Molecular Markers May Improve Colon Cancer Staging, Screening

Extract

With more sophisticated tests now available, the dilemma of just who needs adjuvant treatment for colon cancer and who does not is coming to the fore.

The problem of understaging in colon cancer patients is probably worse than previously thought, based on more sophisticated methods of detecting metastases. Many patients thought to be free of disease may not be.

“The theory is that many who have stage II colon cancer may actually have stage III, and should be getting adjuvant chemotherapy,” said David Ota, M.D., medical director and chief of surgical oncology at the Ellis Fischel Cancer Center in Columbia, Mo., who chaired a session on colorectal cancer at a recent Society of Surgical Oncology meeting in New Orleans.

“Those who are truly node negative by histology, by [reverse transcription]–PCR, and by immunohistochemistry probably will not benefit from systemic chemotherapy because their risk of recurrence is so low,” Ota said in an interview. “We’re not there yet, but if we can determine the high-risk patients, I think that will help out a lot in determining who gets treatment and who doesn’t.” Ota said he thinks it will take a series of molecular markers to really determine who are high-risk patients.