Treatment and Prognosis
The only effective treatment is surgical removal of the tumor and the adjacent colon and mesenÂtery. Hemicolectomy is usually performed for rightsided and leftsided tumors; anterior resecÂtion with anastomosis to the rectal stump for sigÂmoid or upper rectal tumors; and a combined abdominal-perineal resection with a permanent colostomy for lesions within 5 cm of the anal verge. Surgery may also be indicated for palliation even in the presence of obvious metastatic disease when there is obstruction, perforation, or hemÂorrhage. Radiation therapy is used most freÂquently for pelvic recurrences or painful metasÂtases, particularly in bone and sometimes in liver. Chemotherapy, usuallv with 5-fluorouracil. has been used in the treatment of hepatic metastases, but with onlv modest success.
The results of the surgical treatment of early carÂcinoma of the large bowel are excellent, with 80 to 90 per cent 10-year survival for mucosal leÂsions, 60 to 80 per cent with bowel wall invasion, and as high as 50 to 60 per cent even when reÂgional nodes are involved. Postoperatively each patient must be followed closely for recurrence using colonoscopy, radiographic procedures, and measurements of CEA in a regular schedule over many years.