PROGNOSIS

Prognosis depends on stage

• If patient has stage I (T1-2N0) colon cancer 5 year survival is 93 percent [59]
• If patient has stage IIA (T3N0) or stage IIB (T4N0), 5 yr survival is 85 percent and 72 percent respectively [59]
• If patient has stage IIIA (T1-2 N1), IIIB (T3-4 N1) or IIIC (N2), 5 yr survival is 83, 64 and 44 percent respectively [59]
• If patient has stage IV ca colon, 5 yr survival is 8% [59]
• If patient has ca rectum and is in stage IIIA (T1-2, N1), IIIB (T3-4, N1) or IIIC, 5 yr survival is 55.1, 35.3 and 24.5 percent respectively [60]


COUNCELLING


The things you can do to lower your risk include the following:
• Quit smoking. Smoking cigarettes has been clearly linked with higher risk of colon cancer (as well as many other conditions).
• Take an aspirin every day. Because of potential side effects, this is not recommended for everyone. Talk to your health care provider first.
• Take a safe dose of folic acid (for example, 1 mg) every day.
• Engage in physical activity every day.
• Eat a variety of fruits and vegetables every day.
• Avoid red meats and saturated fats
• Increase fiber in your diet
• People who have one first-degree relative (parent, brother, sister, or child) who has experienced colorectal cancer or adenomatous polyps at a young age (before the age of 60 years), or two first-degree relatives diagnosed at any age, should begin screening earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first, and screening should be repeated every 5 years
• People who have one first-degree relative (parent, brother, sister, or child) who has experienced colorectal cancer or adenomatous polyps at age 60 or later should begin screening at age 40, and screening should be repeated as for average risk people. People with a second-degree relative (grandparent, aunt, or uncle) or third-degree relative (great-grandparent or cousin) with colorectal cancer may be screened as average risk people.
• Every patient after 40 years of age should undergo screening for colon cancer


REFRENCES
1. Jemal, A, Siegel, R, Ward, E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56:106.
2. Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW 3rd, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M. Practice parameters for colon cancer. Dis Colon Rectum 2004 Aug;47(8):1269-84.
3. Weir, HK, Thun, MJ, Hankey, BF, et al. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 2003; 95:1276.
4. Seminars in surgical oncology. Colo Rectum. 1998.
5. Troisi, RJ, Freedman, AN, Devesa, SS. Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite, and stage, 19751994. Cancer 1999;85:1670.
6. Eddy, DM. Screening for colorectal cancer. Ann Intern Med 1990; 113:373.
7. Wei, EK, Giovannucci, E, Wu, K, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004; 108:433.
8. Lynch, HT, Smyrk, TC, Watson, P, et al. Genetics, natural history, tumor spectrum, and pathology of hereditary nonpolyposis colorectal cancer: An updated review. Gastroenterology 1993; 104:1535.
9. Atkin, WS, Morson, BC, Cuzick, J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326:658.
10. Ekbom, A, Helmick, C, Zack, M, et al. Ulcerative colitis and colorectal cancer: A population-based study. N Engl J Med 1990; 323:1228.
11. Jee, SH, Ohrr, H, Sull, JW, et al. Fasting serum glucose level and cancer risk in Korean men and women. JAMA 2005; 293:194.
12. Thun, MJ, Peto, R, Lopez, AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997; 337:1705
13. Colangelo, LA, Gapstur, SM, Gann, PH, Dyer, AR. Cigarette smoking and colorectal carcinoma mortality in a cohort with long-term follow-up. Cancer 2004; 100:288.
14. Sandler, RS, Sandler, DP. Radiation-induced cancers of the colon and rectum: Assessing the risk. Gastroenterology 1983; 84:51.
15. Delhougne, B, Deneux, C, Abs, R, et al. The prevalence of colonic polyps in acromegaly: A colonoscopic and pathological study in 103 patients. J Clin Endocrinol Metab 1995; 80:3223.
16. Chao, A, Thun, MJ, Connell, CJ, et al. Meat consumption and risk of colorectal cancer. JAMA 2005; 293:172.
17. Sandhu, MS, White, IR, McPherson, K. Systematic review of the prospective cohort studies on meat consumption and colorectal cancer risk: a meta-analytical approach. Cancer Epidemiol Biomarkers Prev 2001; 10:439.
18. Bini, EJ, Park, J, Francois, F. Use of flexible sigmoidoscopy to screen for colorectal cancer in HIV-infected patients 50 years of age and older. Arch Intern Med 2006; 166:1626.
19. Giovannucci, E, Colditz, GA, Stampfer, MJ. A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 1993; 105:130.
20. Reid, FD, Mercer, PM, Harrison, M, Bates, T. Cholecystectomy as a risk factor for colorectal cancer: A meta-analysis. Scand J Gastroenterol 1996; 31:160.
21. Stewart, M, Macrae, FA, Williams, CB. Neoplasia and ureterosigmoidostomy: A colonoscopy survey. Br J Surg 1982; 69:414.
22. Weitz J et al; Colorectal cancer. Lancet 2005 Jan; 365(9454):153-65.
23. NICE Clinical Guidelines; Colorectal (CSG) June 2004.
24. Panwalker, AP. Unusual infections associated with colorectal cancer. Rev Infect Dis 1988; 10:347.
25. Speights, VO, Johnson, MW, Stoltenberg, PH, et al. Colorectal cancer: Current trends in initial clinical manifestations. South Med J 1991; 84:575.
26. Langevin, JM, Nivatvongs, S. The true incidence of synchronous cancer of the large bowel: A prospective study. Am J Surg 1984; 147:330.
27. Passman, MA, Pommier, RF, Vetto, JT. Synchronous colon primaries have the same prognosis as solitary colon cancers. Dis Colon Rectum 1996; 39:329.
28. Fante, R, Roncucci, L, Di Gregorio, C, et al. Frequency and clinical features of multiple tumors of the large bowel in the general population and in patients with hereditary colorectal carcinoma. Cancer 1996; 77:2013.
29. Association of Coloproctology of Great Britain and Ireland. Referral guidelines for bowel cancer. London (UK): Association of Coloproctology of Great Britain and Ireland; 2002 Apr 25.
30. Collett JA, et al; Distal colonic neoplasms predict proximal neoplasia in average-risk, asymptomatic subjects. J Gastroenterol Hepatol 1999;14(1):67-71
31. Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, Orsay C, Church J, Otchy D, Cohen J, Place R, Denstman F, Rakinic J, Moore R, Whiteford M. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 2005 Mar;48(3):411-23
32. Institute for Clinical Systems Improvement (ICSI). Colorectal cancer screening. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jun. 50 p.
33. Atkin, WS, Morson, BC, Cuzick, J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326:658.
34. Whiteford, MH, Whiteford, HM, Yee, LF, et al. Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum 2000; 43:759.
35. Nelson H et al: A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050
36. Mandel, JS, Bond, JH, Church, TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328:1365.
37. Eddy, DM. Screening for colorectal cancer. Ann Intern Med 1990; 113:373.
38. Softley, A, Clamp, SE, Watkinson, G, et al. The natural history of inflammatory bowel disease: Has there been a change in the last 20 years? Scand J Gastroenterol Suppl 1988; 144:20.
39. American Gastroenterological Association. Giardiello, FM, Brensinger, JD, Petersen, GM. Gastroenterology 2001; 121:195.
40. Laken, SJ, Petersen, GJ, Gruber, SB, et al. Familial colorectal cancer in Ashkenazim due to a hypermutable tract in APC. Nat Genet 1997; 17:79.
41. Hughes, LJ, Michels, VV. Risk of hepatoblastoma in familial adenomatous polyposis. Am J Med Genet 1992; 43:1023.
42. Hamilton, SR, Bussey, HJ, Mendelsohn, G, et al. Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner's syndrome. Gastroenterology 1979; 77:1252.
43. Sieber, OM, Lipton, L, Crabtree, M, et al. Multiple colorectal adenomas, classic adenomatous polyposis, and germ-line mutations in MYH. N Engl J Med 2003; 348:791.
44. Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005 Nov 20;23(33):8512-9.
45. Vasen, HF, Watson, P, Mecklin, JP, et al. Gastroenterology 1999; 116:1453.
46. Brown, GJ, St John, DJ, Macrae, FA, Aittomaki, K. Cancer Risk in Young Women at Risk of Hereditary Nonpolyposis Colorectal Cancer: Implications for Gynecologic Surveillance. Gynecol Oncol 2001; 80:346.
47. Schulmann, K, Brasch, FE, Kunstmann, E, et al. HNPCC-associated small bowel cancer: clinical and molecular characteristics. Gastroenterology 2005; 128:590.
48. Colorectal Cancer Screening. NCCN Practice Guidelines in Oncology – v.1.2007
49. Bingham, SA, Day, NE, Luben, R, Ferrari, P. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet 2003; 361:1496.
50. Kim, YI, Mason, JB. Nutritional chemoprevention of gastrointestinal cancers: A critical review. Nutr Rev 1996; 54:259.
51. Giovannucci, E. Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 2002; 31:925.
52. Chlebowski, RT, Wactawski-Wende, J, Ritenbaugh, C, et al. Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med 2004; 350:991.
53. Giovannucci, E, Egan, KM, Hunter, DJ, et al. Aspirin and the risk of colorectal cancer in women. N Engl J Med 1995; 333:609.
54. Poynter, JN, Gruber, SB, Higgins, PD, et al. Statins and the risk of colorectal cancer. N Engl J Med 2005; 352:2184.
55. Barber FD, Mavligit G, Kurzrock R: Hepatic arterial infusion chemotherapy for metastatic colorectal cancer: a concise overview. Cancer Treat Rev 2004 Aug; 30(5): 425-36
56. Colon Cancer.NCCN. Practice guidelines in oncology. V.1.2007
57. Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005 Nov 20;23(33):8512-9
58. Gastrointestinal Cancer Disease Site Group. Figueredo A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R, Zuraw L, Zwaal C. Follow-up of patients with curatively resected colorectal cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jan
59. O'Connell, JB, Maggard, MA, Ko, CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004; 96:1420.
60. Greene, FL, Stewart, AK, Norton, HJ. New tumor-node-metastasis staging strategy for node-positive (stage III) rectal cancer: an analysis. J Clin Oncol 2004; 22:1778.
61. Kashif Ashraf, Omer Ashraf, Zeeshan Haider, Zafar Rafique. Colorectal carcinoma, preoperative evaluation by spiral computed tomography. J PMA Vol:56, No. 4, April 2006
62. High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study.Dis Colon Rectum. 2001; 44(2):231-5