Medical Health Encyclopedia

Although not yet known with certainty, some data suggest that certain Stage II patients may be at higher risk of recurrence and would theoretically benefit from adjuvant therapy. These include patients with the following conditions:

• Cancers that have obstructed the bowel,
• Cancers that have perforated the wall of the colon, or
• Cancers that have adhered to structures outside the intestine.

Advanced diagnostic techniques are under investigation for helping to select appropriate Stage II candidates for adjuvant therapy. None of these methods, however, are ready to be used routinely to help make treatment decisions. The decision whether to pursue chemotherapy for stage II disease should be made after careful discussion between the patient and his or her oncologist, especially after features, such as bowel perforation or obstruction, are taken into account.

Chemotherapy for Stage III Patients with Colon Cancer. Since the early 1990s, adjuvant chemotherapy with 5-FU and leucovorin has been the standard of care for stage III colon cancer. Numerous trials have shown that adjuvant chemotherapy in this setting reduces the absolute risk of death from colon cancer by approximately one-third and improves survival by 10%. Current clinical trials are investigating whether the addition of new chemotherapy drugs, suchas irinotecan, oxaliplatin, capecitabine, and antibody therapies, will improve cure rates over 5-FU and leucovorin alone. However, most of these new agents should currently not be used for adjuvant treatment of colon cancer unless as part of a clinical trial.

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Chemotherapy for Advanced Colorectal Cancer. Chemotherapy and radiation are generally used to reduce symptoms and prolong life in advanced colorectal cancer. Some experts suggest that chemotherapy should be considered for the following patients:

• Able to carry out all normal activity without restriction.
• Restricted in physically strenuous activity, but able to walk about and carry out light work.
• Able to walk about and capable of all self care, but unable to carry out any work. Out of bed or chair for more than 50% of waking hours.