ABSTRACT
INTRODUCTION AND BACKGROUND Colorectal cancer is the second most common cause of death from cancer overall in industrialized Western countries. There are, however, great international variations – 20-fold variations in incidence rates. Some of the highest rates are found in Connecticut in the USA. A clear relation between the incidence of colorectal cancer and dietary fat content has been demonstrated. Primary treatment is surgical with approximately a 55 percent 5-year survival rate. Adjuvant chemotherapy is widely employed but chemotherapeutic response to recurrence is poor. Follow-up with serum carcinoembryonic antigen (CEA) levels is valuable for detecting recurrence, but CEA is only elevated with active disease in about 50 percent of patients. Resection of limited metastases to the liver has been shown to improve survival in carefully selected patients. Radiation therapy may be used for rectal carcinoma but less commonly for carcinoma of the colon. Only about 20 percent of patients who have recurrence are considered suitable for further resection and of these about half relapse early due to unsuspected metastatic sites elsewhere.
