Cancer Survivorship Issues in Colorectal Cancer

  • Clifford Y. Ko
  • Patricia A. Ganz


Colon and rectal cancers (CRC) are among the most common adult malignancies worldwide, and for a variety of reasons, the numbers of survivors of colorectal cancer are likely to increase in coming years. The incidence of these cancers doubles with each successive decade of life beyond 50 years, and with the expansion of the older population in the coming years, the absolute numbers of CRC patients in the United States will grow substantially.1 It is estimated that by the year 2030 the number of persons over the age of 65 years will have doubled and the number of persons over the age of 85 years will have quadrupled (see Chapter 16).2 Given this expanding and aging population, projections suggest that the numbers of CRC patients may increase by as much as 30%.3 Thus, with these profound demographic changes, it will be imperative to have a better understanding of the late effects and health care needs of long-term CRC survivors.


Rectal Cancer Sexual Dysfunction Total Mesorectal Excision Abdominoperineal Resection Rectal Cancer Patient 
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  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–130.PubMedCrossRefGoogle Scholar
  2. 2.
    Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999;341:2061–2067.PubMedCrossRefGoogle Scholar
  3. 3.
    Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg 2003;238:170–177.PubMedGoogle Scholar
  4. 4.
    Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365–1371.PubMedCrossRefGoogle Scholar
  5. 5.
    Mandel JS, Church TR, Bond JH, et al. The effect of fecal occultblood screening on the incidence of colorectal cancer. N Engl J Med 2000;343:1603–1607.PubMedCrossRefGoogle Scholar
  6. 6.
    Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996;348:1467–1471.PubMedCrossRefGoogle Scholar
  7. 7.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996;348:1472–1477.PubMedCrossRefGoogle Scholar
  8. 8.
    Ransohoff DF, Sandler RS. Clinical practice. Screening for colorectal cancer. N Engl J Med 2002;346:40–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Troisi RJ, Freedman AN, Devesa SS. Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite, and stage, 1975–1994. Cancer (Phila) 1999;85:1670–1676.PubMedCrossRefGoogle Scholar
  10. 10.
    SEER. 2004.Google Scholar
  11. 11.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998;133:894–899.PubMedCrossRefGoogle Scholar
  12. 12.
    Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997;336:980–987.Google Scholar
  13. 13.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–646.PubMedCrossRefGoogle Scholar
  14. 14.
    Rao S, Cunningham D. Adjuvant therapy for colon cancer in the new millennium. Scand J Surg 2003;92:57–64.PubMedGoogle Scholar
  15. 15.
    O’Connell MJ, Laurie JA, Kahn M, et al. Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol 1998;16:295–300.PubMedGoogle Scholar
  16. 16.
    Arkenau HT, Bermann A, Rettig K, Strohmeyer G, Porschen R. 5-Fluorouracil plus leucovorin is an effective adjuvant chemotherapy in curatively resected stage III colon cancer: long-term follow-up results of the adjCCA-01 trial. Ann Oncol 2003;14:395–399.PubMedCrossRefGoogle Scholar
  17. 17.
    Schwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Galloway AC (eds). Principles of Surgery, 7th ed. New York: McGraw Hill, 1999.Google Scholar
  18. 18.
    Joseph NE, Sigurdson ER, Hanlon AL, et al. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol 2003;10:213–218.PubMedCrossRefGoogle Scholar
  19. 19.
    Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999;341:2039–2048.PubMedCrossRefGoogle Scholar
  20. 20.
    Gordon PH, Nivatvongs S. Surgery of the Colon, Rectum, and Anus. London: Saunders, 2001.Google Scholar
  21. 21.
    Corman MC. Surgery of the Colon and Rectum. Philadelphia: Lippincott Williams & Wilkins. 2001.Google Scholar
  22. 22.
    Smith R, Bohl J, McElearney S, et al. Wound infection after elective colorectal resection. Ann Surg 2004;239:599–605.PubMedCrossRefGoogle Scholar
  23. 23.
    Edna TH, Bjerkeset T, Loe B. Small bowel obstruction in patients previously operated on for colorectal cancer. Eur J Surg 1998;164:587–592.PubMedCrossRefGoogle Scholar
  24. 24.
    Cameron J ed). Current Surgical Therapy, 7th ed. St. Louis: Mosby, 2001.Google Scholar
  25. 25.
    Cahalane MJ, Shapiro ME, Silen W, et al. Abdominal incision: decision or indecision? Lancet 1989;1:146–148.PubMedCrossRefGoogle Scholar
  26. 26.
    Millikan KW. Incisional hernia repair. Surg Clin N Am 2003;83:1223–1234.PubMedCrossRefGoogle Scholar
  27. 27.
    Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 2003;237:129–135.PubMedCrossRefGoogle Scholar
  28. 28.
    Sailer M, Fuchs KH, Fein M, Thiede A. Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 2002;89:1108–1117.PubMedCrossRefGoogle Scholar
  29. 29.
    Mancini R, Cosimelli M, Filippini A, et al. Nerve-sparing surgery in rectal cancer: feasibility and functional results. J Exp Clin Cancer Res 2000;19:35–40.PubMedGoogle Scholar
  30. 30.
    Chatwin NA, Ribordy M, Givel JC. Clinical outcomes and quality of life after low anterior resection for rectal cancer. Eur J Surg 2002;168:297–301.PubMedCrossRefGoogle Scholar
  31. 31.
    Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994;37:916–920.PubMedCrossRefGoogle Scholar
  32. 32.
    Makela J, Turku P, Laitinen S. Analysis of late stomal complications following ostomy surgery. Ann Chir Gynaecol 1997;86:305–310.PubMedGoogle Scholar
  33. 33.
    Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569–1574.PubMedCrossRefGoogle Scholar
  34. 34.
    Bass EM, Del Pino A, Tan A, Pearl RK, Orsay CP, Abcarian H. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum 1997;40:440–442.PubMedCrossRefGoogle Scholar
  35. 35.
    Sprangers MA, Taal BG, Aaronson NK, te Velde A. Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 1995;38:361–369.PubMedCrossRefGoogle Scholar
  36. 36.
    Beck D, Wexner SD eds) Fundamentals of Anorectal Surgery. London: Saunders, 1998.Google Scholar
  37. 37.
    Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg 1996;83:384–388.PubMedCrossRefGoogle Scholar
  38. 38.
    Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996;182:495–502.PubMedGoogle Scholar
  39. 39.
    Enker WE, Havenga K, Polyak T, Thaler H, Cranor M. Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 1997;21:715–720.PubMedCrossRefGoogle Scholar
  40. 40.
    van Driel MF, Weymar Schultz WC, van de Wiel HB, Hahn DE, Mensink HJ. Female sexual functioning after radical surgical treatment of rectal and bladder cancer. Eur J Surg Oncol 1993;19:183–187.PubMedGoogle Scholar
  41. 41.
    Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg 1992;16:478–485.PubMedCrossRefGoogle Scholar
  42. 42.
    Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999;25:368–374.PubMedCrossRefGoogle Scholar
  43. 43.
    Balslev I, Harling H. Sexual dysfunction following operation for carcinoma of the rectum. Dis Colon Rectum 1983;26:785–788.PubMedCrossRefGoogle Scholar
  44. 44.
    NIH CC. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.CrossRefGoogle Scholar
  45. 45.
    Guren MG, Dueland S, Skovlund E, Fossa SD, Poulsen JP, Tveit KM. Quality of life during radiotherapy for rectal cancer. Eur J Cancer 2003;39:587–594.PubMedCrossRefGoogle Scholar
  46. 46.
    Ooi BS, Tjandra JJ, Green MD. Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer: an overview. Dis Colon Rectum 1999;42:403–418.PubMedCrossRefGoogle Scholar
  47. 47.
    Temple LK, Wong WD, Minsky B. The impact of radiation on functional outcomes in patients with rectal cancer and sphincter preservation. Semin Radiat Oncol 2003;13:469–477.PubMedCrossRefGoogle Scholar
  48. 48.
    Dahlberg M, Glimelius B, Graf W, Pahlman L. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998;41:543–549; discussion 549–551.PubMedCrossRefGoogle Scholar
  49. 49.
    Dehni N, McNamara DA, Schlegel RD, Guiguet M, Tiret E, Parc R. Clinical effects of preoperative radiation therapy on anorectal function after proctectomy and colonic J-pouch-anal anastomosis. Dis Colon Rectum 2002;45:1635–1640.PubMedCrossRefGoogle Scholar
  50. 50.
    Nathanson DR, Espat NJ, Nash GM, et al. Evaluation of preoperative and postoperative radiotherapy on long-term functional results of straight coloanal anastomosis. Dis Colon Rectum 2003;46:888–894.PubMedCrossRefGoogle Scholar
  51. 51.
    Ammann K, Kirchmayr W, Klaus A, et al. Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 2003;138:257–261.PubMedCrossRefGoogle Scholar
  52. 52.
    Schag CA, Ganz PA, Heinrich RL. Cancer Rehabilitation Evaluation System-short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument. Cancer (Phila) 1991;68:1406–1413.PubMedCrossRefGoogle Scholar
  53. 53.
    Schag CA, Ganz PA, Wing DS, Sim MS, Lee JJ. Quality of life in adult survivors of lung, colon and prostate cancer. Qual Life Res 1994;3:127–141.PubMedCrossRefGoogle Scholar
  54. 54.
    Schag CA, Heinrich RL, Aadland RL, Ganz PA. Assessing problems of cancer patients: psychometric properties of the cancer inventory of problem situations. Health Psychol 1990;9:83–102.PubMedCrossRefGoogle Scholar
  55. 55.
    Ganz PA, Schag CA, Lee JJ, Sim MS. The CARES: a generic measure of health-related quality of life for patients with cancer. Qual Life Res 1992;1:19–29.PubMedCrossRefGoogle Scholar
  56. 56.
    Heinrich RL, Schag CC, Ganz PA. Living with cancer: the Cancer Inventory of Problem Situations. J Clin Psychol 1984;40:972–980.PubMedCrossRefGoogle Scholar
  57. 57.
    Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol 2002;97:1228–1234.PubMedCrossRefGoogle Scholar
  58. 58.
    Sprangers MA. Quality-of-life assessment in colorectal cancer patients: evaluation of cancer therapies. Semin Oncol 1999;26:691–696.PubMedGoogle Scholar
  59. 59.
    Allal A, Bieri S, Pelloni A, et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 2000;82:1131–1137.PubMedCrossRefGoogle Scholar
  60. 60.
    Grumann MM, Noack EM, Hoffmann IA, Schlag PM. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 2001;233:149–156.PubMedCrossRefGoogle Scholar
  61. 61.
    Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 2003;238:203–213.PubMedGoogle Scholar
  62. 62.
    Ko C, Chaudhry S. The need for a multidisciplinary approach to cancer care. J Surg Res 2002;105:53–57.PubMedCrossRefGoogle Scholar
  63. 63.
    Meyerhardt JA, Catalano PJ, Haller DG, et al. Impact of diabetes mellitus on outcomes in patients with colon cancer. J Clin Oncol 2003;21:433–440.PubMedCrossRefGoogle Scholar
  64. 64.
    Lafata JE, Johnson CC, Ben-Menachem T, Morlock RJ. Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent. Med Care 2001;39:361–372.CrossRefGoogle Scholar
  65. 65.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 2002;359:2224–2229.PubMedCrossRefGoogle Scholar
  66. 66.
    Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs. open colectomy for colon cancer: a randomized trial. JAMA 2002;287:321–328.PubMedCrossRefGoogle Scholar
  67. 67.
    Group COoSTS. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059.CrossRefGoogle Scholar
  68. 68.
    Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer. Ann Surg 2002;236:522–529; discussion 529–530.PubMedCrossRefGoogle Scholar
  69. 69.
    Saclarides TJ. Transanal endoscopic microsurgery: a single surgeon’s experience. Arch Surg 1998;133:598–599.Google Scholar
  70. 70.
    Rothenberger DA, Garcia-Aguilar J. Role of local excision in the treatment of rectal cancer. Semin Surg Oncol 2000;19:367–375.PubMedCrossRefGoogle Scholar
  71. 71.
    Blair S, Ellenhorn JD. Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology. Am Surg 2000;66:817–820.PubMedGoogle Scholar
  72. 72.
    Furst A, Burghofer K, Hutzel L, Jauch KW. Neorectal reservoir is not the functional principle of the colonic J-pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis. Dis Colon Rectum 2002;45:660–667.PubMedCrossRefGoogle Scholar
  73. 73.
    Furst A, Suttner S, Agha A, Beham A, Jauch KW. Colonic J-pouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study. Dis Colon Rectum 2003;46:1161–1166.PubMedCrossRefGoogle Scholar
  74. 74.
    Ho YH, Brown S, Heah SM, et al. Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 2002;236:49–55.PubMedCrossRefGoogle Scholar
  75. 75.
    Heald RJ. Total mesorectal exsicion (TME). Acta Chir Iugosl 2000;47:17–18.PubMedGoogle Scholar
  76. 76.
    Merchant NB, Guillem JG, Paty PB, et al. T3N0 rectal cancer: results following sharp mesorectal excision and no adjuvant therapy. J Gastrointest Surg 1999;3:642–647.PubMedCrossRefGoogle Scholar
  77. 77.
    Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000;92:388–396.PubMedCrossRefGoogle Scholar
  78. 78.
    Meagher AP, Ward RL. Current evidence does not support routine adjuvant radiotherapy for rectal cancer. ANZ J Surg 2002;72:835–840.PubMedCrossRefGoogle Scholar
  79. 79.
    Masui H, Ike H, Yamaguchi S, Oki S, Shimada H. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum 1996;39:1140–1145.PubMedCrossRefGoogle Scholar
  80. 80.
    Waddell WR, Ganser GF, Cerise EJ, Loughry RW. Sulindac for polyposis of the colon. Am J Surg 1989;157:175–179.PubMedCrossRefGoogle Scholar
  81. 81.
    Giardiello FM, Yang VW, Hylind LM, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac. N Engl J Med 2002;346:1054–1059.PubMedCrossRefGoogle Scholar
  82. 82.
    Ishikawa H, Akedo I, Suzuki T, Narahara H, Otani T. Adverse effects of sulindac used for prevention of colorectal cancer. J Natl Cancer Inst 1997;89:1381.PubMedCrossRefGoogle Scholar
  83. 83.
    Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003;348(10):891–899.PubMedCrossRefGoogle Scholar
  84. 84.
    Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003;348:883–890.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Clifford Y. Ko
    • 1
  • Patricia A. Ganz
    • 2
    • 3
  1. 1.Department of SurgeryUCLA School of Medicine-West Los Angeles VA Medical CenterLos AngelesUSA
  2. 2.Division of Cancer Prevention and Control ResearchJonsson Comprehensive Cancer Center at UCLAUSA
  3. 3.Schools of Public Health and MedicineUniversity of CaliforniaLos AngelesUSA

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