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General Surgery


Answer 2
  1. Chemotherapy with 5-FU and levamisole. The lesion described by the pathology report is a T3 N1 M0 lesion—ie, extending beyond the muscularis propria and into the pericolonic fat within the sleeves of the mesentery, and 1 to 3 positive nodes. This is a stage III tumor.
    About 25% of patients with stage II tumors and 50% of patients with stage III tumors eventually die from growth of micrometastatic disease that was present at the time of primary tumor resection. Several randomized, prospective studies have demonstrated that postoperative, adjuvant, systemic chemotherapy benefits certain subgroups of patients. Patients with stage III disease had improved disease-free and overall survival rates if treated with the combination of 5-FU and levamisole.1
    Fifty percent of colon cancers that recur do so within 2 years of surgery, and 90% of the recurrences are evident by 3 years.2 Therefore, routine follow-up after a potentially curative operation should include history and physical examination, measurement of CEA levels, and fecal occult blood testing every 6 months for 3 years, then yearly. Liver function tests, abdominal CT scan, colonoscopy, and chest radiograph should also be performed yearly.

    REFERENCES
    1. Moertel CG, Fleming TR, Macdonald JS, et al: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990;322:352-358.

    2. Shelton AA, Wong WD: Colorectal cancer. In Current Surgical Therapy, 6th ed. Cameron JL, ed. St. Louis: Mosby, 1998:226-227.

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