Download Stage II Transverse Colon cancer without high risk factor

Case Presentation
Stage II Transverse Colon cancer
without high risk factor
Joo Han Lim
Dept of Medical Oncology
Inha University School of Medicine and Hospital
Stage II Colon Cancer Subgroups
• 5 year survival after surgical resection alone is:
• Stage I : 85-05%
• Stage II : 60-80%
• Stage III : 30-60%
ESMO Clinical Practice Guidelines 2013
Clinical Case
• 36-years-old man
• Abdominal pain; 1 month /5kg weight loss
• ECOG Performance status 0
• Never colonoscopy
• No hepatosplenomegaly
• No palpable lymph nodes
Past Medical History
No
Medications
No
Social history
Unmarried
Current smoker – total 20 Pack years
Occasional social alcohol: average less than three drinks per
week
Family history
No cancers found in first degree or second degree relatives
• Colonoscopy; ulcerofungating
mass in proximal transverse
colon
• no definite obstruction, but there
was severe luminal narrowing.
• Scope could go through the
lesion.
• moderately differentiated
adenocarcinoma.
PET CT
Op findings
• Op date 25/AUG/2014
• Laparoscopic transverse colectomy with lymphadenectomy
• 5.5cm sized ulcerofungating mass with severe pericolic infiltration,
located on mesocolic border of transverse colon
• Grossly negative regional lymph node
• No distant metastasis
Pathology Report
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Well differentiated adenocarcinoma
5cm size
Depth of invasion: invades pericolic adipose tissue (pT3)
Resection margin: free / safety margin: prox 6cm, distal 3cm
Regional lymph node metastasis: no metastasis in all 12 regional lymph nodes (0/12)
Lymphatic invasion: not identified
Venous invasion:
not identified
Perineural invasion: not identified
Pathologic stage pT3pN0
IHC for microsatellite instability
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MLH1: positive
MSH2: positive
MSH6: positive
PMS2: positive
• 8/SEP/2014
• RLQ area abdomen huge abscess
pocket
• Intraabdominal drainage due to
postoperative intraabdominal
abscess
Adjuvant chemotherapy?
• The surgeon referred to the department
of medical oncology for consideration of
adjuvant chemotherapy after recovery of
infection.
• The surgeon concerned about the
possibility of recurrence.
 The patient’s operation finding was not
favorable.
 Post op intra-abdominal infection: high risk
factor?
• According to pathologic staging, there
was nothing related to high risk feature.
Stage II A, B, C (T3 N0 M0, T4 a-b N0 M0)
Standard treatment options:
(i) Wide surgical resection and anastomosis.
(ii) Following surgery, adjuvant therapy should
not be routinely recommended for unselected
patients. In high-risk patients who present at
least one of the previously mentioned clinical
high-risk features (see above), adjuvant therapy
could be considered in clinical practice.
The general consensus suggests that patients with
stage II are considered at high risk if they present
at least one of the following clinical characteristics:
lymph nodes sampling <12;
poorly differentiated tumour; vascular or lymphatic
or perineural invasion; tumour presentation with
obstruction or tumour perforation and pT4 stage
ESMO Clinical Practice Guidelines 2013
• Discussed patient
• We concluded to treat this patient with adjuvant
chemotherapy.
• Do we treat and if so, with what regimen?
• He had received 6 cycles of LF chemtherapy (adjuvant)