Two Onc Docs Localized Colon Cancer 2025 UPDATE
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Mar 3, 2025 Discover the latest on early-stage colorectal cancer, including the updated screening guidelines recommending checks starting at age 45. Learn about crucial testing and staging processes, particularly the importance of Lynch syndrome screening. Explore advancements in neoadjuvant immunotherapy for high-risk stage 2 tumors and the implications of recent clinical trials on treatment choices. Delve into key findings from the IDEA trial, comparing the effectiveness of three-month versus six-month chemotherapy, and understand the role of genetic testing in management.
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Always Test For Lynch
- Test every colorectal cancer patient for Lynch syndrome with IHC or MSI testing.
- If MLH1/PMS2 loss is present, check BRAF V600E to identify sporadic cases.
Depth And The Dirty Dozen
- T stage in colon cancer reflects depth of invasion, not tumor size, and drives prognosis.
- Ensure at least 12 lymph nodes are examined to accurately assign N stage.
Identify Stage II High-Risk Features
- Consider stage II high-risk features: T4, <12 nodes, obstruction/perforation, LVI, PNI, poor differentiation.
- Exclude MSI-high tumors from this high-risk group when making adjuvant decisions.