Chemotherapy and Follow Up After B2 Colon Cancer
Dear OncoLink "Ask the Experts,"
I was diagnosed with stage II colon cancer in September 2000 at age 39. 21 lymph nodes were removed, all negative. No apparent spread. Angiolymphatic invasion present; B2 tumor. Bowel resection surgery performed. I am just completing 6 rounds of 5FU & Leucovorin. Is there any other treatment available for patients at my stage? My concern is that 5FU is an old drug and I've learned that it really doesn't offer much in adding to the percentage of survival. Also, what follow-up care would you recommend?
James P. Stevenson, MD, Assistant Professor of Medicine in the Hematology/Oncology Division of the University of Pennsylvania School of Medicine, responds:
Although we cannot comment on your specific case, the current recommendations are that patients receive 5-FU and leucovorin for this stage of colon cancer. We know that people with Stage B2 colon cancer have a 75-80% chance of being cured with surgery alone. There is some controversy whether 5-FU chemotherapy benefits B2 patients, but some oncologists believe it does, and in younger patients it is reasonable to be aggressive in the overall treatment.
In terms of follow-up, a reasonable recommendation might be follow-up visits with an oncologist or surgeon every 3 months for 2-3 years, with blood work (including a serum CEA level) performed at each visit, then annually. Many oncologists may also perform an annual chest x-ray, but there is some controversy regarding this. A colonoscopy may be performed one-year after the surgery, and then annually or every 3 years depending on the findings of the post-operative exam.
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