Colorectal cancer--an undertreated disease

Surgery is currently the first-line treatment option for primary colorectal cancer (CRC) and resectable metastatic disease. Cytotoxic chemotherapy is used for adjuvant treatment as well as for the treatment of advanced disease; the combination of 5-fluorouracil (5-FU) plus leucovorin is currently the standard chemotherapeutic regimen used in most centers. In many countries patients with CRC do not receive chemotherapy because some clinicians perceive that the benefits of such treatment do not compensate for the potential negative effects on patient quality of life in terms of toxicity and inconvenient dosage schedules. However, recent evidence suggests that the use of cytotoxic chemotherapy can lead to an improvement in quality of life and effective palliation in CRC. A number of new treatment options are becoming available for the treatment of this malignancy. These include new anticancer agents such as thymidylate synthase inhibitors, monoclonal antibodies and topoisomerase I inhibitors, and new treatment methods including hepatic arterial or i.p. chemotherapy, cryosurgery and chemo-embolization. With the increased referral of patients to oncologists and the use of a multidisciplinary team approach, these new agents and new methods of treatment can be fully evaluated for the treatment of CRC, and should ultimately improve the treatment and outcome of this common disease.