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In this trial, patients in the lowest quintile of the Western dietary pattern, compared with those patients in the highest quintile, experienced an adjusted hazard ratio (HR) for disease-free survival of 3.25 (95% confidence interval, 2.04–5.19 P <. Two prospective observational studies were performed with patients enrolled in the Cancer and Leukemia Group B CALGB-89803 trial (NCT00003835), an adjuvant chemotherapy trial for patients with stage III colon cancer. The cohort studies contained multiple opportunities for unintended bias, and caution is needed when using the data from them. Factors Associated With Recurrence Diet and exerciseĪlthough cohort studies have suggested that a diet or exercise regimen may improve outcomes, no prospective randomized trials have confirmed these findings. The optimal regimen and frequency of follow-up examinations are not well defined because the impact on patient survival is not clear and the quality of data is poor.

Routine use of CEA levels alone for monitoring response to treatment is not recommended.

Postoperative CEA testing should be restricted to patients who would be candidates for resection of liver or lung metastases.

A CEA level is not a valuable screening test for colorectal cancer because of the large number of false-positive and false-negative reports.

A review of the use of this tumor marker suggests the following: To date, no large-scale randomized trials have documented an OS benefit for standard, postoperative monitoring programs.ĬEA is a serum glycoprotein frequently used in the management of patients with colon cancer. This monitoring has limited effect on overall mortality, as few localized, potentially curable metastases are found in patients with recurrent colon cancer. The American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend specific surveillance and follow-up strategies.įollowing treatment of colon cancer, periodic evaluations may lead to the earlier identification and management of recurrent disease. Limited data and no high-level evidence are available to guide patients and physicians about surveillance and management of patients after surgical resection and adjuvant therapy. Racial differences in overall survival (OS) after adjuvant therapy have been observed, without differences in disease-free survival, suggesting that comorbid conditions play a role in survival outcome in different patient populations.

Treatment decisions depend on factors such as physician and patient preferences and the stage of the disease, rather than the age of the patient. Patients with HNPCC reportedly have better prognoses in stage-stratified survival analysis than patients with sporadic colorectal cancer, but the retrospective nature of the studies and possibility of selection factors make this observation difficult to interpret. Microsatellite instability, also associated with HNPCC, has been associated with improved survival independent of tumor stage in a population-based series of 607 patients younger than 50 years with colorectal cancer. Many other prognostic markers have been evaluated retrospectively for patients with colon cancer, though most, including allelic loss of chromosome 18q or thymidylate synthase expression, have not been prospectively validated. Elevated pretreatment serum levels of carcinoembryonic antigen (CEA) have a negative prognostic significance.Bowel obstruction and bowel perforation are indicators of poor prognosis.The prognosis of patients with colon cancer is clearly related to the following: For more information, see Colorectal Cancer Screening. This recommendation is based on the frequency of the disease, ability to identify high-risk groups, slow growth of primary lesions, better survival of patients with early-stage lesions, and relative simplicity and accuracy of screening tests. Screening for colon cancer should be a part of routine care for all adults aged 50 years and older, especially for those with first-degree relatives with colorectal cancer. Personal history of long-standing chronic ulcerative colitis or Crohn colitis.

Hereditary conditions, including familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary nonpolyposis colorectal cancer ).Personal history of colorectal adenomas, colorectal cancer, or ovarian cancer.Family history of colorectal cancer in a first-degree relative.

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