Question: My father underwent a right hemi colectomy on XXXXXXX 29th to remove a malignant tumor. The summary of the biopsy report is:
Specimen type: right hemicolectomy
Specimen length: 985 mm
Tumour site: cecum
Tumour configuration: infiltrative, ulcerating
Tumour size: 55mm (addl dimensions 35 x 50 mm)
Histologic type: adenocarcinoma
Histologic grade: Low grade (well to moderately differentiated) (though before in the same report under 'opinion' it says moderately differentiated adenocarcinoma)
Pathologic staging: Primary tumour. pT3a/b: tumour invades through the muscularis propria into the subserosa or the nonperitonealized pericolic or perirectal soft tissues, invades 5mm or less beyond the border of the muscularis propria
Regional lymph nodes: pN0, no regional lymph node metastasis. Bumber examined 10. Number involved 0.
Distant metastsais: pMX cannot be assessed

Margins: proximal, distal, mesenteric, unresolved by invasive carnioma.

Lymphatic invasion, absent

Venous invasion, absent

Perineural invasion, absent

Intratumoral/peritumoural lymphocytic response, none

Other details that might be significant are that the tumour had caused a near complete obstruction, and my father's sister also had colon cancer and died from it more than ten years ago.

I would like your advice on whether he will need chemotherapy or not. My father is very reluctant to have chemotherapy done. And we, his children, are very scared of a recurrence, but given his gae (76 years) can't see him suffer the side effects of chemotherapy or cancer recurrence. Can you tell us your opinion please?

Thank you very much for your answer, it has provided much relief!

My father's oncologist, who we had to XXXXXXX in secret yesterday because my father (he's a doctor himself) refused to go, has recommended chemotherapy based on there being less than 12 lymph nodes removed and the tumour having caused a near total obstruction. He's suggesting oral chemotherapy. He has also suggested a PET scan to make sure there are no tumours anywhere else in his body.

I know this might be difficult for you to answer, but do you think there is anything in his argument for chemotherapy? If we decide against chemotherapy based on your advice, which appeals to us greatly, is there anything we should do to monitor the situation to make sure there is no recurrence?

I would highly appreciate your advice.

Thank you Dr, Kreuger. I have discussed your advice with my father. The oncologist we consulted here, though he suggested chemotherapy, I noticed he has written in his notes that adjuvant chemotherapy would prevent recurrence 'theoretically speaking'. This, to me suggests, that even he has doubts about its actual benefit - it is not a categorical recommendation to have chemotherapy.

Taking into consideration your advice and that chemotherapy side effects might adversely affect the good recovery my father is making at the moment, and also the fact that my father feels he is fine and is reluctant to consider any further treatment, we have decided against chemotherapy.

Thank you for your advice. I am grateful to you for your help and am hopeful my father will remain well for many years, as you say.

Best wishes
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