Colorectal Cancer (Germany)

Top 10 priorities

1. How radical should the surgery be in the different stages of colorectal cancer, e.g., with regard to pelvic exenteration (=[radical] surgical removal of two or more pelvic organs), preservation of continence [ability to retain stool as desired], or lymph node excision?
2. What measures can be taken to help colorectal cancer patients cope with the disease and the adverse efects and consequences of treatment, e.g., bowel obstruction, diarrhea, anal infammation, incontinence, parenteral nutrition (=nutrition via the veins), sexual problems, sequelae of stoma / stoma closure?
3. What potential is there for individualized treatment of patients with colorectal cancer, e.g., antibody therapies, targeted therapy with new drugs, or immunotherapy?
4. Does the involvement of specialized outpatient and inpatient personnel (nutritional counseling, oncology nurses, care service, stomatherapists, etc.) in the care of colorectal cancer patients improve the outcome?
5. What kind of specific preparation (pre-habilitation) has the potential to improve the outcome of the planned treatment (surgery, radiotherapy, chemotherapy, etc.) in colorectal cancer?
6. What role can be played by complementary medicine, e.g., meditation, osteopathy, traditional Chinese medicine, as a complement to conventional medicine (e.g., in regard to symptom relief and survival) in colorectal cancer?
7. In rectal cancer, how can LARS (low anterior resection syndrome=defecation problems after removal of the rectum) be efectively prevented (e.g., by reconstruction technique [=technique to restore the digestive tract, J pouch, transverse coloplasty, side-to-end anastomosis], pelvic neuromonitoring [=checking nerve function during the operation]) or treated?
8. How can the adverse effects of chemotherapy in colorectal cancer, e.g., polyneuropathy (=nerve damage associated with sensory disturbances and pain) or nausea, be avoided and treated?
9. What is the best sequence of treatment measures (chemotherapy, surgery, radiotherapy) for the diferent stages of colorectal cancer?
10. What measures have the potential to improve the quality of life and the general well-being of patients with colorectal cancer (e.g., nutritional counseling, psychosocial support)?

The following questions were also discussed and put in order of priority at the final workshop

11. In colorectal cancer, what is the best therapy for liver metastases (e.g. with regard to tumour stage, time of occurrence and number of metastases) (e.g. Cyberknife (robot-assisted linear accelerator for radiation surgery), irreversible electroporation (= soft tissue ablation procedure), microwave ablation (= destruction of the tumour by heat from the inside), chemotherapy, surgery, radiofrequency ablation (= destruction of the tumour by applying heat with high-frequency current), TACE/transarterial chemoembolisation (= targeted blockage of arteries by chemotherapy))?
12. What is the best therapy for colorectal cancer with peritoneal carcinomatosis (= tumour spreading into the peritoneum)?
13. In case of colorectal cancer, will life after colostomy be improved by care provided by specialized stoma therapists and what should the framework conditions be (e.g. outpatient, inpatient, before surgery, duration of care)?
14. How can quality of life and risk of recurrence in colorectal cancer be influenced during follow-up (e.g. diet, sport, psychosocial factors)?
15. In what intervals and for how long, depending on the tumour stage and risk profile, should follow-up care for colorectal cancer also be carried out beyond the 5-year period and which examinations (e.g. also new biomarkers, "liquid biopsy" (= detection of tumour cells from blood), "personalized follow-up care") should it include, also for the therapy consequences?
16. How can therapy response and the individual prognosis of colorectal cancer be predicted at the time of diagnosis (e.g. by tumour markers)?
17. How can side effects and consequences of radiotherapy be avoided and treated in colorectal cancer patients?
18. By whom should colorectal cancer follow-up be carried out (e.g. general practitioner, specialized follow-up centres, oncologist) and how can compliance (= active participation of patients) be improved (e.g. PROMs = patient reported outcomes measures = instruments for patient self-documentation of treatment outcome, apps, follow-up passport)?
19. How can complications (e.g. suture leaks, wound healing problems) be avoided, reduced and treated after colorectal cancer surgery?
20. Which types of sport and exercise are possible with colorectal cancer and in which situation (e.g. after surgery, possibly with colostomy, or during chemotherapy), how can they influence the outcome, e.g. in terms of hernia prophylaxis (= prevention of abdominal wall hernias), complication rate and risk of recurrence, and which types of sport should be avoided?
21. What less invasive screening methods are available as an alternative to colonoscopy and how effective are they (e.g. imaging, blood tests, rectoscopy, "liquid biopsy", mirroring using a video capsule)?
22. What specific diet is useful for colorectal cancer patients (also after surgery, with colostomy)?
23. How can participation in screening programs for colorectal cancer be increased in the population?
24. At what age limits and time intervals or case of which symptoms should screening programs for colorectal cancer be carried out, depending on patient characteristics (e.g. family history, previous illnesses)?

Key documents

Colorectal Cancer PSP (Germany) Protocol

Colorectal Cancer PSP Question Verification Form