Background: Colorectal cancer (CRC) is the one of the most common malignancies and is a leading cause of cancer death worldwide. The incidence of mortality from CRC has decreased in Western countries because of earlier diagnosis and improved treatment modalities; however, mortality is still increasing in most other regions of the world. Summary: Progress in the development of imaging modalities has enabled more accurate staging based on the TNM classification. The therapeutic management of CRC should involve a multi-modal approach, including high-quality surgery and an optimal choice of chemotherapy and radiotherapy regimens according to disease characteristics and patient preferences. Even in the case of metastatic disease, the optimal multi-modal treatments could achieve potential cure or long-term survival benefit in some patients. The aim of this review is to present current options regarding the diagnosis, staging and treatment management for CRC based on published research reports and the current management guidelines. Key Message The management of colorectal cancer (CRC) should be undertaken using a multi-modal approach, taking into account the extent, localization and biology of the tumor, as well as individual patient factors. Practical Implications The initial diagnosis of CRC is generally done using colonoscopy, accompanied by histological confirmation of the biopsy. Important staging factors are the depth of tumor invasion, regional lymph node (LN) involvement and distant metastases. The standard curative treatment for colon cancer is surgical resection including colectomy with optimal LN dissection. For rectal cancer, an accurate diagnosis of tumor location, T stage, N stage and relationship of the tumor to the mesorectal fascia are important for defining a therapeutic strategy. Surgery, however, is also the mainstay of treatment. For patients with stage III colon cancer, the benefits of adjuvant therapy using the FOLFOX regimen are well-established. However, this has not been formally demonstrated for rectal cancer patients. For those with resectable liver metastases, the use of perioperative FOLFOX4 regimen resulted in improved 3-year disease-free survival, though the optimal sequence of chemotherapy still remains to be defined. Finally, the management of metastatic CRC involves the use of various drugs used either alone or in combination, including 5-FU/LV, capecitabine, irinotecan, oxaliplatin, bevacizumab, cetuximab, panitumumab, ziv-aflibercept and regorafenib.

Keywords:
Colorectal cancer, Imaging modality, Therapeutic management
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2013
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