A 60-year-old man undergoes curative resection for stage II colon cancer (T3N0M0). Histopathology shows lymphovascular invasion and 9 lymph nodes examined. Which factor in this report indicates consideration for adjuvant chemotherapy?
- A T3 stage alone
- B Lymphovascular invasion and inadequate lymph node sampling (<12 nodes) ✓
- C Age above 55 years
- D Tumor location in the ascending colon
Correct answer: B. Lymphovascular invasion and inadequate lymph node sampling (<12 nodes)
Explanation
High-risk features for stage II colon cancer that warrant consideration of adjuvant chemotherapy include T4 stage, inadequate lymph node sampling (<12 nodes), lymphovascular invasion, perineural invasion, positive margins, obstruction, perforation, and poorly differentiated histology. T3N0 alone without high-risk features does not routinely require adjuvant therapy. Age and tumor location alone are not indications.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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