natelaugh wrote:Hi,
My dad is 79 with colon cancer stage 3b with T3N2M0. He had right colon remove, partial colectomy on 2/19/19. Pre surgery, his CEA was 68. He saw his oncologist this week and the doc suggested to do a 5 fu only for 6 months. My dad post surgery, CEA is 2.8, below the range of 0.0-5.0 ng/mL.
Should my dad do the chemotherapy? Any advise or question I should ask my dad oncologist?
Thanks,
Before deciding about chemotherapy, the doctor or oncologist must look at all seven of the primary pathology risk factors:
According to the NCCN guidelines, the pathology
high-risk features include the following:
- T4 primary tumors,
- poorly differentiated histology,
- presence of lymphovascular invasion (LVI) ◄◄◄,
- presence of perineural invasion (PNI),
- bowel obstruction,
- less than 12 lymph nodes evaluated in the pathology report, or
- close or indeterminate margins.
Since your father was staged as Stage III-B (T3N2M0), this means that he has at least one of the seven high risk factors above (i.e.,
lymphovascular invasion, because of the cancerous lymph nodes that were found). This is a high-risk factor because the cancerous lymph nodes already provide evidence that the tumor has found a way to send circulating tumor cells and micrometastases through the lymphatic system. There is then a good chance that there are other circulating cancer cells or micrometastases still circulating around in the lymphovascular system. That is why some kind of first-line chemotherapy is recommended in this case. This is sometime called "mop up" chemo, and it usually has a a fixed length of 6 months.
Also, your father might have more than just one high-risk factor. In his pathology report, there might be evidence of some of the other six risk factors listed above.
For this situation, the recommended course of treatment in the U.S. is to choose one of the first-line chemotherapy options listed by NCCN. 5FU is one of the recommended first-line treatment options, so your doctor is indeed suggesting one of the standard first-line therapies for a Stage III-B patient. There are other first-line therapies available, such as FOLFOX or XELOX(CAPEOX), but the doctor did not recommend these, perhaps because they are rather difficult regimens that older patients often have difficulty completing.