What to keep in mind for stage 3C patients

Someone had asked about recommendations for stage 3C in the 3rd Lane group.

So I wrote this in reply:

Stage 3C Colon: 6 months of CAPOX or FOLFOX.

Stage 3C Rectal: TNT. FOLFOXIRI maybe available to some patients instead of FOLFOX or CAPOX.

Here’s more on things to consider and discuss with your care team for stage 3C:

What we have seen based on people’s experience in Colontown.

For Colon: Surveillance using multiple modalities like ctDNA MRD, CT scans, CEA, CA19-9 is very important.

Same for rectal: Local regrowth or recurrence may be another thing to keep track of.

Good to be very familiar with the surgical pathology report to check for potential perforations, adhesions, tumor deposits etc mentioned in the surgical pathology report. This can provide some clues about what to keep track of during surveillance scans.

Also good to ask your care team to show you the CT images (not the report) and explain to you what was seen both at the diagnostic imaging as well as the scans after treatment. You may not understand most of what the care team shows you, but this is an opportunity for your oncologist to take a look at the images if they haven’t already done that.

You will be surprised to know that when spots are detected in the liver or lungs, very often people can go back to the previous scan and see the beginnings of the lesion in that scan. It’s hard to see these small growths because they are too small, but when you know where they are, it’s easier to locate them on previous scans.

As a patient, because stage 3C has a much higher chance of progression to stage IV, it may be helpful to stay vigilant in the 1st 2 years after treatment.

Getting a ctDNA MRD test is strongly recommended for surveillance. Also if ctDNA negative after surgery for colon cancer, and if it continues to stay negative, your chances of a great prognosis is very high. So a negative ctDNA MRD test can be very reassuring. But on the flip side, if it’s positive, it can be very anxiety inducing. So it’s important to figure out if you are comfortable with handling the uncertainty and the anxiety from a positive test before you get it.

A discussion with your care team going over all the specific details of your case and asking in particular about what all can be done to lower your chances of recurrence/progression including being on low dose aspirin, Vitamin D supplementation, diet & life style changes etc may be of value.

You could also discuss clinical trials that maybe available that you could enroll after treatment is done (example: Dr. Aparna Parikh’s trial https://classic.clinicaltrials.gov/ct2/show/NCT03803553) More about this trial here: https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.148

Patients who are ctDNA positive after adjuvant therapy can be randomized to this trial to receive FOLFIRI (or other treatments in other arms).