Colorectal Cancer

All patients should undergo a thorax and abdomen CT scan to detect or exclude distant metastasis. If the tumor is located within the distal 15 cm of the bowel, it is defined as rectal cancer, and an MRI of the pelvis should be performed. Additional radiological examinations may be necessary in some instances (possible locally advanced disease, for example). 

For patients with colon cancer, primary surgery is common. However, recent evidence indicates that preoperative chemotherapy may be beneficial in some cases. After surgery, the resected specimen should be analyzed, and patients in stage III are generally recommended for postoperative adjuvant chemotherapy. 
 
Depending on the stage, patients with rectal cancer may undergo primary surgery or preoperative radiotherapy with or without chemotherapy. Many patients can undergo surgery with reconstitution of bowel continuity, but a permanent colostomy may be necessary when the tumor is more distal. In a small proportion of rectal cancer patients, preoperative treatment eradicates the tumor. Surgery can then be deferred, and the patient can be put into a close surveillance program (Watch & Wait protocol). 
 
Treatment is individualized in patients with distant metastasis (stage IV). Generally, treatment starts with chemotherapy, but immunotherapy can be an option in selected cases. 

Karolinska University Hospital is a national and regional referral center for patients with advanced colorectal cancer requiring extensive, complex oncological and surgical treatment. Our CRC unit performs cytoreductive surgery with HIPEC (i.e., intrabdominal treatment with chemotherapy) as well as advanced multiorgan resection surgery on the indication. 
 
When possible, operations are performed with minimally invasive techniques, including robotic and laparoscopic surgery, although complex situations may require open surgery. All patients are treated within an ERAS (Enhanced Recovery After Surgery) protocol, which has been shown to reduce complications and length of hospital stay after surgery significantly. Our unit is also involved in world-leading research in cancer, inflammatory bowel disease, and ERAS.