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

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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
Search terms MeSH terms were ‘colorectal neoplasms’, ‘colonic neoplasms’, ‘rectal neoplasms’, ‘randomised controlled trials’ and ‘chemotherapy adjuvant’. Additional keywords used included ‘adjuvant’, ‘Colorectal Cancer’, publication type and ‘reviews’. Inclusion/exclusion criteria Relevance of reference. Quality of trials, and shortcomings where present, are discussed in text. All identified randomised trials not included in meta-analyses 4, 32, 44, 45 in Chapter 15 and 26, 27, 28 and 29 in Chapter 16 were included in references for the chapters. Results One hundred and thirteen (113) randomised trials were retrieved from PubMed 1 January 1998 to June 2004 and reviewed by the authors of Chapters 12, 15, 16 and 19. Most were not relevant to Chapters 15 and 16; however, seven trials were appropriate and incorporated into Chapters 15 and 16. Comments Recent review articles, meta-analyses and clinical guidelines were identified. The trials listed in these were crosschecked with references that were found by the searches above. The writing committee consisted of two authors who reviewed the trials. The chapters from the first edition of the guidelines were rewritten incorporating updates of trials and reviews in the original chapters, as well as the new trials identified. Formal meta-analysis was not carried out. The drafts were then circulated for external review by five medical oncologists, three radiation oncologists and three colorectal surgeons. Suggestions and feedback were incorporated in the drafts before they were considered by the main Working Party for these guidelines. Chapter 17 — Follow up after curative resection for Colorectal Cancer Search strategy PubMed, Cochrane Library Dates Update of 1999 document from 1 January 1998 – 1 June 2004 (date limits extended if relevant article not previously cited) Search terms Follow up, curative resection, Colorectal Cancer Inclusion/exclusion criteria Headings of subsections in chapter served as search terms. Relevance to chapter subheadings if reference to be included. Articles were excluded if they were not published in English; if they were not found to be relevant to the subject; if they were not relevant to Australian practices, for example, medication such as antibiotics not in routine use in Australia; or if the full publication was not readily available either online or through library resources. Results Two recent meta-analyses relating to intensive follow up and cost-effectiveness were identified and incorporated in the text. No other relevant studies were identified — most related to specific chemotherapeutic follow-up approaches. 308 The prevention, early detection and management of colorectal cancer
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Clinical Practice Guidelines FOR TH
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© The Cancer Council Australia/Aus
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2.11 Conclusions...................
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11.2 High ligation ................
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17.4 Cost effectiveness of follow u
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Table 14.3 Pathological TNM staging
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Executive Summary • Colorectal Ca
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STRENGTH OF RECOMMENDATIONS 2,3 The
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Should red meat intake be altered t
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Chapter Recommendations 4 COMMUNICA
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Chapter 8 Recommendations How shoul
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Chapter Recommendations Should bowe
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Chapter Recommendations When should
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Chapter 17 Recommendations What pos
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Section I Early Colorectal Cancer
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Adenomatous polyps (adenomas) are b
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17. South Australian Cancer Registr
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CHAPTER 2 PRIMARY PREVENTION Studie
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Colorectal adenomas, especially adv
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vegetable (3.5 serves/1000 kcals) d
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mustard greens, swedes and turnips)
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for protection against Colorectal C
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Does selenium supplementation reduc
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the optimal duration of use, and ad
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References 1. Jass JR. Pathogenesis
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34. Kushi L, Giovannucci E. Dietary
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67. Fearon ER, Vogelstein B. A gene
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100. Il'yasova D, Hodgson ME, Marti
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133. Meyskens FL, Jr., Gerner EW. D
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CHAPTER 3 POPULATION SCREENING FOR
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studies also demonstrate that age i
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• symptoms • family medical his
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Should screening be recommended? Gu
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Box 3.3 Screening Pathway used in t
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References 1. Young GP, Levin B, Ro
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33. Alexander F, Weller D. Evaluati
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CHAPTER 4 COMMUNICATION WITH THE PA
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4.6 Coordination of care Treatment
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• assistance with and care of chi
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17. National Breast Cancer Centre,
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CHAPTER 5 THE PATIENT WITH SYMPTOMS
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considered (see 8.1.5). Double cont
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58 The prevention, early detection
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diagnoses prove difficult to confir
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What recommendations are there for
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References 1. Woolf CM. A genetic s
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34. Australian Health Technology Ad
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CHAPTER 7 HIGH-RISK FAMILIAL COLORE
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offered predictive genetic testing.
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endoscopically uncontrollable numbe
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mutation carriers. 52 There is also
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standard for consideration of MSI a
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added to transvaginal ultrasound. 8
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category 2, see Chapter 6) but may
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What screening is recommended for e
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References 1. Vasen HF, Griffioen G
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33. Giardiello FM, Hamilton SR, Kru
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international criteria for the dete
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96. Burt RW, Jass JR. Hyperplastic
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8.1.2 Sigmoidoscopy: rigid versus f
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For radiological imaging of the lar
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8.2.3 Staging for distant metastase
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The feelings and fears of the patie
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18. Rex DK, Cutler CS, Lemmel GT et
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52. Liu SK, Church JM, Lavery IC, F
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strong family history of Colorectal
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A screening interval of 4-6 years i
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BRAF mutation, particularly when mu
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18. Jass JR, Young J, Leggett BA. E
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52. Jass JR, Young J, Leggett BA. H
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What is the role of the stomal ther
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What happens if a blood transfusion
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References 1. Bass EM, Del Pino A,
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32. The National Working Party on t
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CHAPTER 11 ELECTIVE SURGERY FOR COL
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Total or subtotal colectomy may be
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11.12 Self-expanding metal stents f
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18. Gall FP, Tonak J, Altendorf A.
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etween 1993 and 1999. The local rec
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When should local excision of recta
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What factors influence sphincter pr
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It has been demonstrated that there
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References 1. Smith TJ, Hillner BE,
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36. Vernava AM, III, Moran M, Rothe
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69. Pimentel JM, Duarte A, Gregorio
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A clinical diagnosis of large bowel
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When should primary anastomosis be
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17. Deans GT, Krukowski ZH, Irwin S
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Table 14.1 Clinicopathological stag
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The ACPS system embodies the simpli
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14.4 Translation between staging sy
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16. Shepherd NA, Baxter KJ, Love SB
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CHAPTER 15 ADJUVANT CHEMOTHERAPY FO
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isk of death-favouring treatment (H
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improvement in survival at five yea
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There has been one trial 55 of intr
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References 1. National Institute of
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30. Zaniboni A, Labianca R, Marsoni
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57. Gastrointestinal Tumour Study G
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CHAPTER 16 ADJUVANT THERAPY FOR REC
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preoperative RT 45Gy over 5 weeks s
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This suggests that a policy of preo
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Mortality from non-cancer causes wa
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References 1. Fu KK. Interactions o
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29. Swedish Rectal Cancer Trial. Im
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Rates of intraluminal recurrence an
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Ultrasonographic screening Ultrason
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References 1. Nava HR, Pagana TJ. P
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• those with a history of psychia
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References 1. Maisey NR, Norman A,
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CHAPTER 19 RECURRENT AND ADVANCED C
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What are the recommendations for in
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References 1. National Health and M
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31. Phillips RK, Hittinger R, Bleso
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Recurrent and advanced colorectal c
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(23% compared to 12%, p
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more patients having disease down-s
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References 1. Best L, Simmonds P, B
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30. Fuchs CS, Moore MR, Harker G, V
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CHAPTER 21 MANAGEMENT OF LIVER AND
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21.1.3 Imaging controlled destructi
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Does combination systemic chemother
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References 1. Woodington FF, Waugh
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34. Wood BJ, Ramkaransingh JR, Fojo
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66. Headrick JR, Miller DL, Nagorne
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Management of liver and other dista
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years gained can be assessed, which
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‘If neither of the above cases ap
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Study Country Study questions Concl
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Study Country Comparator/ screening
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Page 347 and 348: However, in some cases it was also
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Page 363 and 364: Chemotherapy The use of drugs (whic
Page 365 and 366: Malignant Cancerous Malignant cells
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