From The Editor's Desk

James Smith

Each article in this issue of The Ochsner Journal begins with a pronouncement on the significance of colorectal cancer. With an estimated 148,340 new cases and 56,600 deaths for the year 2002, it is the third leading cause of cancer and the second leading cause of cancer-related death in the United States. Despite this tremendous impact, this cancer has not received the attention or publicity one would expect. In the past several years, public awareness has increased due to a number of factors. Medicare recently approved screening for colorectal cancer for the asymptomatic individual, and many insurance companies have followed suit. Of possibly more importance to the lay public was the live, televised colonoscopy of Katie Couric. People are no longer embarrassed to talk about colorectal cancer.

In the first article of this issue, Drs. Wills and Burt review the hereditary aspects of colon cancer. Dr. Burt truly is a world authority on this subject, and it is an honor to have him as the featured guest author. I believe this article represents the most comprehensive and up-to-date review of heredity and colon cancer available in the literature.

If there is to be a decrease in the number of colorectal cancer cases in future years, it will be due to the success of screening programs. I have tried to objectively review the different screening strategies in my article. Although I conclude with the merits of universal colonoscopic screening, I cannot say this is the standard of care in 2002. It is not approved by every insurance company, and the alternative strategies of barium enema and flexible sigmoidoscopy have their own advantages.

Although screening may hold promise for reducing the incidence of colorectal cancer, we must address the staging and treatment of the many patients who will be diagnosed with cancer. Dr. Oussama Nachar, the Director of the Ochsner Department of Nuclear Medicine and PET Imaging Section, has reviewed the current and future role of positron emission tomography. He covers the science behind this exciting new technology, leading into a discussion of indications and actual case reports. Accurate staging is essential to the surgeon and oncologist. Dr. David Beck, the Chairman of the Department of Colon and Rectal Surgery, has used his vast personal and departmental experience to report on the surgical management of colon and rectal cancer.

The role of chemotherapy is addressed by Drs. Gonzalez-Angulo and Fuloria, from the Department of Hematology/Oncology. The combination of 5-fluorouracil and leucovorin has been considered the standard treatment strategy. The authors review this but also discuss new chemotherapy regimens, alternative methods of drug delivery such as hepatic artery infusion, and some novel therapies. Dr. Roland Hawkins adds his comprehensive article on the role of radiation therapy for the patient with rectal carcinoma.

In the Under the Microscope section, Dr. Om Prakash from the Division of Research, has joined Drs. Fuloria and Gonzalez-Angulo to cover a topic of interest and vast potential importance: the chemoprevention of colon cancer. In the Scanning the Literature section, Drs. Steven Granier and Greg Johnson have chosen and summarized a number of recently published articles representing various aspects of colon cancer. And finally, some of the ongoing clinical protocols for colon cancer treatment and screening at Ochsner Clinic Foundation are highlighted. As always, we hope you enjoy the issue and welcome any personal comments.