I would like to learn your approach if you had a 78YM ECOG 1 with pT3N0M0 transverse colon adenocarcinoma s/p R hemicolectomy and not a CEA secretor and the only risk feature identified on path being moderately to poorly differentiated adeno. Would you offer adjuvant chemo? Would you obtain ctDNA?
I’m assuming this patient has an MSS tumor. I would not offer adjuvant therapy based on the differentiation alone. In my practice, I do check and serially follow ctDNA. If positive at the first time point, I would give adjuvant therapy. If positive and it has been a bit since the pre-op scans, I would check a CT CAP before starting any therapy.
