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Therapeutic considerations in Dukes C colon cancer

(2001) Bleeker, Willem Aldert

Colon cancer is one of the main health issues in the western world. In the Netherlands more than 7000 patients are diagnosed yearly with this disease and half of them will die from it.
Prognosis largely depends on tumor stage, which is estimated by radiological, clinical and histological characteristics. After histological research; tumor depth, surgical resection margins and lymph node involvement is assessed. These histo-pathological variables are used in classification systems to estimate the prognosis of the patient. Since Dukes described the first classification system for colorectal tumors in 1932, many other classification systems were introduced like the Astler Coller, modified Dukes, TNM and Jones classification.
All these prognostic models are used to assess the individual prognosis of the treated patient.
Unfortunately, most of these classification systems are only indicative for a patient’s prognosis. But, a useful and accurate staging system remains the key to a successful oncological treatment. Due to the expanding genetic knowledge of the initiation and development of tumors the development of a staging system that predicts individual prognosis and to use it in daily clinical practice might be possible. Although genetic research expands enormously in the last decade, clinical implications for sporadic colorectal cancer are not yet recognized. In contrast, genetic counseling of patients with Familial Polyposis Colon cancer and Hereditary Non Polyposis Colon Cancer (HNPCC) has lead to clinical implications, primarily by preventive colorectal resection. The future will show if gene-therapy will offer a solution for patients with hereditary colorectal cancer. In chapter II the immunological reaction on a dermal stimulus of Di-Nitro-Chloro- Benzene (DNCB) is presented.
The reason for this investigation was based on the renewed interest in the clinical use of levamisole in the treatment of Dukes C colon cancer. Patients with decreased T-cell function have absent skin reactions but if treated with Levamisole, skin tests can be restored to normal indicating restoration of a defective T-cell system. Patients with a normal T-cell system have no immunological reaction on stimulation with Levamisole. After a curative resection of a Dukes C colon cancer, most patients have a normal DNCB skin test. It is hypothesized that only patients with defective T-cell systems, and absent DNCB skin tests, are treated usefully with Levamisole. Adjuvant treatment of patients with Dukes’ C colon cancer is very intensive (patients are treated with 5FU and Levamisole on a weekly basis for a period of 12 months), and a selection of patients who will benefit from adjuvant treatment with Levamisole is essential.