Colorectal carcinoma: overview of management techniques

The fact that the national death rate from carcinoma of the colon and rectum has remained static over the past two decades is strong incentive for future investigation of measures to allow detection in its early and more favorable stage. Although no significant improvements in surgical techniques have afforded improvement in longevity, certain technical factors are known to inhibit tumor implantation during surgery. Data suggest that the extent of en bloc resection is the most crucial factor in avoiding recurrence. Extensive use of radiotherapy as the sole method of treatment or as preoperative or postoperative adjunctive therapy remains investigational, but it seems likely that this form of treatment will play an increasing role in the future. Preoperative radiotherapy seems to be useful in reducing the stage of the neoplasm and the incidence of extraserosal involvement; postoperative radiotherapy is beneficial for palliation. Chemotherapy, particularly with the fluorinated pyrimidines (5-FU and 5-FUDR), is being evaluated for its usefulness in lengthening survival time; response to 5-FU is occasionally dramatic. It remains for major investigational centers to clarify the role of combination chemotherapy in metastatic disease. Immunotherapy at present must be considered an unproven mode of treatment and of inconclusive benefit in any stage of colorectal carcinoma. Carcinoembryonic antigen assay is a useful prognostic and diagnostic tool in localizing primary tumor and in subsequent evaluation of response to treatment.