Preface

Colorectal cancer is the third leading cause of cancer death in the world, and its incidence is steadily increasing in developing nations. Yet, the majority of colorectal cancer is sporadic and largely attributable to the constellation of modifiable environmental risk factors characterizing westernization (e.g., obesity, physical inactivity, poor diets, alcohol drinking and smoking). As such, the burden of colorectal cancer is shifting towards low-income and middle-income countries as they become westernized. This book examines state-of-the-art research relating to the etiology, diagnosis, prevention and treatment of colorectal cancer. Section 1 presents the epidemiological aspect. Section 2 discusses imaging in diagnosis and treatment. Sections 3 and 4 explore surgery and related aspects. Section 5 concludes with a discussion of palliative care.

Given the complex physiopathology of colorectal tumors, treatment and management approaches should not be limited to a single specialty but should involve a number of specialties (surgery, gastroenterology, radiology, biology, oncology, radiotherapy, nuclear medicine, physiotherapy) in an integrated fashion. This book encompasses this concept, as Jim Valvano remembers: "Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul."

**II**

**Chapter 7 129**

**Chapter 8 161**

**Chapter 9 183**

Best Supportive Care **203**

**Chapter 10 205**

*by Ana João Pissarra, Catarina Abreu, André Mansinho, Ana Lúcia Costa,* 

*Sara Dâmaso, Soraia Lobo-Martins, Marta Martins and Luís Costa*

Landscape of Current Targeted Therapies for Advanced

Colorectal Cancer

**Section 5**

*by Ricardo Caponero*

Adjuvant Therapies in Colon Cancer *by Thiru Prasanna and Desmond Yip*

Palliative Care in Colorectal Cancer

Retinoids in Treatment of Colorectal Cancer *by Caroline O.B. Facey and Bruce M. Boman*

> **Alberto Vannelli** Director, General Surgery (Valduce Hospital), Como, Italy

Section 1

Epidemiology

**1**

Section 1 Epidemiology

**Chapter 1**

**Abstract**

**1. Introduction**

**3**

Public Health: Prevention

interactive intervention strategies need to be empower.

**Keywords:** screening, prevention, FOBT, colonoscopy, fecal test

Nowadays, colorectal cancer prevention strategies play an essential role in reducing the incidence and mortality of the cases. A well-designed and establishment of the clinical pathway of screening programme needed in all country. Types of screening tools used may vary between the country with the use of FOBT and colonoscopy. The standard guideline related to screening programme such as for high-risk group should be emphasized more as compared to the low-risk group. The uptake of screening for CRC should be highlighted more as the program have showed a significantly reduction of the cases and mortality. The barrier of CRC screening uptake mainly due to poor awareness, discomfort, low physician recommendation, low socioeconomic and improper screening programme. Therefore others prevention strategies beside screening program such as health education and

Colorectal cancer (CRC) incidence and mortality rates vary across worldwide,

with distinct gradients across human development levels were seen, pointing towards an increasing burden in countries in transition. In general, CRC incidence and mortality rates are still rising rapidly in many low-income and middle-income countries, particularly in Eastern Europe, Asia, and South America. While stabilizing or decreasing trends are seen in highly developed countries such as Japan, the United States and Australia, where rates remain among the highest in the world [1]. CRC mortality can be reduced if cases are detected and treated early. When identified early, CRC is more likely to respond to effective treatment and can result in a greater probability of surviving, less morbidity, and less expensive treatment. On the other hand, CRC screening aims to identify individuals with abnormalities suggestive of cancer or pre-cancer who have not developed any symptoms and to refer them for diagnosis and treatment. Nonetheless, a screening program is a far

more complex public health intervention compared to early diagnosis [2].

CRC screening programs are currently underway in most European countries, Canada, specific regions in North and South America, Asia, and Oceania. The most comprehensive screening strategies were based on fecal occult blood testing, and more recently, the fecal immunochemical test (FIT) [3]. While other options for CRC screening are fecal immunochemical test annually, guaiac-based fecal occult

**2. Colorectal cancer screening programs**

*Azmawati Mohammed Nawi*
