CLINICAL PRACTICE GUIDELINE
GI-004
EARLY STAGE COLON CANCER
Date Developed: February, 2008
Date Revised: August, 2009
The recommendations contained in this guideline are a consensus of the Alberta Provincial Gastrointestinal
Tumour Team synthesis of currently accepted approaches to management, derived from a review of relevant
scientific literature. Clinicians applying these guidelines should, in consultation with the patient, use
independent medical judgment in the context of individual clinical circumstances to direct care.
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Revised 8/25/09
EARLY-STAGE COLON CANCER
CLINICAL PRACTICE GUIDELINE
Purpose of Guideline:
This guideline was developed to outline the management recommendations for patients with colon cancer
resected with curative intent and without evidence of metastatic disease.
Development Panel:
This guideline was developed by the members of the Provincial Gastrointestinal Tumor Team.
Preamble:
According to statistics provided by the Canadian Cancer Society in 2008, one in fourteen Canadian males
and one in sixteen Canadian females will be diagnosed with colorectal cancer in their lifetime.
A patient may be predisposed to develop colorectal cancer by a hereditary condition (e.g.: hereditary non-
polyposis colon cancer, familial adenomatous polyposis) or a personal history of either inflammatory bowel
disease (e.g.: Crohn’s disease, ulcerative colitis) or adenomatous polyps. Over 60% of colorectal cancers
are without a clearly identifiable predisposing factor, however.
In the absence of hereditary cancer syndromes, the progression from adenoma to adenocarcinoma occurs
sporadically as a result of acquired genetic alterations. Allelic loss, chromosomal amplifications, or
translocations account for 85% of such cases. In the other 15%, epigenetic silencing of a component of the
DNA mismatch repair system allows frame-shift mutations and base-pair substitutions to persist. The
resultant accumulation of tandemly repeated nucl