Part 2—Colorectal cancer: Current practices and future developments (Guest editorial)

Last month, the British Columbia Medical Journal published the first three articles in this series designed to update physicians throughout the province on the management of patients with colorectal cancer. The following three articles are the last in the group and will deal with issues regarding chemotherapy, surgery, and follow-up.

In the first article, Dr Shah gives a simple and concise account of current practices in the administration of adjuvant and therapeutic chemotherapy. His article will be a valuable reference for any physician who is not a medical oncologist and has a patient with colorectal cancer for whom they bear direct or indirect responsibility. These policies are established by the Systemic Therapy Subcommittee of the GI Tumor Group at the BC Cancer Agency, which meets to review policy on a regular basis. Patients may be assured that the recommendations of the Cancer Agency represent up-to-date policy based on current knowledge. Where appropriate, patients are invited to participate in clinical trials to aid in the development of improved therapy.

The surgical management of colorectal cancer is reviewed in the next article. In particular, the management of rectal cancer is undergoing rapid evolution based on new understanding of the embryology and anatomy of the mesorectum. It is now incumbent upon surgeons who deal with colorectal cancer to familiarize themselves with these concepts. A subgroup of the GI Tumor Group is now collecting data regarding current management practices in the province for rectal cancer. As in all forms of treatment, ongoing outcome analysis is important to ensure our patients are receiving the best possible care. This is an expensive, time-consuming process; the BC Cancer Agency has an obligation to assist physicians and surgeons with this task.

Another subcommittee of the GI Tumor Group, chaired by Dr Klaassen, has carefully examined the available literature regarding follow-up for colorectal cancer patients. It is recognized that in these days of cost constraint, follow-up measures must be curtailed to those that are truly proving of benefit to patients. This article represents the BC Cancer Agency policy, which is in agreement with that of the BCMA Follow-up Committee except in the use of carcinoembryonic antigen determinations.

I hope that these six articles help to clarify the current guidelines for treatment of colorectal cancer for those physicians who do not see it on a day-to-day basis. The approach has been developed by consensus among members of the GI Tumor Group at all four centres across the province. The group continues to meet on a regular basis and welcomes input from physicians around the province.

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