title: Future directions for the early detection of colorectal cancer recurrence.
abstract: Surgical resection remains a mainstay of treatment and is highly effective for localized colorectal cancer. However, ~30-40% of patients develop recurrence following surgery and 40-50% of recurrences are apparent within the first few years after initial surgical resection. Several variables factor into the ultimate outcome of these patients, including the extent of disease, tumor biology, and patient co-morbidities. Additionally, the time from initial treatment to the development of recurrence is strongly associated with overall survival, particularly in patients who recur within one year of their surgical resection. Current post-resection surveillance strategies involve physical examination, laboratory, endoscopic and imaging studies utilizing various high and low-intensity protocols. Ultimately, the goal is to detect recurrence as early as possible, and ideally in the asymptomatic localized phase, to allow initiation of treatment that may still result in cure. While current strategies have been effective, several efforts are evolving to improve our ability to identify recurrent disease at its earliest phase. Our aim with this article is to briefly review the options available and, more importantly, examine emerging and future options to assist in the early detection of colon and rectal cancer recurrence.
authors.affiliation: 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA.
authors.forename: Avery S
authors.initials: AS
authors.lastname: Walker
authors.affiliation: 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: 2. University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.affiliation: 3. Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Stojadinovic
authors.affiliation: 4. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.affiliation: 5. Bon Secours Cancer Institute, Richmond VA, USA.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Brucher
authors.affiliation: 6. University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
authors.affiliation: 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
keywords: Colorectal cancer; biomarkers.; recurrence