Adjuvant Chemotherapy Indications
In general, most patients with stage three colon cancer will be offered chemotherapy after surgery. There are some cases where this might not be offered, but that’s a more detailed conversation that you will have with your oncologist. Stage two colon cancer patients are offered chemotherapy if they have certain features like lymphovascular invasion or invasion of the nerve cells of the tumor noticed at the time of surgery, if your bowel was perforated or had a hole in it at the time of surgery, if your bowels were blocked or obstructed because of the cancer. At the time of surgery, if you had less than 12 lymph nodes removed. If you had any positive margins or tumor budding, and usually that’s tumor located on the very outside of your specimen. We also take a look at your tumor and see how aggressive does this look? Is this poorly differentiated or is it well differentiated? Poorly differentiated tumors are usually more aggressive and will contribute to the need for chemotherapy. And again, back to your stage or your T staging of the tumor, if it’s T4, that’s also a risk factor that will contribute to you needing chemotherapy. Another risk factor that we look at is something called microsatellite instability. If you are MSI high, some of these rules will not apply to you. However, if you’re MSS or microsatellite stable, then these risk factors will contribute to you needing chemotherapy.