Future directions for the early detection of colorectal cancer recurrence

Abstract

Surgical resection remains a mainstay of treatment and is highly effective for localized colorectal cancer. However, ~30-40% of patients develop recurrence following surgery and 40-50% of recurrences are apparent within the first few years after initial surgical resection. Several variables factor into the ultimate outcome of these patients, including the extent of disease, tumor biology, and patient co-morbidities. Additionally, the time from initial treatment to the development of recurrence is strongly associated with overall survival, particularly in patients who recur within one year of their surgical resection. Current post-resection surveillance strategies involve physical examination, laboratory, endoscopic and imaging studies utilizing various high and low-intensity protocols. Ultimately, the goal is to detect recurrence as early as possible, and ideally in the asymptomatic localized phase, to allow initiation of treatment that may still result in cure. While current strategies have been effective, several efforts are evolving to improve our ability to identify recurrent disease at its earliest phase. Our aim with this article is to briefly review the options available and, more importantly, examine emerging and future options to assist in the early detection of colon and rectal cancer recurrence.

Keywords: Colorectal cancer; biomarkers.; recurrence.

Figure 1

A 12-month Bayesian Belief Network. Each box in the figure represents a feature within the study data set, the edges represent patterns of dependence between features. This allows an estimate of mortality based on the different combinations. (With Permission, Springer Publishing)

Figure 2

Indigo carmine chromoendoscopy showing mucosal alteration in the sigmoid: (a) before staining and (b) after staining. (With permission Oxford University Press).

Figure 3

High Resolution Endoscopy (A) and Auto Fluorescence Imaging (B) of a flat and depressed type of colon cancer with submucosal invasion not seen on HRE. (With Permission, InTech Publishing).