Skip to main content
SpringerLink
Log in

Stage II Colon Cancer: Towards an Individualized Approach

  • Chapter
  • First Online:
Difficult Decisions in Colorectal Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

  • 1103 Accesses

Abstract

Like many oncologists, the sight of a stage II colon cancer patient on my schedule draws a sigh. I know the discussion will be long and the concepts confusing even to the statistically literate; and at the end of the day, I will have to leave it up to the patient to make the decision because neither guidelines nor data in the vast majority of the cases clearly point to the correct answer of whether they should or should not receive chemotherapy. The problem is that stage II colon cancer is a wastebasket of likely different cancers biologically with SEER 5-year survival rates ranging from 66 % in stage IIA cancers to 37 % for stage IIC disease [1]. In this chapter, I will present the current state of science for stage II colon cancer with the hopes of allowing the practitioner to better risk stratify patients and thereby select those who are most likely to benefit or not benefit from adjuvant chemotherapy. I will conclude with my recommendations for specific cases with the strength of that recommendation based on the science.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  2. http://www.uptodate.com/contents/adjuvant-chemotherapy-for-resected-stage-ii-colon-cancer?source=search_result&search=stage+ii+colon+cancer&selectedTitle=1%7E150. Accessed 1 Dec 2016.

  3. Quasar Collaborative G, Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet. 2007;370(9604):2020–9. doi:10.1016/S0140-6736(07)61866-2.

    Article  Google Scholar 

  4. Figueredo A, Coombes ME, Mukherjee S. Adjuvant therapy for completely resected stage II colon cancer. Cochrane Database Syst Rev. 2008(3):CD005390. doi:10.1002/14651858.CD005390.pub2.

  5. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol Off J Am Soc Clin Oncol. 1999;17(5):1356–63.

    Google Scholar 

  6. Andre T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(19):3109–16. doi:10.1200/JCO.2008.20.6771.

  7. Gill S, Loprinzi CL, Sargent DJ, Thome SD, Alberts SR, Haller DG et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Off J Am Soc Clin Oncol. 2004;22(10):1797–806. doi:10.1200/JCO.2004.09.059.

  8. Glimelius B, Dahl O, Cedermark B, Jakobsen A, Bentzen SM, Starkhammar H, et al. Adjuvant chemotherapy in colorectal cancer: a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Acta Oncol. 2005;44(8):904–12. doi:10.1080/02841860500355900.

    Article  CAS  PubMed  Google Scholar 

  9. Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen CM, et al. Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. J Clin Oncol Off J Am Soc Clin Oncol. 1995;13(12):2936–43.

    Google Scholar 

  10. Taal BG, Van Tinteren H, Zoetmulder FA. Group N. Adjuvant 5FU plus levamisole in colonic or rectal cancer: improved survival in stage II and III. Br J Cancer. 2001;85(10):1437–43. doi:10.1054/bjoc.2001.2117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yothers G, O’Connell MJ, Allegra CJ, Kuebler JP, Colangelo LH, Petrelli NJ, et al. Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin. Oncol Off J Am Soc Clin Oncol. 2011;29(28):3768–74. doi:10.1200/JCO.2011.36.4539.

  12. Kumar A, Kennecke HF, Renouf DJ, Lim HJ, Gill S, Woods R, et al. Adjuvant chemotherapy use and outcomes of patients with high-risk versus low-risk stage II colon cancer. Cancer. 2015;121(4):527–34. doi:10.1002/cncr.29072.

    Article  PubMed  Google Scholar 

  13. O’Connor ES, Greenblatt DY, LoConte NK, Gangnon RE, Liou JI, Heise CP, et al. Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(25):3381–8. doi:10.1200/JCO.2010.34.3426.

  14. NCCN Guidelines. Colon Cancer Version 2.2016. NCCN.org. Accessed 1 Oct 2015.

    Google Scholar 

  15. Sinicrope FA. DNA mismatch repair and adjuvant chemotherapy in sporadic colon cancer. Nat Rev Clin Oncol. 2010;7(3):174–7. doi:10.1038/nrclinonc.2009.235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Gavin PG, Colangelo LH, Fumagalli D, Tanaka N, Remillard MY, Yothers G, et al. Mutation profiling and microsatellite instability in stage II and III colon cancer: an assessment of their prognostic and oxaliplatin predictive value. Clin Cancer Res Off J Am Assoc Cancer Res. 2012;18(23):6531–41. doi:10.1158/1078-0432.CCR-12-0605.

  17. Hutchins G, Southward K, Handley K, Magill L, Beaumont C, Stahlschmidt J, et al. Value of mismatch repair, KRAS, and BRAF mutations in predicting recurrence and benefits from chemotherapy in colorectal cancer. J Clin. Oncol Off J Am Soc Clin Oncol. 2011;29(10):1261–70. doi:10.1200/JCO.2010.30.1366.

  18. Klingbiel D, Saridaki Z, Roth AD, Bosman FT, Delorenzi M, Tejpar S. Prognosis of stage II and III colon cancer treated with adjuvant 5-fluorouracil or FOLFIRI in relation to microsatellite status: results of the PETACC-3 trial. Ann. Oncol Off J Eur Soc Med Oncol/ESMO. 2015;26(1):126–32. doi:10.1093/annonc/mdu499.

  19. Sargent DJ, Marsoni S, Monges G, Thibodeau SN, Labianca R, Hamilton SR, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(20):3219–26. doi:10.1200/JCO.2009.27.1825.

  20. Gray RG, Quirke P, Handley K, Lopatin M, Magill L, Baehner FL, et al. Validation study of a quantitative multigene reverse transcriptase-polymerase chain reaction assay for assessment of recurrence risk in patients with stage II colon cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(35):4611–9. doi:10.1200/JCO.2010.32.8732.

  21. Le DT, Uram JN, Wang H, Bartlett BR, Kemberling H, Eyring AD, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509–20. doi:10.1056/NEJMoa1500596.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sinicrope FA, Foster NR, Thibodeau SN, Marsoni S, Monges G, Labianca R, et al. DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-fluorouracil-based adjuvant therapy. J Natl Cancer Inst. 2011;103(11):863–75. doi:10.1093/jnci/djr153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Roth AD, Tejpar S, Delorenzi M, Yan P, Fiocca R, Klingbiel D, et al. Prognostic role of KRAS and BRAF in stage II and III resected colon cancer: results of the translational study on the PETACC-3, EORTC 40993, SAKK 60-00 trial. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(3):466–74. doi:10.1200/JCO.2009.23.3452.

  24. Watanabe T, Kobunai T, Yamamoto Y, Matsuda K, Ishihara S, Nozawa K, et al. Chromosomal instability (CIN) phenotype, CIN high or CIN low, predicts survival for colorectal cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(18):2256–64. doi:10.1200/JCO.2011.38.6490.

  25. Venook AP, Niedzwiecki D, Lopatin M, Ye X, Lee M, Friedman PN, et al. Biologic determinants of tumor recurrence in stage II colon cancer: validation study of the 12-gene recurrence score in cancer and leukemia group B (CALGB) 9581. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(14):1775–81. doi:10.1200/JCO.2012.45.1096.

  26. Yothers G, O’Connell MJ, Lee M, Lopatin M, Clark-Langone KM, Millward C, et al. Validation of the 12-gene colon cancer recurrence score in NSABP C-07 as a predictor of recurrence in patients with stage II and III colon cancer treated with fluorouracil and leucovorin (FU/LV) and FU/LV plus oxaliplatin. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(36):4512–9. doi:10.1200/JCO.2012.47.3116.

  27. Jover R, Zapater P, Castells A, Llor X, Andreu M, Cubiella J, et al. The efficacy of adjuvant chemotherapy with 5-fluorouracil in colorectal cancer depends on the mismatch repair status. Eur J Cancer. 2009;45(3):365–73. doi:10.1016/j.ejca.2008.07.016.

    Article  CAS  PubMed  Google Scholar 

  28. Kim GP, Colangelo LH, Wieand HS, Paik S, Kirsch IR, Wolmark N, et al. Prognostic and predictive roles of high-degree microsatellite instability in colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project Collaborative Study. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25(7):767–72. doi:10.1200/JCO.2006.05.8172.

Download references

Author information

Authors and Affiliations

  1. Section of Hematology/Oncology, University of Chicago Biological Science Division, Chicago, IL, USA

    Blase N. Polite MD, MPP

Authors
  1. Blase N. Polite MD, MPP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Blase N. Polite MD, MPP .

Editor information

Editors and Affiliations

  1. Medical Center, University of Chicago, Chicago, Illinois, USA

    Neil Hyman

  2. Medical Center, University of Chicago, Chicago, Illinois, USA

    Konstantin Umanskiy

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Polite, B.N. (2017). Stage II Colon Cancer: Towards an Individualized Approach. In: Hyman, N., Umanskiy, K. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-40223-9_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40223-9_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40222-2

  • Online ISBN: 978-3-319-40223-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation