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World J Gastroenterol. Dec 14, 2013; 19(46): 8468-8473
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8468
Early stage colon cancer
Hugh James Freeman
Hugh James Freeman, Department of Medicine, University of British Columbia, Vancouver V6T 1W5, Canada
Author contributions: Freeman HJ solely contributed to this paper.
Correspondence to: Hugh James Freeman, MD, CM, FRCPC, FACP, Professor, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver V6T 1W5, Canada. hugfree@shaw.ca
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: September 29, 2013
Revised: November 6, 2013
Accepted: November 28, 2013
Published online: December 14, 2013
Abstract

Evidence has now accumulated that colonoscopy and removal of polyps, especially during screening and surveillance programs, is effective in overall risk reduction for colon cancer. After resection of malignant pedunculated colon polyps or early stage colon cancers, long-term repeated surveillance programs can also lead to detection and removal of asymptomatic high risk advanced adenomas and new early stage metachronous cancers. Early stage colon cancer can be defined as disease that appears to have been completely resected with no subsequent evidence of involvement of adjacent organs, lymph nodes or distant sites. This differs from the clinical setting of an apparent “curative” resection later pathologically upstaged following detection of malignant cells extending into adjacent organs, peritoneum, lymph nodes or other distant sites, including liver. This highly selected early stage colon cancer group remains at high risk for subsequent colon polyps and metachronous colon cancer. Precise staging is important, not only for assessing the need for adjuvant chemotherapy, but also for patient selection for continued surveillance. With advanced stages of colon cancer and a more guarded outlook, repeated surveillance should be limited. In future, novel imaging technologies (e.g., confocal endomicroscopy), coupled with increased pathological recognition of high risk markers for lymph node involvement (e.g., “tumor budding”) should lead to improved staging and clinical care.

Keywords: Colon cancer, Node-negative colon cancer, Staging of colon cancer, Nodal micrometastases, Follow-up and surveillance of early colon cancer

Core tip: Evidence has now accumulated that colonoscopy and removal of polyps, especially during screening and surveillance programs, is effective in overall risk reduction for colon cancer. After resection of malignant pedunculated colon polyps or early stage colon cancers, long-term repeated surveillance programs can also lead to detection and removal of asymptomatic high risk advanced adenomas and new early stage metachronous cancers. In future, novel imaging technologies (e.g., confocal endomicroscopy), coupled with increased pathological recognition of high risk markers for lymph node involvement (e.g., “tumor budding”) should lead to improved staging and clinical care.