Clinical Practice Guidelines - National Health and Medical Research ...

Clinicopathological staging, rectal cancer
PubMed — one RCT
Colorectal Cancer staging
Cochrane Library — three systematic reviews, nine RCTs
Clinical evidence — three
Ovid — 1one review
MD Consult — three
PubMed — nine meta-analyses
PubMed — 85 RCTs
Comments
Clinicopathological staging and reporting involving use of minimum data set. The clinical and
histological findings are outlined in Sections 14.1 and 14.2, including Tables 14.1, 14.2 and 14.3.
This chapter is essentially unchanged. It relates to ‘the classification of the tumour according to the
extent of spread in a manner that has a clinically useful correlation with prognosis’.
References to specific imaging techniques such as MRI, PET and CT scanning do not relate to staging
in its true sense; rather, they represent modalities of investigation for assessing the extent of the
tumour spread at the time of diagnosis (see Chapter 8). Staging requires surgical and histopathological
input as outlined in the guidelines to confer a stage on the tumour. Imaging modalities do not relate to
prognosis in a statistically reproducible fashion and therefore, strictly speaking, they make no
contribution to staging in the pure sense of the word.
There is no known, reliable preoperative staging system that correlates accurately with patient
survival.
Chapter 15 and 16 — Adjuvant therapy for colon cancer and adjuvant therapy
for rectal cancer
Search strategy
A systematic literature search was performed of the Medline database (January 1996 – January 2003).
The Cochrane Library 2002 Issue 4 was also searched using the search phrases ‘colorectal’, ‘colon’,
‘rectal’ and ‘cancer’. A title alert was set up on Zetoc, the British Library Electronic Table of
Contents service, using the terms ‘colon’ and ‘adjuvant’ (July 2002 – July 2003) to identify new
articles as they were published. Hand searches were conducted of Conference Proceedings of the
American Society of Clinical Oncology (1996–2003), the European Cancer Conference (1999, 2001,
2002), European Society of Therapeutic Radiation Oncology (2002) and the American Society for
Therapeutic Radiation and Oncology (2001–2003).
Further searches of the Cochrane Database of Systematic Reviews, BMJ Clinical Evidence, Ovid,
EBMR and PubMed to June 2004, using search terms ‘surgery’ and ‘rectal cancer’ revealed the
following results.
Dates
Update of 1999 document from 1996 to 2004
Literature review 307