CHANGING SURVIVAL PROSPECTS IN RECTAL AND COLONIC CANCER

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Abstract
Cancer specific survival analysis in a series of 2204 patients managed for large-intestinal cancer shows a worsened outcome for patients treated operatively for rectal cancer from 1970-1979 in comparison with the 2 previous decades (P < 0.05). Cancer specific survival after curative resection has also worsened (P < 0.001). These changes are partly explained by an increase in Dukes'' stage C tumors (P = 0.01). Paradoxically, the deterioration has been paralleled by earlier diagnosis (P < 0.01). The worsened outcome cannot be accounted for by changes in sex or age distribution, tumor site, patient referral pattern or by an increase in sphincter-saving operations. The hypothesis advanced that a real change has occurred in the behavior of rectal cancer in the Australian community requires further testing. There has been no significant change in survival prospects between the last 2 decades for colonic cancer patients treated operatively. A national cancer registry should be established to monitor changes in the epidemiology and survival prospects of large-intestinal cancer and other malignancies.