1. Dr. Efraim Idelevich MD, PhD, Dr. Efraim Idelevich MD, PhD, Gastrointestinal Oncology Unit Kaplan Medical Center RehovotIsrael June 2011 Multimodal Treatment of Colorectal Cancer Liver Metastases

2. COLORECTAL CANCER Worldwide incidence* *Incidence per 100,000 population. Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64. Male39.8 Female29.0 Male25.3 Female18.5 Male39.5 Female24.6 Male45.8 Female34.8 Male5.0 Female3.8 Male6.0 Female4.2 Male11.2 Female 8.5 Male8.8 Female7.9 Male44.3 Female32.8 EasternEurope Japan Australia/ New Zealand South Central Asia NorthernAfrica SouthernAfrica CentralAmerica Western Europe Europe NorthAmerica Israel Male44.1 Female31.0

3. COLORECTAL CANCER 1930-1997 Age-adjusted death rate*, male, USA 80 70 60 50 40 30 20 10 0 Year Lung & Bronchus Prostate Colon & Rectum 19301940195019601970198019901997 Rate per 100,000 Male Population Estimated incidence (% of all cancers in men): Prostate=31%; Lung & Bronchus=14%; Colon and rectum=10% *Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

4. COLORECTAL CANCER 1930-1997 Age-adjusted death rate*, female, USA Year 80 70 60 50 40 30 20 10 0 Lung & Bronchus Colon & Rectum Breast 19301940195019601970198019901997 Rate per 100,000 Female Population Estimated 2001 incidence (% of all cancers in women): Breast=31%; Lung=13%; Colon and rectum=11% *Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

5. COLORECTAL CANCER Hamilton IM, Grem JL. Current Cancer Therapeutics. 3rd ed. 1998;157. Stage I15% Stage II20%–30% Stage III30%–40% Stage IV20%–25% Disease Stage at Time of Diagnosis

6. Metastatic carcinoma Carcinoma Abnormal production of cytokines Angiogenic switch Polyp Mutations in growth control genes Mutations in apoptosis control genes EGF

7. Stage IV Colon Cancer Group I Group II Group III Group IV Curable Potentially Symptomatic Asymptomatic disease curable non curable non curable disease disease disease disease disease disease !Non curable

8. EORTC, ASCO 2007