EARLY STAGE COLON CANCER

Case History:
Our patient, 42-year-old gentleman, has history of recurrent abdominal pain for a duration of around one year, on initial evaluation he was found to have duodenal ulcer and H pylori infection is stomach. He was treated for same by gastro physician. However, the pain continued intermittently, and he also developed constipation, so he was again investigated thoroughly and was found to have colon carcinoma involving hepatic flexure. Further staging workup showed non metastatic tumor and so he underwent curative colon cancer surgery i.e. Right hemicolectomy with ileostomy under our gastro surgical team. He had post-operative complication of anastomotic hemorrhage, which was managed with re-exploration and blood transfusion with good response. His post-operative recovery was overall slow and he had significant weight loss for which dietary changes and nutritional supplements were added. Diagnosis: His final histopathology report of surgery confirms the ulcerative poorly differentiated adenocarcinoma of hepatic flexure along with mucinous component and signet ring cells, involving pericolic fat, margins were negative, all 71 lymph nodes were negative for metastasis, no lymph vascular or perineural invasion. So final stage comes to be pT3N0M0, Gr3 (AJCC stage IIA). He was than counseled for further treatment options and their benefits.

Discussion:
The aim of adjuvant therapy is to eradicate residual micro metastasis thus improving the cure rate in early stage. Adjuvant chemotherapy has become standard for stage III colon cancer and most for the centers uses 6 months of FOLFOX or CAPOX regimens, However the decision to treat a patient with stage II colon cancer with adjuvant chemotherapy can be challenging. Although the benefit of treatment is clear in most patients with stage III disease, the decision to provide chemotherapy after surgical resection in stage II disease, must be made on an individual basis. Several trails have demonstrated the small but absolute benefits of receiving adjuvant chemotherapy for stage II colon cancer for disease-free survival and overall survival (2 to 58