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Colorectal cancer (CRC) incidence rates in the UK are among the highest in the world.
The recognition that inherited genetic factors play an important role in disease causation now provides us with the opportunity to identify the individuals at risk who would benefit most from chemoprevention strategies, active surveillance and presymptomatic diagnosis. As part of a comprehensive approach to disease prevention and management the role of the general practitioner in recognising predictive symptoms or symptom clusters is again emphasized as is the relationship between early access to specialist surgery with clinical outcome.
Since the early 1990's adjuvant chemotherapy of CRC has grown in importance in the management of early disease and it now appears likely that either infusional 5-fluorouracil based regimens or oral fluoropyrimidines will replace intravenous 5-FU in the coming years with newer agents such as irinotecan and oxaliplatin currently undergoing evaluations of effectiveness in this setting following demonstration of their considerable benefits in advanced disease. The dilemma now facing oncologists is how to select the best combination or sequence of these drugs for particular groups of patients; might younger and fitter patients warrant combination therapy as first line treatment if they demonstrate pauci-metastatic disease in an attempt to downstage disease prior to potentially curative second line surgery? Might older, more frail patients benefit more from a less aggressive regimen based on the oral fluoropyrimidines which have now been shown to be at least as effective as intravenous bolus 5-FU? Increasing options such as these should simplify the logistics of treatment. With early studies showing the feasibility of three and four drug combinations, the treatment of CRC has become a multimodality scenario with the place of synchronous chemoradiation becoming increasingly well-defined. It is encouraging that colorectal cancer remains one of the most active areas of molecular and clinical cancer research and well designed trials of the wide range of potential novel therapies and also increased patient recruitment will remain central to continuing progress in the effective management of the disease.
The current Third Edition volume is advanced as an extremely thorough and completely state-of-the-art review of current evidence and opinion for the prevention, investigation and management of colorectal cancer. As such it is highly recommended to medical and clinical oncologists, gastroenterologists and cancer surgeons for continuing professional development, to clinical nurse specialists and oncology pharmacists and to the planners and commissioners of cancer services; indeed to all those colleagues with a responsibility for or interest in the effective management of colorectal cancer. |
