From the Guidelines
T4bN0 colon cancer is classified as stage IIC disease and should be treated with surgical resection followed by adjuvant chemotherapy, as the deep invasion of the tumor carries a significant risk of micrometastatic disease and recurrence. The standard adjuvant chemotherapy regimen is FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine plus oxaliplatin) for 6 months, as recommended by the NCCN guidelines 1. For elderly patients or those who cannot tolerate oxaliplatin, single-agent capecitabine or 5-FU/leucovorin may be considered.
Key Considerations
- The 5-year survival rate for stage IIC colon cancer is approximately 50-65% 1, which is lower than some stage III cancers, highlighting the importance of the T stage in determining prognosis.
- Regular follow-up with CEA testing, CT scans, and colonoscopies is essential for surveillance after treatment completion, as recommended by the ESMO guidelines 1 and NCCN guidelines 1.
- High-risk factors for recurrence, such as poorly differentiated histology, lymphatic/vascular invasion, bowel obstruction, and close or positive margins, should be considered when selecting adjuvant therapy 1.
Treatment Options
- Surgical resection of the primary tumor along with the invaded adjacent organ or structure is the primary treatment for T4bN0 colon cancer.
- Adjuvant chemotherapy with FOLFOX or CAPOX for 6 months is recommended for patients with stage IIC colon cancer.
- Alternative adjuvant chemotherapy regimens, such as single-agent capecitabine or 5-FU/leucovorin, may be considered for elderly patients or those who cannot tolerate oxaliplatin.
Surveillance and Follow-up
- Regular follow-up with CEA testing, CT scans, and colonoscopies is essential for surveillance after treatment completion.
- The NCCN guidelines recommend history and physical examination every 3-6 months for 2 years, then every 6 months for a total of 5 years, and CEA every 3-6 months for 2 years, then every 6 months for a total of 5 years 1.
From the Research
Stage of T4bN0 Colon Cancer
- T4bN0 colon cancer is a type of advanced colon cancer where the tumor has directly invaded adjacent structures, but there are no regional lymph node metastases 2.
- The prognosis of T4bN0 colon cancer depends on various factors, including the tumor location, invaded organ, and the type of surgical procedure required 2.
- Surgical treatment for T4bN0 colon cancer typically involves en bloc resection, which aims to remove the tumor and the invaded adjacent structures in a single operation 2.
- Neoadjuvant treatment for advanced colon cancer, including T4bN0, may be challenging to apply, and the ability to achieve an R0 resection depends on the tumor location and the type of surgical procedure required 2.
- There is limited information available on the specific treatment and outcomes of T4bN0 colon cancer, as most studies focus on earlier stages of colon cancer or more advanced stages with metastases 3, 4, 5, 6.