The clinical management of early and advanced colorectal cancer

Despite the impressive developments in the fields of preclinical research and chemoprevention of colorectal cancer, this disease remains the second most common cause of cancer death after lung cancer in the western hemisphere. Things are moving along, however, and it is common opinion that the medical treatment of colorectal cancer is the field of Medical Oncology where the most signifcant advances have been achieved in the last 10 years. The value of adjuvant chemotherapy for colorectal cancer has been confirmed in several randomized trials and it has been firmly established that systemic chemotherapy doubles the survival of patients with advanced colorectal cancer compared to untreated controls. In addition, for the first time in 40 years since 5-fluorouracil development, there seem to be valuable alternatives/ adjuncts to the fluoropyrimidines. The management of individual patiens, however, remains a very challenging matter both in the adjuvant and the advanced setting. In this connection, no rigid guidelines can be given, as too many factors play crucial roles in the clinical decision-making. The purpose of this article is reviewing the evidence to suggest the most appropriate treatment for each condition.