Colorectal Cancer Management: Evolving Recommendations

Author: Paul F. Engstrom MD
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The October 2007 issue of JNCCN focuses primarily on colorectal cancer (CRC), with the updated guidelines for CRC diagnosis and management leading the issue. These guidelines emphasize the now multidisciplinary nature of therapy for a disease that was once believed to be surgical: if the surgeon did not remove all of the cancer with adequate margins, patients were destined to develop recurrence. Chemotherapy and radiotherapy were considered salvage or palliative treatment at best. Fortunately, the days of unacceptable recurrence rates and ineffective chemotherapy are past. The NCCN CRC Guidelines Panel reflects this modern approach. Not only does the panel include colorectal surgeons who practice in the busiest academic cancer centers in the country, but radiotherapists, medical oncologists, gastroenterologists, and pathologists who are also highly focused on CRC are included as well. This panel should be commended for producing a critical document that is also understandable for the practicing community. The NCCN staff have done yeomen work to faithfully present the panel's recommendations in a readable format, and they also deserve credit for transforming the guidelines discussion into a scholarly narrative article that documents the rationale behind the guideline recommendations with the appropriate citations. The guidelines algorithms and manuscripts are the most current “textbook” any clinician could desire for education and as a reference for managing CRC patients in his or her practice. This issue also includes authored manuscripts—focused commentaries on 4 of the most controversial and important issues to the clinical management of CRC today. First, Cooper summarizes current literature...

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Paul F. Engstrom, MD, is Senior Vice President for Extramural Research Programs and Medical Director of the Fox Chase Cancer Center Partners Program and Professor of Medicine at Temple University School of Medicine.

Dr. Engstrom is board certified in internal medicine and medical oncology and is a fellow of the American College of Physicians.

In addition to authoring numerous articles and book chapters, Dr. Engstrom serves on the editorial boards of several journals, including the Journal of Clinical Oncology and the Journal of the National Comprehensive Cancer Network. He is also active in several medical organizations.

Dr. Engstrom is chair of the NCCN Colon/Rectal/Anal Cancers Panel and a member of the NCCN Genetic/Familial High-Risk Assessment: Breast and Ovarian, Neuroendocrine Tumors, and Senior Adult Oncology Panels. He is also a member of the NCCN Board of Directors and the NCCN Guidelines Steering, Colorectal Disease Specific Executive, and CME Advisory Committees.

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