BUFFALO, NYRecent advances in colorectal cancer detection and
treatment planning are improving quality of life and disease control
in colorectal cancer patients, according to research discussed at the
Roswell Park Cancer Institute Surgical Oncology Symposium.
Patients diagnosed with colorectal cancer can benefit from
whole-body 18F-fluorodeoxyglucose positron emission tomography
(FDG-PET), both in staging and follow-up said Ralph Doerr, MD,
chief of surgical oncology, State University of New York at Buffalo,
School of Medicine and Biomedical Sciences.
PET scans may allow the elimination of some tests used in the
follow-up of patients with resected colorectal cancer. When the CEA
rises in these patients, it is possible to use colonoscopy and then a
PET scan for a focused work-up. CT scans can be used in a more
limited fashion and may even be eliminated, Dr. Doerr said. PET
scanning can impact preoperative decision making and will affect the
management of up to 63% of colorectal cancer patients, he noted.
Up to 50% of all colorectal cancer patients will develop liver
metastasis, he said. Generally only 10% to 15% of these patients will
derive a survival benefit from surgical resection of the liver
tumors. PET scanning can confirm which patients are able to benefit
In a University of Buffalo study, 20 patients with liver metastases
were deemed resectable by CT and magnetic resonance imaging (MRI).
When these same patients were examined using PET scans, 12 of the 20
were found to have either extrahepatic disease or extensive
intrahepatic disease. No liver resection was performed in these 12
patients on the basis of PET scanning. The other eight patients were
resected. PET scanning offers surgeons the opportunity to offer
the best treatment options available to their patients, Dr.
Although use of PET scanning is more limited in rectal cancer, new
surgical techniques are impacting survival and quality of life for
patients with rectal cancer.
In the rectum, sphincter preservation techniques using staples
and colon-anal reconstruction have made significant improvements in
patients quality of life, said Alfred M. Cohen, MD, chief
of the Colorectal Service, Department of Surgery, Memorial
Sloan-Kettering Cancer Center. Other advances for these
patients include adjuvant chemoradiation, autonomic nerve
preservation, and colonic J-pouch reconstruction.
Many of these advances are due to a shift to use of a sharp
mesorectal excision rather than a blunt pelvic dissection in rectal
cancer patients, Dr. Cohen said. This newer technique improves the
preservation of the mesorectum and the autonomic nerves that maintain
sexual function in men. These changes also decrease the incidence of
late bowel dysfunction, offering superior quality of life.
In addition to these technical changes, improved staging and
preoperative chemotherapy and radiation may increase overall survival
and decrease morbidity, Dr. Cohen said. However, the need
for clinical trials to confirm all of our observations is critical.