Advance Colorectal Cancer: Is it a Losing Battle?

Written by Manuel Francisco T. Roxas, MD, FPCS, FPSCRS, FPSGS, FACS | 22 March 2010

Advanced colorectal cancer can either present as locally advanced or metastatic disease. Internationally, there has been much progress to improve the outcomes in these groups of patients, with over-all median 5 year survival rates hovering above 60%. In the Philippines, majority of patients present with advanced stages. Median 5 year survival is starkly lower than those reported in foreign literature, with colon cancer at 47.72% and rectal cancer much worse at 19.45%.

This lecture will focus on our efforts to improve outcomes by focusing on areas where stringent quality of care measures have been scientifically proven to decrease local recurrence and increase over-all survival. In no other cancer has this been so elucidated as in rectal cancer. Objective measures to assess quality of care include the following:

Accurate pre-treatment staging, particularly as to TNM and projected Circumferential Resection Margins (CRM);
Multidisciplinary team approach (MDT) to pre-treatment planning and management;
Neoadjuvant chemoradiotherapy when required;
Precise specimen-oriented surgery, with either
- Total Mesorectal Excision (TME) and sphincter-preservation for the majority; or
- Cylindrical abdominoperineal excision (APR) for the few patients with frank involvement of the external anal sphincters;
- Pathologic audit as to the completeness of the specimen, as well as CRM; and
- Adjuvant chemotherapy.

The UP-PGH Colorectal Polyp and Cancer Study Group was formed in 2007, and is composed of staff members from the sections of gastroenterology, medical oncology, radiation oncology, colorectal surgery, pathology, psychiatry and enterostomal nursing. One of its primary objectives is to adopt and institutionalize the multidisciplinary team approach to the management of colorectal cancer, both to improve outcomes for patients, and to instil this paradigm of cancer management in the trainees. The lecture will be presenting our preliminary data, specifically on how objective quality of care measures for rectal cancer are implemented and audited.

Comments

0 #1 Nancy Sandevi 2011-12-14 18:09

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CarpoNovum’s in-house expert competence of cancer surgery has given the company a very good understanding of what is needed to radically improve the surgical instruments and preoperative conditions in order to reduce complication rates. Following 10 years of research and product development, the company now have surgical instruments aimed to be used at cancer surgery in large intestine.

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Advance Colorectal Cancer: Is it a Losing Battle?

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