**13. Tertiary prophylaxis of CRC**

Follow-up, chemoprevention and polypectomy are cornerstones of tertiary CRC prvention. Tertiary prevention is performed after surgical treatment for CRC and its aim is elongation of the survival and improvement of the quality of life of patients who have been treated with resection for curable CRC. This purpose can be achieved by treatment of the patient's complaints, which are connected with the primary disease or with the systemic chemotherapy, as well and by disclosure of relapses in early and curable stage. We have not to forget, that occupational and psychosocial rehabilitation are very important in these patients. Large studies, which offer standard approach to these patients, are missing. Nevertheless, the following factors must be considered: tumor stage, general condition of the patient and life expectancy, and the patient's gain from treatment with a new, potentially curable surgeon intervention in case with proven relapse of CRC. 8,4 % of our patients develop metachronous CRC with mean age 69±11 years. The mean difference between diagnosis (CRC) of first and second localization is 6 years (2-15). This is the time for tertiary prophylaxis of CRC.

Follow-up of patients with CRC is achieved by: personal history, physical examination, carcinoembryonic antigen (CEA) test, lab tests, fecal occult blood test, chest X-ray, abdominal ultrasound, echo-endoscopy, CТ, MRI, colonoscopy and PET-CT.

In conclusion, primary prophylaxis of the disease is the ultimate aim of every clinical physician. Can we apply the primary prophylaxis in colorectal adenomas and CRC? Encouraging examples for this possibility exist. Low physical activity, high uptake of saturated fats and arterial hypertension were recognized as risk factors for cardiovascular diseases. For a few years broad public campaigns resulted in dramatic reduction of mortality from coronary heart disease. Similar results are obtained and in some countries, in which restrictive government politics for tobacco smoking exists. No single factor is responsible for CRC carcinogenesis, but combination of some important factors, which are associated with the diet and lifestyle, is crucial.

May be the true pathway is to seek some average healthy diet and lifestyle, which play preventive role for many diseases. This recommendation is especially useful for the persons who are genetically predisposed, because the environmental risk factors can promote faster carcinogenesis.

Revival of the healthy Balkan (Bulgarian) feeding habits from the first half of the 20-th century seems reasonable (Ribarova et al., 2004). More protective foods must be included in our daily meal and this task looks feasible. We have to consume regularly fruit, vegetables, cereals, low-fat dairy products, legumes, poultry, fish, sea products, fibers and to reduce the intake of animal fats, red meat and preserved food. We have to be physical active, restrict alcohol usage, and to avoid tobacco smoking and usage of grilled and fried food.

Many countries introduced a large scale programs for reduction of risk factors and promotion of protective factors for CRC. Besides that, such programs are useful and for prophylaxis of cardiovascular diseases, some other cancers and important metabolite diseases, like diabetes mellitus II type and obesity.
