Best Supportive Care

**205**

**Chapter 10**

Cancer

**Abstract**

*Ricardo Caponero*

survival advantages.

**1. Introduction**

Palliative Care in Colorectal

**Keywords:** palliative care, supportive measures, symptom control

cumulative risk of onset between 0 and 74 years [3].

intent, with improvements in a 5-year survival [7].

remains the main prognostic factor.

Approximately 25% of patients present with liver metastases at the time of the first diagnosis and up to 50% will further develop recurrence in the liver during their disease course. Traditionally approached surgically, by resection of the primitive tumor or stoma, the management to incurable stage IV colorectal cancer patients has significantly changed over the last three decades and is nowadays multidisciplinary, with a pivotal role played by chemotherapy. Most patients with stage IV colorectal cancer have a poor prognosis, but numerous palliative modalities are available today. When a cure is no longer possible, treatment is directed toward providing symptomatic relief. Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer

Cancer is a major public health problem worldwide, and colorectal cancer is the third most diagnosed cancer among both men and women in the United States [1], Brazil [2] and, overall, it is the third more frequent malignant disease around the world (1.85 million of new cases/years; 10.2% of total malignancies), with a 2.27%

The mortality from colorectal cancer varies with several factors from the genetic variations of disease to the developmental status of a nation. Tumor staging

The last two decades have seen substantial progress in the treatments to metastatic disease offering significant improvements in survival. According to SEER, the 5-year relative survival rate for patients diagnosed from 2008 to 2012 was about 64% for all stages taken together, and it was 14% for patients with metastatic disease [4]. At the time of first diagnosis, approximately 25% of patients present stage IV, with liver metastases, and up to 50% will develop recurrence in the liver during the disease course [5]. Most of these patients have liver metastasis considered unresectable at presentation [6], but about 20–30% of patients have a resectable disease that is confined to the liver [3], and despite a metastatic diagnosis, a half these of patients may benefit from the surgical resection of liver metastasis with curative

Colorectal cancer survival disparities are largely driven by socioeconomic inequalities that result in differences in access to early detection tests, refinements in molecular diagnosis, and the receipt of timely, high-quality treatment [8].
