From the Guidelines
The recommended treatment for cecal adenocarcinoma is a right hemicolectomy, which is considered the standard surgical approach. This procedure involves removing the right colon (including the cecum, ascending colon, and proximal transverse colon), along with its blood supply and regional lymph nodes, followed by reconnecting the remaining bowel. The surgery is typically performed with curative intent for localized disease.
Key Points to Consider
- In addition to surgery, adjuvant chemotherapy may be recommended depending on the stage of the cancer, particularly for stage III disease or high-risk stage II disease, as shown in studies such as 1 and 1.
- The specific chemotherapy regimen often includes FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin), typically administered for about 3-6 months.
- Right hemicolectomy is indicated because the cecum's anatomical location and lymphatic drainage pattern requires removal of the entire right colon and its associated lymph nodes to ensure complete cancer excision and accurate staging, providing the best chance for cure by removing all potential areas of cancer spread while preserving as much bowel function as possible.
- For advanced disease with metastasis, treatment may include a combination of surgery, chemotherapy, targeted therapy, and immunotherapy based on molecular testing of the tumor.
Follow-Up Care
- Follow-up care may include colonoscopy at year 1 and thereafter every 3–5 years to look for metachronous adenomas and cancers, as recommended by 1 and 1.
- Ultrasonography of the liver every 6 months for 3 years and after 4 and 5 years, and CT scan of the chest and abdomen for 3 years can be considered in patients who are at higher risk for recurrence.
- CEA determination every 3–6 months for 3 years and every 6–12 months in years 4 and 5 after surgery if initially elevated, as suggested by 1 and 1.
From the Research
Treatment for Cecal Adenocarcinoma
- The recommended treatment for cecal adenocarcinoma is right hemicolectomy, which is the surgical removal of the right colon 2.
- Right hemicolectomy is usually recommended for low-grade appendiceal mucinous adenocarcinomas (LAMA) 3.
- However, studies have shown that right hemicolectomy may not provide a survival benefit for right-sided mucinous colon adenocarcinoma 4.
Indications for Right Hemicolectomy
- Right hemicolectomy is indicated for bulky tumors of the base of the appendix invading the cecum or for associated carcinoma of the right colon 5.
- The presence of mucinous production cells is a further indication for secondary right hemicolectomy 5.
- Tumor size greater than 2 centimeters and base localization are also indications for right hemicolectomy 5.
Survival Benefits
- A study found that a patient with cecal adenocarcinoma who underwent right hemicolectomy and chemotherapy had no recurrence and a high quality of life after 80 months 2.
- However, another study found that right hemicolectomy did not increase disease-specific or overall survival in patients with localized LAMA 3.
- The use of adjuvant oxaliplatin in clinical stage II or III rectal adenocarcinoma has been shown to improve overall survival, but its efficacy in cecal adenocarcinoma is not well established 6.