Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

Abstract

Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.

Keywords: COVID-19 pandemic; Colorectal cancer; Screening; Surveillance; Stage upgrading; Elective surgery; Emergency surgery

Core Tip: Management and screening of colorectal cancer was severely affected by the changes implemented during the coronavirus disease 2019 (COVID-19) pandemic. These approaches resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. Though the management of colorectal cancer did not adversely change during the pandemic, modifications of existing guidelines were proposed to minimize the risk of COVID-19 spread while not compromising oncological care and outcome. This review was conducted to analyze the impact of the COVID-19 pandemic on the management of colorectal cancer and to identify the changes made to adapt to the COVID-19 pandemic.