Key Points
➤ An estimated 105,000 new cases of colon cancer were diagnosed
in the United States in 2021, of which approximately 39% were
localized.
➤ Stage II cancers are characterized by a lack of metastatic spread or
lymph node involvement, and the main treatment is surgical resection
of the primary tumor.
➤ Prognosis after resection is relatively favorable, with an estimated
five-year disease-free survival rate of approximately 68–83% with
surgery alone.
➤ In order to eradicate micrometastatic disease following surgery,
adjuvant therapy may be considered for patients with a high risk
of recurrence, however, the extent to which established prognostic
factors can predict response to treatment is not well defined.
Treatment
Recommendation 1.1
➤ Adjuvant chemotherapy (ACT) should not routinely be offered to
patients with stage II colon cancer. (Strong recommendation; EB-
H-M)
Note: See Recommendations 1.3 and 1.4 for scenarios where ACT may be
appropriate for specific subgroups of patients with stage II colon cancer.
Recommendation 1.2
➤ ACT should not routinely be offered to patients who are at low risk for
recurrence, including patients with stage IIA (T3) tumors with at least
12 sampled lymph nodes of the surgical specimen, tumors without
perineural or lymphatic invasion, poor or undifferentiated tumor
grade, clinical intestinal obstruction, tumor perforation, and less than
grade BD3 tumor budding. (Weak recommendation; EB-H-L)
Qualifying statement:
▶ There is no compelling evidence to suggest that age of patient should alter
this recommendation. Specifically, there is no evidence that younger low risk
stage II patients should be offered ACT based on their age alone.
