Colorectal malignancy is the focus of the Rice Memorial Hospital 2005 Cancer Center report.  With 39 new cases diagnosed in 2005 colorectal cancer remains the fourth most common cancer at Rice Memorial.  This mirrors Minnesota statewide data where colorectal cancer comprises 9.7% (Figure 1) of all malignancies.  This number has been fairly steady at our facility; we had 130 cases over the years 2000-2003 (Figure 2).  Nationwide, colorectal cancer (CRC) is the 3rd most common malignancy and the second most common cause of cancer death.  Figure 3 shows RMH age and gender distribution of the 2005 CRC cases.

While our numbers are fairly small it is educational to review the local experience with colorectal carcinoma.

The stage distribution of CRC cases in 2005 is shown in Figure 4.  The numbers represent 23%, 25%, 26%, and 18% for Stages 1-4 respectively.  This is similar to the values of combined data from 2000-2003 when the numbers were 25%, 31%, 26%, and 8% (Figure 5).

The most common symptoms noted with CRC are shown in Figure 6.  Altered bowel habits was the most commonly noted symptom but it is important to note that just as common was the asymptomatic patient.  Other symptoms included pain, bleeding, and anemia followed by the much less-often seen +FOB or malaise.

Colorectal cancer is predominantly a surgical disease with only a few patients avoiding surgery as at least a portion of their care.  Colon cancer treatment may be surgical only for lower stage disease or may include chemotherapy or chemotherapy plus radiation therapy for advanced stage disease.  The same is true for rectal carcinoma although neoadjuvant therapy, usually chemRx plus XRT given before surgery, may be utilized for some rectal malignancies as local recurrence rates may be lowered in some cases.  See Figure 7 for RMH treatment summary.

Minimally invasive colon surgery for benign disease has come of age with some morbidity advantages shown when compared to open procedures.  Minimally invasive cancer resections have only recently been shown to maintain cancer resection capabilities while also offering the same morbidity advantages.  Thus, various minimally invasive techniques; laparoscopic, laparoscopic-assisted, and hand-assisted laparoscopic procedures are being performed with more regularity.

Five-year survival data for RMH colorectal cancer cases from 1995-2000 (Figure 8) mimic the national SEER relative survival rates (Figure 9).  Clearly, distant disease portends a very guarded prognosis.

Colorectal cancer screening has the potential advantage over many screening tools as it may be preventative.  It is estimated that at least 90% of colorectal malignancies originate from a benign polyp.  Risk factors for CRC include family history of CRC; personal history of CRC, of polyps, or of IBD; Familial adenomatous polyposis; Hereditary non-polyposis colorectal cancer; and obesity.   Screening the general population remains vital, however, as over 75% of patients diagnosed with CRC have no risk factors.

Minnesota is #2 in the US for percentage of eligible population screened but our relative success (approx. 55%-Figure 10) is still well below the American Cancer Society 2015 goal of 75%.

As colorectal cancer screening becomes more commonplace it would be expected that more cases are diagnosed as stage one or two disease.  RMH has yet to see this ‘downstaging’ occur.

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