Does a 91-year-old male with a history of open right hemicolectomy (surgical removal of the right side of the colon) for an obstructing ascending colon mass and cecal perforation, with pathology showing moderately differentiated adenocarcinoma and one node positive for metastatic disease, have colon cancer?

From the Guidelines

Yes, the 91-year-old male has colon cancer, specifically stage III colon cancer based on the pathology findings showing moderately differentiated adenocarcinoma with one lymph node positive for metastatic disease. The patient underwent an open right hemicolectomy for an obstructing ascending colon mass with cecal perforation, which was the appropriate surgical intervention for his condition. The presence of cancer cells in a lymph node indicates that the cancer has spread beyond the primary tumor site in the colon wall, classifying it as stage III disease. This staging is important because it helps determine the need for additional treatment beyond surgery, such as adjuvant chemotherapy. For a 91-year-old patient, treatment decisions would need to consider age, overall health status, and functional status, weighing the potential benefits of adjuvant therapy against risks and quality of life concerns, as suggested by 1. The moderately differentiated histology provides information about the aggressiveness of the tumor, falling between well-differentiated (less aggressive) and poorly differentiated (more aggressive) cancers. Given the patient's age and the fact that he has stage III colon cancer, the decision to use adjuvant chemotherapy should be made cautiously, considering the potential benefits and risks, as discussed in 1 and 1. It is also important to note that follow-up care, including colonoscopy, ultrasonography of the liver, and CT scans, should be considered to monitor for recurrence and metachronous cancers, as recommended by 1 and 1. However, the most recent and highest quality study 1 suggests that age alone should not exclude any stage III colon cancer patient from consideration for adjuvant therapy, but for patients over 75, age may be a legitimate consideration. Therefore, the patient's treatment plan should be individualized, taking into account his overall health status, functional status, and preferences, with a focus on maximizing his quality of life and minimizing morbidity and mortality.

From the FDA Drug Label

The patient had undergone complete resection of the primary tumor without gross or microscopic evidence of residual disease and had histologically proven stage II (T3 to T4 N0 M0; Dukes’ B2) or III (any T N1-2 M0; Dukes’ C) colon carcinoma. The patient has colon cancer, as indicated by the presence of a moderately differentiated adenocarcinoma in the ascending colon, which is a type of colon cancer. The patient's pathology report and history of surgical removal of the tumor are consistent with a diagnosis of colon cancer 2.

From the Research

Diagnosis

• The patient's pathology report shows moderately differentiated adenocarcinoma, which is a type of colon cancer 3.
• The tumor measures 5 cm and there is one node positive for metastatic disease, indicating that the cancer has spread to at least one lymph node.
• The margins are negative, which means that the cancer was completely removed during the surgery.

Treatment and Prognosis

• The patient underwent an open right hemicolectomy, which is a surgical procedure to remove the right side of the colon 4, 3.
• The presence of metastatic disease in one lymph node indicates that the patient may require additional treatment, such as chemotherapy or radiation therapy.
• The prognosis for the patient depends on various factors, including the stage of the cancer, the patient's overall health, and the effectiveness of the treatment.

Comparison with Similar Cases

• A study published in 2008 reported a case of a 53-year-old woman with poorly differentiated adenocarcinoma in the ascending colon, who survived for more than 11 years after undergoing surgery and adjuvant chemotherapy 4.
• Another study published in 2020 reported a case of a 69-year-old man with moderately differentiated adenocarcinoma and a heterogeneous lymphoepithelioma-like carcinoma component in the ascending colon, who achieved complete remission with chemotherapy after noncurative excision 3.
• These cases suggest that the prognosis for patients with colon cancer can vary widely depending on the specific characteristics of the tumor and the effectiveness of the treatment.