Colorectal carcinoma: recent advances in its biology and treatment

Recent advances in the molecular biology and treatment of rectal carcinoma were reviewed mainly on the basis of our own experience. Remarkable improvement in molecular biology has been achieved in the colorectal diseases, and the new knowledge derived from molecular genetics is now being used in the clinical field. The deeper understanding of colorectal carcinogenesis and wider clinical use of molecular diagnosis is one of the examples, and further advances are expected in the next century. Surgical advances are noted particularly in the field of rectal surgery. Various modalities make it possible to assess the clinical stage more precisely, which leads to careful application of the fine surgical procedures used to maintain urinary and sexual functions with low rates of local recurrence and prolonged survival. This decision making should be conducted and can be accomplished by experienced colorectal surgeons with the team members supporting them. The earlier the detection of disease, the easier the operation, with a lower risk of recurrence and longer survival; therefore, early detection of colorectal cancer by means of occult blood test is essential for this purpose. Establishment of the proper training system for appropriate colorectal surgery is also mandatory for this most common gastrointestinal cancer in the Western world, and this is also the case for Japan. The Japan Society for Cancer of the Colon and Rectum is expected to play an important role in this respect.