ABC of colorectal cancer: Treatment of advanced disease

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Abstract
Advanced colorectal cancer can be defined as colorectal cancer that at presentation or recurrence is either metastatic or so locally advanced that surgical resection is unlikely to be carried out with curative intent. Despite most patients undergoing potentially curative surgery and the availability of adjuvant chemotherapy, about 50% of patients presenting with colorectal adenocarcinoma die from subsequent metastatic disease. The five year survival rate for advanced colorectal cancer is lower than 5%. In the past few years several therapeutic advances—underpinned by multiprofessional, site specialised team working—have finally changed the view that advanced colorectal cancer is an untreatable disease. Although cytotoxic chemotherapy is not suitable for all patients, widespread use in appropriate situations can improve survival and quality of life Local recurrence of a tumour is more common in rectal than colon primaries. It may be identified early in the asymptomatic phase by follow up monitoring or may present with similar symptoms to the primary lesion. Blood loss through the rectum, mucous discharge, altered bowel habit, and straining are common features of recurrent rectal cancer. Pain and urinary symptoms are features of localised pelvic recurrence. Recurrent intra-abdominal disease can present as small or large bowel obstruction, and recurrence at other sites may be indicated by focal features such as hepatic capsular pain, jaundice, dyspnoea, localised bone pain, or neurological symptoms. Systemic features of weight loss, anorexia, nausea, and asthenia are symptoms commonly associated with advanced colorectal cancer. The tumour is often palpable on rectal or abdominal examination, and malignant ascites may also be evident. #### Clinical presentation

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