Introduction: management of resectable locally recurrent disease and metastatic disease

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Clinical practice guidelines for the prevention, early detection and management of colorectal cancer > Introduction: management of resectable locally recurrent disease and metastatic disease

Following curative treatment of colorectal cancer, 15–20% of stage II and 30–40% of stage III colorectal cancers will recur.[1][2][3] The purpose of follow-up after curative resection is to allow early detection of these recurrences so that further curative resection may be undertaken if appropriate (see Follow-up after curative resection for colorectal cancer).

Previous studies documenting the patterns of recurrence after curative resection of colorectal cancer have found systemic recurrence to be most common followed by locoregional recurrence and both systemic and locoregional recurrence.[4][5] The management of these recurrences is complex and needs to be tailored to individual needs, based on the extent of disease, the severity of symptoms, physical fitness for further treatment, and the patient’s values and preferences.

Multidisciplinary care is important as most of these patients will have complex needs that will require input from surgical teams, medical oncology teams, radiation oncology teams and palliative care. Although clinicians are at the forefront of these patients’ management, input from nurses (palliative care nurses) and other allied health members (stomal therapists, dietitians, physiotherapists, psychologists and social workers) is also indispensable in ensuring holistic care, a seamless transition from hospital to community care and, if appropriate, end-of-life care.

Surgical treatment of resectable metastatic disease and resectable local recurrences has come a long way in the past decade. Improved staging modalities, understanding of what drives long-term survival in patients and improved chemotherapy options have all allowed increasingly aggressive management of systemic and local recurrences. Depending on the pattern of recurrence (e.g. systemic versus locoregional), patients will require slightly different investigations, although the key objectives remain the same:

  • to confirm the presence of recurrence
  • to stage the disease accurately so as to determine disease resectability
  • to rule out more widespread disease that may preclude curative resection.

See also:

Imaging a patient with diagnosis of colon/rectal adenocarcinoma

Follow-up after curative resection for colorectal cancer

  1. André T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009 Jul 1;27(19):3109-16 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19451431.
  2. Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006 Aug;244(2):254-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16858188.
  3. O'Connell MJ, Campbell ME, Goldberg RM, Grothey A, Seitz JF, Benedetti JK, et al. Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. J Clin Oncol 2008 May 10;26(14):2336-41 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18467725.
  4. Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons RJ Jr, Pemberton JH, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1992 Jan;174(1):27-32 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1729745.
  5. Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 1997 Jan;40(1):15-24 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9102255.