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42

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

4

Nonmetastatic cancer

Stages II and III

Guide 9

lists the options for adjuvant treatment for

stages II and III cancers. Adjuvant treatment is given

when all visible cancer has been removed. The aim

of this treatment is to kill any unseen cancer cells. If

adjuvant treatment is right for you, receive it as soon

as possible for the best results.

Deciding factors

Options for adjuvant treatment are partly based on

pathologic stage. Stage IIA cancer has grown into

the fourth layer of the colon wall. Stage IIB cancer

has grown through the colon wall but not to nearby

structures. Stage IIC cancer has grown to nearby

structures. Stage III cancer has spread to nearby

lymph nodes.

In some cases, options are also based on MMR

status and risk level. The MMR system is explained

in Part 2. A high-risk level means the cancer is more

likely to return.

The risk level is high if these conditions are met:

†

†

Positive surgical margin is cancer within the

normal-looking tissue around the tumor.

†

†

Close surgical margin is cancer near the

normal-looking tissue around the tumor.

†

†

Unknown surgical margin is an unclear

assessment of the normal-looking tissue around

the tumor.

†

†

Cancer grade 3 or 4 means the cancer cells

don’t look much like normal cells.

†

†

Angiolymphatic invasion is cancer spread into

the tumor’s lymph and blood vessels.

†

†

Perineural invasion is cancer spread around or

into the nerves.

Guide 9. Adjuvant treatment

Pathologic stage MMR status

Risk level

What are the options?

Stage IIA

MSI-H or dMMR

Any level

• Start follow-up testing

Stage IIA

MSS, MSI-L, or normal MMR Not high risk

• Clinical trial

• Start follow-up testing

• Consider capecitabine or 5-FU/LV

Stage IIA

MSS, MSI-L, or normal MMR High risk

• Capecitabine or 5-FU/LV

• FOLFOX or CAPEOX

• Clinical trial

• Start follow-up testing

Stage IIB

Any status

Any level

Stage IIC

Any status

Any level

Stage III

Any status

Any level

• FOLFOX or CAPEOX

• Capecitabine

• 5-FU/LV