Treatment and Prognosis



The only effective treatment is surgical removal of the tumor and the adjacent colon and mesen­tery. Hemicolectomy is usually performed for rightsided and leftsided tumors; anterior resec­tion with anastomosis to the rectal stump for sig­moid or upper rectal tumors; and a combined abdominal-perineal resection with a permanent colostomy for lesions within 5 cm of the anal verge. Surgery may also be indicated for palliation even in the presence of obvious metastatic disease when there is obstruction, perforation, or hem­orrhage. Radiation therapy is used most fre­quently for pelvic recurrences or painful metas­tases, particularly in bone and sometimes in liver. Chemotherapy, usuallv with 5-fluorouracil. has been used in the treatment of hepatic metastases, but with onlv modest success.

The results of the surgical treatment of early car­cinoma of the large bowel are excellent, with 80 to 90 per cent 10-year survival for mucosal le­sions, 60 to 80 per cent with bowel wall invasion, and as high as 50 to 60 per cent even when re­gional nodes are involved. Postoperatively each patient must be followed closely for recurrence using colonoscopy, radiographic procedures, and measurements of CEA in a regular schedule over many years.





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