise their own surveillance protocols. The cost of follow-up and the risk of excessive "medicalization" [9] of patients render these aspects even more relevant and underscore the need of developing appropriate guidelines for the increasing number of patients who undergo bowel resection for cancer.
M. Ponz de Leon, Colorectal Cancer © Springer-Verlag Berlin Heidelberg 2002
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Survival and Follow-up of Colorectal Cancer
Factors Influencing Colorectal Cancer Survival Gender, Age and Stage at Diagnosis
The overall 5-year cancer-specific survival for colorectal neoplasms is of the order of 50 % [10]; since late mortality is unusual for this type of tumor, at present half of these patients are cured from their disease, at least in Western countries [2]. The situation is not so bright in Eastern Europe and in many Asian and African countries [2,11], where survival rates of 30% or less have been reported, mainly as a consequence of late diagnosis. In most investigations, no appreciable differences in survival by gender have been reported [2, 12]. In contrast, conflicting results have been found as far as site of the tumor and age of the patient at diagnosis are concerned. Various studies showed a worse prognosis for rectal malignancies [13,14]' sometimes with a
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