Colon cancer clinical practice guidelines

The NCCN Colon/Rectal/Anal Cancer Guidelines panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection. For patients with stage 111 disease, 5-FU-based adjuvant therapy is recommended. A patient who has metastatic disease in the liver or lung should be considered for surgical resection if he or she is a candidate for surgery and if surgery can extend survival. Surgery should be followed by adjuvant chemotherapy. The panel advocates a conservative posttreatment surveillance program for colon carcinoma patients. Serial CEA determinations are appropriate if the patient is a candidate for aggressive surgical resection, should recurrence he detected. Abdominal and pelvic CT scans should be used only when there are clinical indications of possible recurrence. Patients whose disease progresses during 5-FU-based therapy should be treated with combination chemotherapy consisting of 5-FU/leucovorin and either irinotecan or oxaliplatin.