Colon cancer

Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson, Yi Jen Chen, Michael A. Choti, Harry S. Cooper, Anne Covey, Raza A. Dilawari, Dayna S. Early, Peter C. Enzinger, Marwan G. Fakih, James Fleshman, Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Edward Lin, Mary F. Mulcahy, Sujata RaoDavid P. Ryan, Leonard Saltz, David Shibata, John M. Skibber, Constantinos Sofocleous, James Thomas, Alan P. Venook, Christopher Willett

Research output: Contribution to journalReview article

233 Citations (Scopus)

Abstract

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 and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important with a goal of evaluating at least 12 nodes. Adjuvant therapy with FOLFOX (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended by the panel for patients with stage III disease, and as an option for patients with high-risk stage II disease (category 2A for all 3 treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if all original sites of disease are amenable to resection (R0) and/or ablation. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease or when a response to chemotherapy may convert a patient from an unresectable to a resectable state (i.e., conversion therapy). Adjuvant chemotherapy should be considered following resection of liver or lung metastases. The recommended post-treatment surveillance program for colon cancer patients includes serial CEA determinations; periodic chest, abdominal, and pelvic CT scans; colonoscopic evaluations; and a survivorship plan to manage long-term side effects of treatment, facilitate disease prevention, and promote a healthy lifestyle. Recommendations for patients with previously untreated disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at the start of therapy include pre-planned strategies for altering therapy for patients in both the presence and absence of disease progression, including plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy options for advanced or metastatic disease depend on whether or not the patient is appropriate for intensive therapy. The more intensive initial therapy options include FOLFOX, FOLFIRI, CapeOX, and FOLFOXIRI (category 2B). Addition of a biologic agent (e.g., bevacizumab or cetuximab) is either recommended, or listed as an option, in combination with some of these regimens, depending on available data. Chemotherapy options for patients with progressive disease are dependent on the choice of initial therapy.

Original languageEnglish (US)
Pages (from-to)778-831
Number of pages54
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume7
Issue number8
DOIs
StatePublished - Jan 1 2009

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Colonic Neoplasms
Therapeutics
Drug Therapy
Anus Neoplasms
Continuity of Patient Care
Biological Factors
Adjuvant Chemotherapy
Rectal Neoplasms
Lymph Node Excision
Fluorouracil
Lung Diseases
Disease Progression
Liver Diseases
Colorectal Neoplasms
Colon
Thorax
Survival Rate
Lymph Nodes
Clinical Trials
Guidelines

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Engstrom, P. F., Arnoletti, J. P., Benson, A. B., Chen, Y. J., Choti, M. A., Cooper, H. S., ... Willett, C. (2009). Colon cancer. JNCCN Journal of the National Comprehensive Cancer Network, 7(8), 778-831. https://doi.org/10.6004/jnccn.2009.0056

Colon cancer. / Engstrom, Paul F.; Arnoletti, Juan Pablo; Benson, Al B.; Chen, Yi Jen; Choti, Michael A.; Cooper, Harry S.; Covey, Anne; Dilawari, Raza A.; Early, Dayna S.; Enzinger, Peter C.; Fakih, Marwan G.; Fleshman, James; Fuchs, Charles; Grem, Jean L.; Kiel, Krystyna; Knol, James A.; Leong, Lucille A.; Lin, Edward; Mulcahy, Mary F.; Rao, Sujata; Ryan, David P.; Saltz, Leonard; Shibata, David; Skibber, John M.; Sofocleous, Constantinos; Thomas, James; Venook, Alan P.; Willett, Christopher.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 7, No. 8, 01.01.2009, p. 778-831.

Research output: Contribution to journalReview article

Engstrom, PF, Arnoletti, JP, Benson, AB, Chen, YJ, Choti, MA, Cooper, HS, Covey, A, Dilawari, RA, Early, DS, Enzinger, PC, Fakih, MG, Fleshman, J, Fuchs, C, Grem, JL, Kiel, K, Knol, JA, Leong, LA, Lin, E, Mulcahy, MF, Rao, S, Ryan, DP, Saltz, L, Shibata, D, Skibber, JM, Sofocleous, C, Thomas, J, Venook, AP & Willett, C 2009, 'Colon cancer', JNCCN Journal of the National Comprehensive Cancer Network, vol. 7, no. 8, pp. 778-831. https://doi.org/10.6004/jnccn.2009.0056
Engstrom PF, Arnoletti JP, Benson AB, Chen YJ, Choti MA, Cooper HS et al. Colon cancer. JNCCN Journal of the National Comprehensive Cancer Network. 2009 Jan 1;7(8):778-831. https://doi.org/10.6004/jnccn.2009.0056
Engstrom, Paul F. ; Arnoletti, Juan Pablo ; Benson, Al B. ; Chen, Yi Jen ; Choti, Michael A. ; Cooper, Harry S. ; Covey, Anne ; Dilawari, Raza A. ; Early, Dayna S. ; Enzinger, Peter C. ; Fakih, Marwan G. ; Fleshman, James ; Fuchs, Charles ; Grem, Jean L. ; Kiel, Krystyna ; Knol, James A. ; Leong, Lucille A. ; Lin, Edward ; Mulcahy, Mary F. ; Rao, Sujata ; Ryan, David P. ; Saltz, Leonard ; Shibata, David ; Skibber, John M. ; Sofocleous, Constantinos ; Thomas, James ; Venook, Alan P. ; Willett, Christopher. / Colon cancer. In: JNCCN Journal of the National Comprehensive Cancer Network. 2009 ; Vol. 7, No. 8. pp. 778-831.
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AU - Engstrom, Paul F.

AU - Arnoletti, Juan Pablo

AU - Benson, Al B.

AU - Chen, Yi Jen

AU - Choti, Michael A.

AU - Cooper, Harry S.

AU - Covey, Anne

AU - Dilawari, Raza A.

AU - Early, Dayna S.

AU - Enzinger, Peter C.

AU - Fakih, Marwan G.

AU - Fleshman, James

AU - Fuchs, Charles

AU - Grem, Jean L.

AU - Kiel, Krystyna

AU - Knol, James A.

AU - Leong, Lucille A.

AU - Lin, Edward

AU - Mulcahy, Mary F.

AU - Rao, Sujata

AU - Ryan, David P.

AU - Saltz, Leonard

AU - Shibata, David

AU - Skibber, John M.

AU - Sofocleous, Constantinos

AU - Thomas, James

AU - Venook, Alan P.

AU - Willett, Christopher

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N2 - 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 and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important with a goal of evaluating at least 12 nodes. Adjuvant therapy with FOLFOX (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended by the panel for patients with stage III disease, and as an option for patients with high-risk stage II disease (category 2A for all 3 treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if all original sites of disease are amenable to resection (R0) and/or ablation. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease or when a response to chemotherapy may convert a patient from an unresectable to a resectable state (i.e., conversion therapy). Adjuvant chemotherapy should be considered following resection of liver or lung metastases. The recommended post-treatment surveillance program for colon cancer patients includes serial CEA determinations; periodic chest, abdominal, and pelvic CT scans; colonoscopic evaluations; and a survivorship plan to manage long-term side effects of treatment, facilitate disease prevention, and promote a healthy lifestyle. Recommendations for patients with previously untreated disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at the start of therapy include pre-planned strategies for altering therapy for patients in both the presence and absence of disease progression, including plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy options for advanced or metastatic disease depend on whether or not the patient is appropriate for intensive therapy. The more intensive initial therapy options include FOLFOX, FOLFIRI, CapeOX, and FOLFOXIRI (category 2B). Addition of a biologic agent (e.g., bevacizumab or cetuximab) is either recommended, or listed as an option, in combination with some of these regimens, depending on available data. Chemotherapy options for patients with progressive disease are dependent on the choice of initial therapy.

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