dr. efraim idelevich md, phd, dr. efraim idelevich md, phd, gastrointestinal oncology unit kaplan...
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Dr. Efraim Idelevich MD, PhD, Dr. Efraim Idelevich MD, PhD,
Gastrointestinal Oncology Unit Gastrointestinal Oncology Unit Kaplan Medical CenterKaplan Medical Center
RehovotRehovotIsraelIsrael
June 2011June 2011
Multimodal Treatment Multimodal Treatment of Colorectal Cancer of Colorectal Cancer
Liver MetastasesLiver Metastases
COLORECTAL CANCERCOLORECTAL CANCERWorldwide incidence*Worldwide incidence*
*Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
MaleMale39.839.8
FemaleFemale29.029.0
MaleMale25.325.3
FemaleFemale18.518.5
MaleMale39.539.5
FemaleFemale24.624.6
MaleMale45.845.8
FemaleFemale34.834.8
MaleMale5.05.0
FemaleFemale3.83.8
MaleMale6.06.0
FemaleFemale4.24.2
MaleMale11.211.2
FemaleFemale 8.58.5
MaleMale8.88.8
FemaleFemale7.97.9
MaleMale44.344.3
FemaleFemale32.832.8
Eastern Eastern EuropeEurope
JapanJapan
Australia/Australia/New ZealandNew Zealand
South CentralSouth CentralAsiaAsia
Northern Northern AfricaAfrica
Southern Southern AfricaAfrica
Central Central AmericaAmerica
WesternWestern Europe Europe
NorthNorthAmericaAmerica
IsraelIsrael MaleMale 44.144.1FemaleFemale 31.031.0
COLORECTAL CANCERCOLORECTAL CANCER1930-1997 Age-adjusted death rate*,1930-1997 Age-adjusted death rate*,
male, USAmale, USA80
70
60
50
40
30
20
10
0
YearYear
Lung & BronchusProstate
Colon & Rectum
1930 1940 1950 1960 1970 1980 1990 1997
Rat
e p
er 1
00,0
00 M
ale
Po
pu
lati
on
Rat
e p
er 1
00,0
00 M
ale
Po
pu
lati
on
Estimated incidence (% of all cancers in men):Prostate=31%; Lung & Bronchus=14%; Colon and rectum=10%
*Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
COLORECTAL CANCERCOLORECTAL CANCER1930-1997 Age-adjusted death rate*,1930-1997 Age-adjusted death rate*,
female, USAfemale, USA
YearYear
80
70
60
50
40
30
20
10
0
Lung & BronchusColon & Rectum
Breast
1930 1940 1950 1960 1970 1980 1990 1997
Rat
e p
er 1
00,0
00 F
emal
e P
op
ula
tio
nR
ate
per
100
,000
Fem
ale
Po
pu
lati
on
Estimated 2001 incidence (% of all cancers in women):Breast=31%; Lung=13%;Colon and rectum=11%
*Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
COLORECTAL CANCERCOLORECTAL CANCER
Hamilton IM, Grem JL. Current Cancer Therapeutics. 3rd ed. 1998;157.
Stage IStage I 15%15%
Stage IIStage II 20%–30%20%–30%
Stage IIIStage III 30%–40%30%–40%
Stage IVStage IV 20%–25%20%–25%
Disease Stage at Time of DiagnosisDisease Stage at Time of Diagnosis
Metastaticcarcinoma
Carcinoma
Abnormalproductionof cytokines
Angiogenic switchAngiogenic switch
Polyp
Mutations inMutations ingrowth controlgrowth controlgenesgenes
MutationsMutationsin in apoptosisapoptosiscontrol genescontrol genes
EGFEGF
Stage IV Colon CancerStage IV Colon CancerGroup I Group II Group III Group IVGroup I Group II Group III Group IV
Curable Curable Potentially Symptomatic Asymptomatic Potentially Symptomatic Asymptomatic
disease disease curablecurable non curablenon curable non curablenon curable
disease disease diseasedisease disease disease
!
Non curable Non curable
EORTC, ASCO 2007
