Stage II Colon Cancer Adjuvant Therapy

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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.

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