Advances in the treatment of early- to late-stage colorectal cancer: 20 years of progress.

Numerous scientific and clinical advances have made significant changes in our understanding of the etiology of colorectal cancer and in the diagnosis and treatment of patients with large bowel malignancy or its precursor lesions. A personal view of 20 years of progress was presented at the Commission on Cancer lecture during the 1993 Clinical Convocation of the American College of Surgeons. Improvement in the diagnosis and treatment of early bowel cancers, significant benefit from multimodality therapy of more advanced resectable bowel cancers, and better articulated selection criteria in patients with recurrent colorectal cancers are reviewed. Most importantly, both physical and emotional consequences of our therapies are shown to have diminished without sacrificing the ability to cure. Perhaps the next major challenge is for the general surgeon to assume responsibility as the primary medical manager of any patient with gastrointestinal cancer from the time of diagnosis onward.