Although the year 2008 is young, many exciting developments have already taken place that will continue to improve the detection and treatment of colorectal cancer.
A broad spectrum of health care organizations, including the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE) and the American Cancer Society (ACS) recently updated their screening guidelines for colorectal cancer. Colonoscopy every 10 years for average risk adults age 50 and over is still the gold standard for the detection and treatment of colorectal polyps and cancer. Flexible sigmoidoscopy and barium enemas every 5 years are still on the list, and virtual colonoscopy was added as well. In addition, newer tests for the detection of cancer were added as well. Stool DNA testing and immunologic stool blood testing were added to the standard guaic based tests as well.
More results are being added to the data supplied by the North American multi center trial comparing laparoscopic versus open colectomy for cancer cure was published in the New England Journal of Medicine (COST Trial). There are no differences in cancer survival or recurrence among minimally invasive or open groups, proving that laparoscopic surgery is as safe as open surgery for cancer. The laparoscopy patients have an earlier return of GI function, shorter hospital stay and lower analgesic use as compared to the open patients. In the hands of surgeons trained in laparoscopic colectomy for cancer, it is the procedure of choice for colon cancers. Studies are underway which will continue to evaluate the efficacy of the laparoscopic approach for rectal cancers over the next few years.
Eloxatin, a third generation platinum based chemotherapeutic agent for the treatment of metastatic colorectal cancer is now in its third year. Data from the National Cancer Institute sponsored inter-group study led by the North Central Cancer Treatment Group showed that the use of Eloxatin in combination with 5-FU/Leucovorin increased patient survival by five months when compared with conventional treatment.
Two newer types of chemotherapeutic agents, monoclonal antibodies to tumor growth factors, are also now widely used. Avastin, an antibody to vascular endothelial growth factor (VEGF) helps block angiogenesis. Erbitux, better known for the trial involving Martha Stewart, has also shown the ability to inhibit tumor progression by blocking epidermal growth factor receptor (EGFR). Avastin was shown to improve survival by five months when used in combination with irinotecan, 5-fluorouracil (5FU) and leucovorin. Erbitux was given in combination with irinotecan or as monotherapy, with the combination protocol showing an improved duration of tumor response.
