Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 6964-6968
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.6964
Reconsideration of recurrence and metastasis in colorectal cancer
Rui Wang, Qi Su, Zhao-Peng Yan
Rui Wang, Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Qi Su, Zhao-Peng Yan, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Yan ZP contributed to the conception and design of the work; Wang R drafted the work and revised it critically for important intellectual content; Su Q was involved in the acquisition and analysis of the data.
Supported by the 345 Talent Project of Shengjing Hospital of China Medical University.
Conflict-of-interest statement: The authors have declared that no competing interest exists.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-Peng Yan, MD, PhD, Associate Chief Physician, Associate Professor, Surgeon, Department of General Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. yanzpus@outlook.com
Received: February 10, 2021
Peer-review started: February 10, 2021
First decision: March 15, 2021
Revised: March 31, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 26, 2021
Processing time: 194 Days and 10.3 Hours
Abstract

To discuss recurrence patterns and their significance in colorectal cancer. Preexisting medical hypotheses and the clinical phenomena of recurrence in colorectal cancer were evaluated and integrated. Colorectal cancer recurrence/ metastasis consists of two types: recurrence from the activation of dormant cancer cells and recurrence from postoperative residual cancer cells. These two recurrences have their own unique mechanisms, biological behaviors, responses to therapy, and prognoses. For type 1 recurrences, surgical resection should be considered. Type 2 recurrences should be managed systematically in addition to surgical resection. The two types of colorectal cancer recurrence should be evaluated and managed separately.

Keywords: Colorectal cancer; Cancer recurrence; Cancer dormancy; Metastasis; Cancer relapse

Core Tip: In this work, we proposed the recurrence/metastasis of colorectal cancer consists of two types: recurrence from activation of dormant cancer cells and recurrence from proliferation of post-operative residual cancer cells. These two recurrences have their own unique mechanisms, biological behaviors, response to therapy, and prognosis. For type 1 recurrences, surgical resection should be considered. Type 2 recurrences should be managed systematically, in addition to surgical resection. Our theory also suggests that the tumor-node-metastasis staging system should be re-evaluated.