Informed decisions on colorectal cancer treatment

There is much to consider when deciding on adjuvant chemotherapy

Sylvia, a previously well 64-year-old presented recently with altered bowel habits.

There was no associated weight loss and no personal or family history of note. She took no regular medications.

A test for faecal occult blood was positive, and was followed by a colonoscopy that revealed a non-obstructing tumour of the ascending colon.

Preoperative CT scans of chest, abdomen and pelvis arranged by her surgeon showed no distant metastases.

Sylvia underwent right hemicolectomy with satisfactory postoperative recovery.

Histological examination showed full thickness penetration of the colonic wall by undifferentiated adenocarcinoma.

However, none of 24 resected lymph nodes was affected and no perineural or lymphovascular invasion seen (T3N0M0). Immunohistochemistry showed loss of MLH1 protein expression.

Sylvia wanted to minimise the risk of recurrence and requested