II. Epidemiology

  1. Accounts for 8.5% of all new cancer cases
  2. Incidence (2014, U.S.): 137,000/year
  3. Mortality (2014, U.S.): 50,000/year
  4. Highest Incidence of Colon Cancer
    1. North America
    2. Western Europe
    3. Australia and New Zealand
    4. Japan

III. Risk Factors

IV. Management: Non-resectable hepatic metastases

  1. Radiofrequency Ablation
    1. Small trials suggest prolonged survival or cure
    2. Wong (2001) Am J Surg 182:552-7 [PubMed]

VI. Course

  1. Recurrence risk
    1. Highest risk within first 5 years post-resection

VII. Complications

  1. Colorectal Cancer recurrence (typically in first 5 years after treatment)
  2. Second primary Colorectal Cancer
  3. Gastrointestinal adverse effects
    1. Diarrhea
      1. Dietary Fiber supplementation
      2. Periodic Imodium use
    2. Abdominal Pain
    3. Fecal Incontinence
    4. Radiation Proctitis
    5. Ostomy care
  4. Fatigue
    1. Common in Colorectal Cancer survivors
    2. Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism)

VIII. Protocol: Monitoring post-resection

  1. See Cancer Survivor Care
  2. Colonoscopy
    1. Perform at one year and 3 years (if year 1 normal) post-resection
    2. Then, repeat every 5 years
  3. Intensive monitoring protocol for Stage T3/T4 or positive nodes
    1. Colonoscopy as above
    2. Clinical examination and Carcinoembryonic Antigen (CEA-125)
      1. Initially repeat every 3 months for 2 years
      2. Later repeat every 6 months for up to 5 years
      3. Focus areas
        1. Ostomy problems or Stool Incontinence
        2. Radiation Proctitis
        3. Bowel adhesions
    3. Chest, Abdomen and pelvic CT
      1. Repeat every year for 5 years

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