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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Second Colorectal Cancer in Patients Who Had First Colon Cancer Treated with Surgery and Chemotherapy
19 February 2002 | Volume 136 Issue 4 | Page I29
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Surveillance for Second Primary Colorectal Cancer after Adjuvant Chemotherapy: An Analysis of Intergroup 0089." It is in the 19 February 2002 issue of Annals of Internal Medicine (volume 136, pages 261-269). The authors are RJ Green, JP Metlay, K Propert, PJ Catalano, JS Macdonald, RJ Mayer, and DG Haller.
What is the problem and what is known about it so far?
Colorectal cancer is cancer of the colon (large intestine) or rectum. Second colorectal cancer can occur in patients after treatment for first colon cancer. For this reason, patients typically have surveillance with periodic colonoscopy after treatment for colon cancer. Colonoscopy involves looking into the rectum and colon through a tube-shaped instrument for precancerous abnormalities or tumors. Current recommendations suggest that patients should have colonoscopy 1 year after treatment; then, if the results of the first colonoscopy are normal, they should have colonoscopy every 3 to 5 years. However, it is not known whether this follow-up is adequate because limited information is available about the frequency and timing of second cancer.
Why did the researchers do this particular study?
To learn more about the frequency and timing of second colorectal cancer after treatment for first colon cancer.
Who was studied?
3278 patients treated with surgery and chemotherapy for colon cancer that had not spread beyond the intestine or intestinal lymph nodes (stage II and stage III). All of the patients were participating in a large study of chemotherapy that began in 1989.
How was the study done?
The researchers collected information about patients every 3 months for the first year, then every 6 months for 4 years, and then every year until death or the end of the study. Information collected included whether any surveillance procedures were done and whether second colorectal cancer was detected. The researchers then compared the rates of second colorectal cancer in study patients with the rates of first colorectal cancer in two comparison groups: 1) the general U.S. population during the same time period and 2) patients who participated in the National Polyp Study, a large study to see whether frequent colonoscopy and removal of any polyps found decreased colorectal cancer.
What did the researchers find?
Despite surveillance, the rate of second cancer after treatment for first colon cancer was higher than the cancer rates in the two comparison populations. In addition, patients' cancer was diagnosed during a relatively short period after their most recent colonoscopy.
What were the limitations of the study?
While this study shows that the rates of second colon cancer are higher in the patients studied than in the comparison groups, it does not prove that more frequent colonoscopy would result in better patient outcomes.
What are the implications of the study?
Despite surveillance, the rates of second colorectal cancer in patients who have had treatment for first colon cancer are high. This information will be useful in developing better strategies to reduce the rates of second cancer and associated rates of death.
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