Primary colon cancer: ESMO clinical recommendations for diagnosis, adjuvant treatment and follow-up.

Staging provides essential prognostic information relevant for choosing adequate therapy and should also identify patients with resectable distant metastases. Preoperative staging consists of clinical examination, blood counts, liver and renal function tests, carcino-embryonic antigen (CEA), chest X-ray or CT scan, CT scan of the abdomen, and colonoscopy of the entire large bowel, i.e. with postoperative repeat colonoscopy if proximal parts of the colon were not accessible preoperatively. Pathologic staging should be carried out according to the TNM 2002 system with optional listing of the modified Dukes stage, as described in Table 1. Risk factors for colorectal cancer are: family history, familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) syndromes, hereditary non-polyposis colorectal cancer (HNPCC) syndrome, past history of colorectal cancer or adenoma, chronic ulcerative colitis and Crohn’s disease.