Skip to main content

Colon Cancer

  • Chapter
  • First Online:
Book cover International Manual of Oncology Practice

Abstract

Colon cancer ranks worldwide the second place in prevalence among men (10%) and third place among women (9.2%) (GLOBALCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012, 2012). Although well-established diagnostic methods are indicated for the early diagnosis of the disease, the access and adherence to these screening programs is a global problem. The knowledge of its etiology, molecular changes and pathophysiology will introduce new diagnostic methods with better population reach and new treatments based on specific targets can transform the history of colorectal cancer. This chapter aims to discuss general aspects of colon cancer, its etiology, diagnostic methods and therapeutic possibilities according to its staging.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. GLOBALCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012

    Google Scholar 

  2. Binefa G, Rodriguez-Moranta F, Teule A, Medina-Hayas M (2014) Colorectal cancer: from prevention to personalized medicine. World J Gastroenterol 20(22):6786–6808

    Article  PubMed  PubMed Central  Google Scholar 

  3. SOCIETY AC. Colorectal cancer facts & figures 2014–2016. Atlanta 2014. Available from: http://www.cancer.org/acs/groups/content/documents/document/acspc-042280.pdf

  4. Fearon ER, Vogelstein B (1990) A genetic model for colorectal tumorigenesis. Cell 61(5):759–767

    Article  CAS  PubMed  Google Scholar 

  5. Colucci D (2013) Molecular pathways involved in colorectal cancer: implications for disease behavior and prevention. Int J Mol Sci 14:16365

    Article  CAS  Google Scholar 

  6. Carethers JM (2017) Microsatellite instability pathway and EMAST in colorectal cancer. Curr Colorectal Cancer Rep 13(1):73–80

    Article  PubMed  PubMed Central  Google Scholar 

  7. Boland CR, Goel A (2010) Microsatellite instability in colorectal cancer. Gastroenterology 138(6):2073–2087. e3

    Article  CAS  PubMed  Google Scholar 

  8. Majumdar SR, Fletcher RH, Evans AT (1999) How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 94(10):3039–3045

    Article  CAS  PubMed  Google Scholar 

  9. Huddy JR, Ni MZ, Markar SR, Hanna GB (2015) Point-of-care testing in the diagnosis of gastrointestinal cancers: current technology and future directions. World J Gastroenterol 21(14):4111–4120

    Article  PubMed  PubMed Central  Google Scholar 

  10. Alberti LR, Garcia DPC, Coelho DL, De Lima DCA, Petroianu A (2015) How to improve colon cancer screening rates. World J Gastrointest Oncol 7(12):484

    Article  PubMed  PubMed Central  Google Scholar 

  11. Force UPST (2008) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627

    Article  Google Scholar 

  12. Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP et al (2014) Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 370(14):1287–1297

    Article  CAS  PubMed  Google Scholar 

  13. Amin MB, Edge SB (2017) AJCC cancer staging manual. Springer, Cham

    Book  Google Scholar 

  14. Network NCC. Clinical practice guidelines in oncology (NCCN Guidelines®): Colon Cancer Version 2.2017 2017. Available from: https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf

  15. Group FC (2012) Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol 13(11):1152–1160

    Article  CAS  Google Scholar 

  16. Jayne D, Thorpe H, Copeland J, Quirke P, Brown J, Guillou P (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645

    Article  CAS  PubMed  Google Scholar 

  17. Des Guetz G, Nicolas P, Perret G-Y, Morere J-F, Uzzan B (2010) Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer 46(6):1049–1055

    Article  PubMed  Google Scholar 

  18. Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM (2011) Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 305(22):2335–2342

    Article  CAS  PubMed  Google Scholar 

  19. Shi Q, Sobrero AF, Shields AF, Yoshino T, Paul J, Taieb J, et al (2017) Prospective pooled analysis of six phase III trials investigating duration of adjuvant (adjuv) oxaliplatin-based therapy (3 vs 6 months) for patients (pts) with stage III colon cancer (CC): the IDEA (International Duration Evaluation of Adjuvant chemotherapy) collaboration. American Society of Clinical Oncology

    Google Scholar 

  20. Sato H, Maeda K, Sugihara K, Mochizuki H, Kotake K, Teramoto T et al (2011) High-risk stage II colon cancer after curative resection. J Surg Oncol 104(1):45–52

    Article  PubMed  Google Scholar 

  21. Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N et al (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27(31):5131–5137

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN, French AJ, Goldberg RM et al (2003) Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med 349(3):247–257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Forones NMTM (1999) CEA and CA 19-9 as prognostic indexes in colorectal cancer. Hepato-Gastroenterology 46(26):905–908

    CAS  PubMed  Google Scholar 

  24. Sargent DJ, Shi Q, Yothers G, Tejpar S, Bertagnolli MM, Thibodeau SN et al (2014) Prognostic impact of deficient mismatch repair (dMMR) in 7,803 stage II/III colon cancer (CC) patients (pts): a pooled individual pt data analysis of 17 adjuvant trials in the ACCENT database. Proc Am Soc Clin Oncol 32:3507

    Article  Google Scholar 

  25. Group QC (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020–2029

    Article  CAS  Google Scholar 

  26. André T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27(19):3109–3116

    Article  CAS  PubMed  Google Scholar 

  27. Tournigand C, André T, Bonnetain F, Chibaudel B, Lledo G, Hickish T et al (2012) Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly patients (between ages 70 and 75 years) with colon cancer: subgroup analyses of the Multicenter International Study of Oxaliplatin, Fluorouracil, and Leucovorin in the Adjuvant Treatment of Colon Cancer trial. J Clin Oncol 30(27):3353–3360

    Article  CAS  PubMed  Google Scholar 

  28. Yothers G, O’Connell MJ, Allegra CJ, Kuebler JP, Colangelo LH, Petrelli NJ et al (2011) Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol 29(28):3768–3774

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. André T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T et al (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350(23):2343–2351

    Article  PubMed  Google Scholar 

  30. Saltz LB, Niedzwiecki D, Hollis D, Goldberg RM, Hantel A, Thomas JP et al (2007) Irinotecan fluorouracil plus leucovorin is not superior to fluorouracil plus leucovorin alone as adjuvant treatment for stage III colon cancer: results of CALGB 89803. J Clin Oncol 25(23):3456–3461

    Article  CAS  PubMed  Google Scholar 

  31. Twelves CJ, Investigators X-A (2006) Xeloda® in adjuvant colon cancer therapy (X-ACT) trial: overview of efficacy, safety, and cost-effectiveness. Clin Colorectal Cancer 6(4):278–287

    Article  CAS  PubMed  Google Scholar 

  32. Haller DG, Tabernero J, Maroun J, de Braud F, Price T, Van Cutsem E et al (2011) Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancer. J Clin Oncol 29(11):1465–1471

    Article  CAS  PubMed  Google Scholar 

  33. Schmoll H-J, Tabernero J, Maroun J, De Braud F, Price T, Van Cutsem E et al (2015) Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial. J Clin Oncol 33(32):3733–3740

    Article  CAS  PubMed  Google Scholar 

  34. de Gramont A, Van Cutsem E, Schmoll H-J, Tabernero J, Clarke S, Moore MJ et al (2012) Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (AVANT): a phase 3 randomised controlled trial. Lancet Oncol 13(12):1225–1233

    Article  CAS  PubMed  Google Scholar 

  35. Alberts SR, Sargent DJ, Nair S, Mahoney MR, Mooney M, Thibodeau SN et al (2012) Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA 307(13):1383–1393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Neugut AI, Matasar M, Wang X, McBride R, Jacobson JS, Tsai W-Y et al (2006) Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol 24(15):2368–2375

    Article  CAS  PubMed  Google Scholar 

  37. Mol L, Verhoef C, de Haan AF, Yilmaz M, Punt CJ, de Wilt JH et al (2014) The CAIRO4 study: the role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer–a randomized phase III study of the Dutch Colorectal Cancer Group (DCCG). BMC Cancer 14(1):741

    Article  PubMed  PubMed Central  Google Scholar 

  38. Van Cutsem E, Lenz H-J, Köhne C-H, Heinemann V, Tejpar S, Melezínek I et al (2015) Fluorouracil, leucovorin, and irinotecan plus cetuximab treatment and RAS mutations in colorectal cancer. J Clin Oncol 33(7):692–700

    Article  CAS  PubMed  Google Scholar 

  39. Douillard J-Y, Oliner KS, Siena S, Tabernero J, Burkes R, Barugel M et al (2013) Panitumumab–FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 369(11):1023–1034

    Article  CAS  PubMed  Google Scholar 

  40. Le DT, Uram JN, Wang H, Bartlett BR, Kemberling H, Eyring AD et al (2015) PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med 372(26):2509–2520

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Overman MJ, McDermott R, Leach JL, Lonardi S, Lenz H-J, Morse MA et al (2017) Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study. Lancet Oncol 18(9):1182–1191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947

    Article  PubMed  Google Scholar 

  43. Douillard J-Y (2000) Irinotecan and high-dose fluorouracil/leucovorin for metastatic colorectal cancer. Oncology (Williston Park, NY) 14(12 Suppl 14):51–55

    CAS  Google Scholar 

  44. Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22(2):229–237

    Article  CAS  PubMed  Google Scholar 

  45. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran S-E et al (2014) FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 15(10):1065–1075

    Article  CAS  PubMed  Google Scholar 

  46. Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M et al (2007) Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol 25(30):4779–4786

    Article  CAS  PubMed  Google Scholar 

  47. Douillard J-Y, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M et al (2010) Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol 28(31):4697–4705

    Article  CAS  PubMed  Google Scholar 

  48. Cascinu S, Rosati G, Nasti G, Lonardi S, Zaniboni A, Marchetti P et al (2017) Treatment sequence with either irinotecan/cetuximab followed by FOLFOX-4 or the reverse strategy in metastatic colorectal cancer patients progressing after first-line FOLFIRI/bevacizumab: an Italian Group for the Study of Gastrointestinal Cancer phase III, randomised trial comparing two sequences of therapy in colorectal metastatic patients. Eur J Cancer 83:106–115

    Article  CAS  PubMed  Google Scholar 

  49. Fukui T, Suzuki K, Ichida K, Takayama Y, Kakizawa N, Muto Y et al (2017) Sequential administration of XELOX and XELIRI is effective, feasible and well tolerated by patients with metastatic colorectal cancer. Oncol Lett 13(6):4947–4952

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Tabernero J, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R et al (2015) Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol 16(5):499–508

    Article  CAS  PubMed  Google Scholar 

  51. Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausová J, Macarulla T et al (2012) Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol 30(28):3499–3506

    Article  CAS  PubMed  Google Scholar 

  52. van de Velde CJ, Baumann M, Kerr DJ, Haller DG, Saijo N (2016) Oxford textbook of oncology. Oxford University, Oxford

    Google Scholar 

  53. Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M et al (2013) Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 381(9863):303–312

    Article  CAS  PubMed  Google Scholar 

  54. Mayer RJ, Van Cutsem E, Falcone A, Yoshino T, Garcia-Carbonero R, Mizunuma N et al (2015) Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med 372(20):1909–1919

    Article  PubMed  Google Scholar 

  55. Loupakis F, Cremolini C, Masi G, Lonardi S, Zagonel V, Salvatore L et al (2014) Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med 371(17):1609–1618

    Article  CAS  PubMed  Google Scholar 

  56. Folprecht G, Gruenberger T, Bechstein WO, Raab H-R, Lordick F, Hartmann JT et al (2010) Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 11(1):38–47

    Article  CAS  PubMed  Google Scholar 

  57. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P et al (2013) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 14(12):1208–1215

    Article  CAS  PubMed  Google Scholar 

  58. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 371(9617):1007–1016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Primrose J, Falk S, Finch-Jones M, Valle J, O’Reilly D, Siriwardena A et al (2014) Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol 15(6):601–611

    Article  CAS  PubMed  Google Scholar 

  60. Lieberman DA (2014) Colon polyp surveillance: clinical decision tool. Gastroenterology 146(1):305–306

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ramon Andrade De Mello .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Muniz, P.C., Tadokoro, H., De Mello, R.A., Forones, N.M. (2019). Colon Cancer. In: De Mello, R., Mountzios, G., Tavares, Á. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-16245-0_16

Download citation

Publish with us

Policies and ethics