Which cancer surgery commonly requires consideration of adjuvant chemotherapy based on nodal involvement?

• A. Prostate cancer
• B. Pancreatic cancer
• C. Breast cancer
• D. Colorectal cancer

Answer: (D)

Nodal involvement after surgical removal of a tumor signals a higher risk of systemic (microscopic) spread, so delivering additional systemic therapy afterward helps target any remaining cancer cells and reduce recurrence.

In colorectal cancer, if lymph nodes are positive, adjuvant chemotherapy is standard because it substantially lowers the risk of distant relapse and improves survival. After colectomy, patients with node-positive disease typically receive a fluoropyrimidine-based regimen with oxaliplatin (such as FOLFOX) for several months. This makes adjuvant chemotherapy a routine, therapy-driven decision specifically tied to nodal status in colorectal cancer.

Other cancers differ in this regard: pancreatic cancer is commonly treated with adjuvant chemotherapy after resection regardless of nodal status; prostate cancer decisions hinge more on risk factors and may involve hormonal therapy rather than standard adjuvant chemotherapy; breast cancer nodal status also guides systemic therapy, but the classic surgical scenario emphasizing adjuvant chemotherapy strictly based on nodal involvement is most clearly exemplified in colorectal cancer.