The biggest issue is the liver feature, if it is not cancerous then he is stage 2 and M0.
If it is detected as cancerous he is M1, an early stage 4a but with some good, potentially curative options at this moment. He is assumed M0 without additional clear, direct findings.
Where I have a lot of technical dissatisfaction with NCCN is for patients who belatedly turned out to be stage 4 or mCRC, at the divergence between US practices and easy risk factors described in the literature. In some places, CEA and CA19-9 are done before and after surgery.
Some authors have demonstrated that the statistical CRC cutoff for a single CA19-9 test (before diagnosis and surgery) should be 25-27 units, not 34 - 40 units, as typically used in pancreatic cancer diagnostics. Very low 25 hydroxy vitamin D levels are a risk factor as are platelets over 400, high LDH, ESR and AFP. These are cheap, common blood panels; prices can vary greatly with how you order. We've used hsCRP to monitor transient even silent inflammations that can distort markers greatly.
In any case, for us, we've found (paying for and) serially monitoring these extra blood panels very enlightening and allow us to change my wife's immunochemo in real time to beat ominous marker levels down as well as more closely monitor than is possible with scans alone. I would be bitter if we had followed NCCN's knuckle dragging there and gotten torpedoed with "too late" diagnoses. Also we better know what formula works at the personalized level.
What would I do in your situation? If no chemo, I'd definitely get extra blood data every 5-6 weeks for 6-12 months, where NCCN now admits 2 month intervals might be better than 3 months. Chemo for stage 2 can have several options, from 3-6 months xeloda with or without nutritional and immune support, to folfox. Some patients overcome Xeloda's side effects with diet, supplements and IV vitamin C.
Although we buy an oral chemo not approved in the US instead of xeloda, we've seen that high dose supplements, IV C, and off label drugs can intensify 5FU based oral chemo while suppressing its side effects and living well.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC