Staging and management of colorectal cancer

The management of colorectal cancer becomes ever more complex. Rational decision-making depends on knowledge of the apparent stage of the disease in the individual patient. Many decisions require input from the patient, who therefore must be party to all relevant information, including any that is predictive of the likely outcome of the disease and the effects of treatment. The process of staging once required only pathologic information gleaned from the surgical specimen. Later clinical information was often added to produce a more practically useful prediction of outcome; necessarily, the staging process, whether pathologic or clinicopathologic, could only be completed postoperatively. Today there is a momentum toward preempting this process through the use of scanning and other modalities, so "staging" information can be used when planning primary treatment, including neoadjuvant therapy and surgery. The ultimate staging system would comprise just two reliably predictive patient categories: those expected to survive and those destined to die. So far no system has approached that "ideal." Given such a system, therapeutic and research efforts could be concentrated on reversing the outcome for those predicted to die.