Initial Presentation With Stage IV Colorectal Cancer

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Abstract
COLORECTAL carcinoma is the second most frequently diagnosed malignant neoplasm, with more than 130,000 new cases and 57,000 deaths occurring annually in the United States.1 Surgery is the primary treatment for patients with localized disease and results in cure in 50% of patients. However, approximately 20% of patients with colorectal carcinoma are initially seen with stage IV disease, and their 5-year survival is dismal.2 Patients with colorectal cancer and synchronous stage IV disease represent a heterogeneous group of patients. A small subset of patients will have potentially resectable synchronous hepatic metastases. The vast majority, however, have variable metastatic tumor burden that is unresectable in the setting of either a symptomatic or an asymptomatic primary lesion. The treatment of this group of patients is not well defined.