Colon cancer: treatment options, genetic testing and biomarkers
Colon cancer is one of the most common types of cancer. We asked Professor Hans-Joachim Schmoll, a member of the CareAcross Scientific Committee and a very experienced medical oncologist a few questions on treatment options, genetic testing and biomarkers.
- Professor Schmoll, when is surgery considered adequate treatment for colon cancer?
Surgery to resect the primary tumor is adequate when the treatment aim is curative. This is also the case if there are resectable or unresectable liver or lung metastases, which could or did shrink under chemotherapy enabling a complete resection.
If the treatment aim is not the cure due to disseminated disease, resection of the primary tumor should not be done (with exceptions due to specific reasons).
Lymph nodes must be resected as well, together with the hemicolectomy*; at least 12 lymph nodes must be resected.
- When is complementary chemotherapy required after colon cancer surgery?
Complementary chemotherapy after colon cancer surgery is required in the following cases:
- In stage II without lymph node mestastases, but primary stage higher than stage T2**: adjuvant chemotherapy for 6 months is probably indicated in younger patients (below age 70) with poor histology (undifferentiated histology, lymphatic or vascular invasion), with XELOX or FOLFOX, or Capecitabine monotherapy.
- In stage III with positive lymph nodes: for 6 months with XELOX (or FOLFOX)
- In case of resectable liver metastases: preoperative 3 months of FOLFOX or XELOX, followed by surgery and again thereafter, 3 months of chemotherapy.
- Are there specific tests which may indicate familial colon cancer?
The following tests can indicate a genetic predisposition to colon cancer:
- Familial Adenomatous Polyposis (FAP)
- Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer)
- Mismatch Repair (MMR) genes
- Are tissue biomarkers specific for colon cancer and possibly useful targets for treatment?
There is the RAS mutation (NRAS, KRAS codon 2,3,4) for selection of treatment with antibodies against the Epidermal-Growth-Factor-Receptor (EGFR). When the RAS mutation is found in the cancer tissue, then the antibodies against EGFR are not effective.
* Hemicolectomy: resection of part of the colon
** Stage T2 colon cancer indicates a tumor that has grown into the muscle layer of the colon
About Professor Schmoll
Professor Hans-Joachim Schmoll has a long career focusing, among others, on gastrointestinal and testicular cancer. He is the Head of the Department of Oncology and Hematology, at the University of Halle (Germany), where he is also Associate Professor of Internal Medicine, and Hematology/Oncology, Hemostaseology.
Professor Schmoll is editor-in-chief of online oncology journal OncoTargets & Therapy, and his many professional positions include that of Past Chairman of the German Association of Medical Oncology.