Chemotherapy in Colorectal Cancer - Past, Present and Future

Colorectal cancer (CRC) ranks fourth among the most commonly diagnosed cancers worldwide and second most frequent cause of cancer related deaths in USA. Every year about 1,023,000 new cases and 5,29,000 deaths are estimated to occur. In 2005, USA alone will have 1, 45,290 new cases and 56,290 deaths. Pathological stage at presentation is the most important prognostic indicator in CRC. The TNM system of staging (by AJCC-American Joint Committee on Cancer) has now mostly replaced the original and modified Dukes’ staging system. Fiveyear survival based on this TNM staging is reflected in Table-I. About 30% of patients with this malignancy present in advanced stage and 50% of those who present in early stage develop advanced recurrence during their life time. Early stage disease can be managed with satisfactory long term results by surgery alone. Advanced stage disease poses particular problems and is incurable.