Part 1—Colorectal cancer: Current practices and future developments (Guest editorial)

The British Columbia Cancer Agency subdivides responsibility for provincial cancer care into several different tumor groups with multidisciplinary representation. The Gastrointestinal Tumor Group is one of these. At one of our meetings the concept of a group of articles for the British Columbia Medical Journal on colorectal cancer arose, since at the time, it seemed that little attention was being paid to this disease—one that affects men and women alike and costs many lives each year in our province.

There have been significant developments and changes in treatment policies over the past 10 years, and we felt that BCMJ readers might value a review of current policy, as well as discovering what the future might bring.

In spite of the best attempts at prevention, patients continue to be diagnosed with colorectal cancer and need some idea of their prognosis. The stage of cancer at the time of presentation is one of the major predictors of outcome, and although overall 5-year survival is about 70%, it varies from 90% for Dukes’ A to 60% for Dukes’ C cancers. This is why screening is so crucial.

The first article, by Greg Hislop and Shirley Hobenshield, relates to the incidence and mortality from colorectal cancer in our province. Happily, the rates seem to be declining in recent years, but the fact remains that this disease will continue to affect hundreds of lives each year. The challenge of prevention continues to be paramount, and the authors have presented a thorough review of current dietary and lifestyle recommendations.

Screening offers the best hope of early detection and cure. In recent years we have seen the publication of several exciting clinical trials demonstrating the effectiveness of fecal occult blood testing as a screening tool for colorectal cancer. Dr Cleator, the lead author of ‘‘Screening for colorectal cancer in British Columbia,’’ has long championed the cause of screening in this province and continues to work in this field.

A subcommittee of the GI Tumor Group has worked with Dr Cleator in developing a proposal for a pilot project for the two-tier system, which has now been submitted to government. The economic impact of a population-based fecal occult blood-screening program is potentially enormous, and this issue must be addressed jointly by the BCCA, BCMA, and the government. Ideally, an organized program akin to the cervical cytology program and the breast-screening program can be achieved.

The management of most patients with colorectal cancer now requires a multidisciplinary approach in order to achieve the best chance of cure or long-term survival. The remaining four articles will encompass the clinical aspects of treatment. In ‘‘Radiotherapy for colorectal cancer,’’ Drs Agranovich and Berthelet have provided a concise outline of the practical aspects of radiotherapy for this disease. This background should help to determine whether to refer patients and to help support them through their treatment. The importance of preoperative radiotherapy for rectal cancer illustrates the need to consider all modalities of therapy prior to surgical intervention.

—G.I. McGregor , MD,FRCSC, FACS Chair, GI Tumor Group, BC Cancer Agency,Vancouver Centre