[Colorectal cancer: what should be the management of primary tumour?]

Colon and rectal cancer are in France a challenging problem in public health, reaching the second place in cancer related deaths. Surgery is still the key of curative treatment. Crude survival increased from 33% to 55% during twenty years. Colonoscopy is the referent exam for positive diagnosis. In rectal cancer, endorectal ultrasound and MRI have optimised local staging. The quality of general staging is important since it could change therapeutic strategy. Spiral CT scan is now probably superior to conventional ultrasound in the detection of liver metastases. Laparotomy is still the standard surgical approach. Main prospective studies in the evaluation of laparoscopic approach are still ongoing. Rectal resection for cancer is today a standardised procedure: total mesorectal excision (TME) should be done for rectal tumours below peritoneal reflection; TME decreases both the risk of local recurrence and the frequency of urogenital sequelae. The quality of surgical resection for colorectal cancer should always be checked and particularly, the number of lymph nodes, the longitudinal and lateral margins for rectal cancer, and resection for fixed tumours. Adjuvant chemotherapy with 5 fluorouracil and folinic acid is a standard for UICC stage III patients, but with a clearer benefit for colon tumours. Preoperative irradiation for T3-T4 rectal tumours is an European standard, providing a better local control; irradiation could also improved survival. In the oncoming years, surgeon and hospital specialization will probably be the main factor of progress in the management of colorectal cancer in France.