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Adjuvant therapy for resected stage III (node-positive) colon cancer

Jeffrey W Clark, MD
Hanna K Sanoff, MD, MPH
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


Approximately 95,520 new cases of colon cancer are diagnosed annually in the United States [1]. Data on global incidence are available from the World Health Organization (WHO) Globocan database.

Surgical resection is the only curative treatment for locoregional colon cancer. Outcome is most closely related to the extent of disease at presentation (table 1 and figure 1) [2]. (See "Clinical presentation, diagnosis, and staging of colorectal cancer", section on 'TNM staging system'.)

For patients who have undergone potentially curative resection, disease recurrence is thought to arise from clinically occult micrometastases that are present at the time of surgery. The goal of postoperative (adjuvant) therapy is to eradicate these micrometastases, thereby increasing the cure rate.

The benefits of adjuvant chemotherapy have been most clearly demonstrated in stage III (node-positive (table 1)) disease, whereas benefit in stage II disease remains controversial. This topic review will cover adjuvant therapy for patients with resected stage III colon cancer. Adjuvant therapy for stage II (node-negative) colon cancer, adjuvant therapy for colon cancer in elderly patients, surgical management and prognosis of colon cancer, chemotherapy after resection of colorectal cancer liver metastases, a compilation of protocols for treatment of colon cancer, and recommendations for posttreatment follow-up are discussed separately. (See "Adjuvant chemotherapy for resected stage II colon cancer" and "Adjuvant therapy for resected colon cancer in elderly patients" and "Overview of the management of primary colon cancer" and "Management of potentially resectable colorectal cancer liver metastases" and "Treatment protocols for small and large bowel cancer" and "Surveillance after colorectal cancer resection".)


Early studies of fluorouracil (FU) monotherapy failed to show a survival benefit relative to resection alone [3]. Interest in adjuvant chemotherapy was revived in the late 1980s with reports that suggested a survival benefit from FU-based combination regimens [4,5] and by the discovery of modulators of FU activity, such as leucovorin (LV) and levamisole, an immunomodulatory drug that proved to be toxic to the central nervous system and is no longer available.

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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2017.
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