What management options are available for patients diagnosed with stage II colorectal cancer?

For patients diagnosed with stage II colorectal cancer, the primary management option is typically surgical resection NICE NG151, (Stintzing 2014).

For stage II colon cancer, the role of adjuvant chemotherapy remains controversial (Fotheringham et al. 2019, Stintzing 2014). While adjuvant chemotherapy is recommended for stage III disease NICE NG151, its use in high-risk stage II colon cancer is debated (Fotheringham et al. 2019). Molecular markers can help guide treatment decisions in these cases (Fotheringham et al. 2019). Preoperative systemic anti-cancer therapy may be considered for people with cT4 colon cancer, which can include some stage II cases NICE NG151.

For stage II rectal cancer, which is considered locally advanced, total neoadjuvant therapy (TNT) is a preferred approach (Scott et al. 2024). This typically involves chemotherapy and radiation before surgery (Scott et al. 2024). Organ preservation strategies may also be considered (Scott et al. 2024). For early rectal cancer (cT1-T2, cN0, M0), various treatments are offered after discussion and shared decision-making NICE NG151.

Following potentially curative surgical treatment for non-metastatic colorectal cancer, including stage II, follow-up is offered for the first three years to detect local recurrence and distant metastases NICE NG151. This follow-up should include serum carcinoembryonic antigen (CEA) and CT scans of the chest, abdomen, and pelvis NICE NG151.

Patients should receive information about possible short-term, long-term, permanent, and late side effects of treatment, such as altered bowel, urinary, or sexual function, nerve damage, and mental/emotional changes NICE NG151. Advice on adapting physical activity, diet, weight management, and healthy lifestyle choices is also provided for discharge after treatment NICE NG151. Patients are advised on how and when to seek help if side effects become problematic NICE NG151.