Should patients with stage II colon cancer be treated with adjuvant chemotherapy?

Abstract

Patients with stage II colon cancer, as defined by pTNM/AJCC 2017, when analysed with regards to the risk of recurrence and to DFS and OS prolongation with adjuvant chemotherapy, make up a heterogenous patient population. That is why, a qualified oncologist, who makes a decision to apply adjuvant chemotherapy, taking into consideration the patient’s well-being, should formulate a post-operative strategy, the main objective of which will be to minimise
the risk of cancer recurrence and to prolong survival.
The author of this paper believes that adjuvant chemotherapy should be provided for every patient in the very high risk group (IIC) and high risk group (IIA/IIB MSI-L/MSS and inadequate lymphadenectomy and BRAF mutation), and also in the group of intermediate risk of cancer recurrence (IIA/IIB MSI-L/MSS with an adequate scope of lymphadenectomy
and BRAF mutation as well as IIA MSI-L/MSS with inadequate scope of lymphadenectomy and lack of BRAF mutation), after obtaining the patient’s informed consent. In a situation when an oncologist is unable to obtain the result of microsatellite instability or the BRAF gene mutation, it would be advisable to refer the patient to a centre which has access to such tests; this would allow the adjuvant chemotherapy to have optimum application, which would by all means translate into the improvement of the treatment results in patients with colon cancer.