Colorectal cancer: what has changed in diagnosis and treatment over the last 50 years?
OBJECTIVE
This overview focuses on what has changed in the diagnosis and treatment of colorectal cancer over the last 50 years.


METHODS
The most important international registers (SEER, European and Italian) as well as the literature have been consulted. Furthermore, many prognostic factors are analyzed with the aim to understand the reasons why 5-year survival has improved over the last two decades.


RESULTS
Since the biologic characteristics of the tumor cannot be changed, improved survival must be supported by concomitant multiple factors, such as earlier diagnosis (as given by a more informed educational behavior and the advent of screening) as well as the wide use of colonoscopy and the technical improvement of surgical and medical treatment. However, it seems that the greatest improvement in survival is limited to 5-year controls, whereas long-term survival does not appear to show any significant improvement.


CONCLUSIONS
We can hypothesize that our efforts have just delayed the inevitable end: death. Nevertheless, further research should be done to confirm this hypothesis, perhaps in the field of molecular biology, which may also be the right approach to understanding the biologic aggressiveness of each tumor.
Gennari
Leandro
L
IRCCS Istituto Clinico Humanitas, Rozzano (Milan), Italy. leandro.gennari@humanitas.it
Russo
Antonio
A
Rossetti
Carlo
C
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D011230:Precancerous Conditions / Q000175:diagnosis; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents