Treatment of Colon Cancer with Bulky Nodal Disease or T4b in pMMR/MSS Non-Metastatic Disease
This protocol covers non-metastatic colon adenocarcinoma where testing shows proficient mismatch repair (pMMR) / microsatellite stable (MSS) status and imaging reveals clinical T4b disease or bulky nodal disease — a presentation that calls for a specific perioperative strategy.
Clinical Scenario
The patient has pMMR/MSS colon adenocarcinoma at a non-metastatic stage. The defining features driving this pathway are clinical T4b disease — indicating direct invasion into adjacent structures — or bulky nodal disease on staging. These findings shape both the surgical planning and the decision about treatment sequencing.
Treatment Approach (Overview — Partial)
In this setting, a neoadjuvant systemic therapy approach before surgery is among the options considered, with the goal of optimising resectability prior to colectomy. The complete regimen options, sequencing, and surgical details are outlined in the full protocol.
Full regimen, selection criteria, and surgical algorithm available below ›
References
- Proficient MMR (pMMR)/microsatellite stable (MSS)
- Clinical T4b
- Bulky nodal disease
- Consider neoadjuvant therapy
- FOLFOX or CAPEOX
- Colectomy with en bloc removal of regional lymph nodes
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