Current trends in the treatment of colorectal cancer

In recent years interest in the management of bowel cancer has focussed mainly on two main considerations:- A The prospect of improving the overall curability by:- The achievement of much earlier presymptomatic diagnosis with the aid of Hemoccult screening of sections of the population at risk; The deployment of more radical techniques of operation, especially in regard to rectal cancer; The supplementation of surgical excision with adjuvant radiotherapy and chemotherapy; The development of a more meticulous regime of follow-up after operation, using CEA monitoring and occasional "second look" operations to deal with recurrence. B The greater use of sphincter-saving types of excision for growths of the middle and lower parts of the rectum. To this end several new techniques of rectal resection have become popular--especially the downward extrusion of low anterior resection with the aid of the circular stapler. In addition, for small very favourable low growths local excision or local destruction by diathermy fulguration or contact irradiation have been employed. The rationale and success of these two forms of endeavour are examined.