Stage 1 CRC with Lymphovascular Invasion (LVI) - Chemo or Surveillance

Posted by vickih @vickih, Dec 21, 2023

Hi, I'm posting my summary story to assist others hopefully who receive confusing interpretations of early stage CRC and recommended action plan. I had a right colectomy recently and the biopsy showed a pT2N0M0 dMMR (Stage 1) cancer with Lymphovascular Invasion (LVI). My surgeon referred me to oncology with the belief that chemo would be recommended because of the LVI. My oncologist showed me the NCCN.org guidelines which clearly indicated a 5-year surveillance was the appropriate course. He was not concerned about the LVI. The dMMR status played a role in the surveillance recommendation over chemo. Both my surgeon and oncologist are fantastic, and I'm grateful for their skill and guidance. I would highly recommend the NCCN.org website for anyone new to cancer and trying to learn asap to make decisions.

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Colleen Young, Connect Director | @colleenyoung | Dec 23, 2023

Welcome, @vickih. Reports can be confusing. It is really important to have confidence in your cancer team, which you clearly do.

Looking up deficient mismatch repair (dMMR), I found this information:
"Approximately 15% of colorectal cancers develop because of defective function of the DNA mismatch repair (MMR) system. ...Patients with dMMR colon cancers have reduced rates of tumor recurrence, delayed time to recurrence, and improved survival rates, compared with pMMR colon cancers." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110173/

Did your oncologist explain why/how the the dMMR plays a role in your diagnosis? With the active surveillance plan, how often is it recommended for you to have a colonoscopy?

vickih | @vickih | Dec 26, 2023

HI, to the best of my understanding, my oncologist indicated that the dMMR status actually put the colon cancer into a "different category" of cancer - he actually used those words. Thus, when he pulled up the NCCN treatment flow chart, he distinguished it from the pMMR colon cancers - different treatment pathways and discussions. He went on to state that tumors with the dMMR status are not be as responsive to chemo until much later into treatment - that the first line of treatment would be immunotherapy and not until likely Stage 3 would chemo be tried, and only after immunotherapy had been attempted.

As far as the colonoscopy, my next one is scheduled for one year from my most recent. Depending on those results, he anticipated if fine, probably 3 years. If not, then repeat colonoscopies would be dependent on the findings.

I have gained a lot of insight from this support group in a short period of time. Hopefully, my little contribution can help others.

Regards, Vicki