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etween 59 and 85 percent. However, there is a subset of patientswith stage II cancers who do benefit from adjuvant chemotherapy.Stage III colorectal cancers exist when cancer is present in one ormore lymph nodes with any level of bowel wall penetration. Colonresection and, in most cases, postoperative chemotherapy yield a fiveyearsurvival rate between 44 and 84 percent depending on the subsetwithin stage III cancers.Stage IV colorectal cancers are present when cancer hasmetastasized to other locations in the body and has a five-year survivalof 10 percent or less. Surgical resection of the primary cancer site isappropriate in almost all cases. When surgical or radiation therapytreatment can be used to eliminate all metastatic disease, the patient’sfive-year survival may approach 25 percent. Radiation therapy is usedin select cases and chemotherapy is recommended for all.With rectal cancer, preoperative radiographic testing is critical todetermine the proper treatment recommendations. Rectal ultrasoundand, more recently, rectal MRI (which is available at St. Anthony’s) areused to identify whether the cancer is stage I, II or III before surgery.Stage I rectal cancers are treated with surgery alone and yield afive-year survival rate of 70-80 percent. Both stage II and stage IIIrectal cancers are treated most often with preoperative radiation andchemotherapy followed by an appropriate rest period before surgicalresection. In nearly all cases, these patients should receive furtherchemotherapy after healing from their surgery. Five-year survival ratesfor stage II is 50-60 percent and stage III is 30-40 percent.Stage IV rectal cancers are treated similarly to stage IV coloncancers.All of the latest treatments for colorectal cancer are available atSt. Anthony’s Medical Center. State-of-the-art surgical treatmentsinclude laparoscopic colectomy and other minimally invasive surgicaltechniques to remove the cancer. Transanal endoscopic microsurgeryis available for select early rectal cancers. This outpatient procedureallows the patient to return to work and a normal lifestyle within afew days. Today, with rare exception, if patients have a rectal cancerthat does not directly invade the anal canal, they can be reassured apermanent colostomy will not be necessary.As described, even when colon and rectal cancers are treatedwith the latest and most sophisticated techniques, some patientswill develop a cancer recurrence. Careful monitoring is critical aftertreatment for a minimum of five years with an appropriate history,physical examination, laboratory evaluations and radiographic testing.When patients have their recurrent cancer detected early, and treatedwith the selective use of surgery, radiation and/or chemotherapy,there is a greater probability for improved quality of life and, in someinstances, cure.10David Schuval M.D. FACS FASCRS