Colorectal cancer: all hands on deck

The past 50 years has seen substantial progress in our understanding of and in the management of colorectal cancer (CRC). Surveillance colonoscopy with resection of premalignant polyps has led to a decreased incidence of CRC even though compliance with the recommendations is suboptimal. Epidemiologic and genetic information allow us to identify individuals at risk for cancer and should allow us to prevent the disease in many individuals. Patients diagnosed with metastatic CRC live much longer than in the past, and some with metastatic disease are cured. This is attributed to many factors, including cross-sectional imaging that identifies metastases earlier, new surgical and radiation techniques, and numerous new chemotherapies. Higher resolution imaging modalities have improved the ability to find limited and resectable metastatic disease; surgical advances include laparoscopic-assisted procedures and safer and more extensive hepatic resection; and radiation techniques allow for higher dose and less morbidity. Biologic therapies have not yet been maximized, but we are learning when and where some should be used. Soon we expect to be staging patients by biologic and genetic characteristics rather than by gross pathology-treating patients based on biologic features but preferably identifying people at risk and preventing CRC altogether.