Molecular Testing in Colorectal Cancer

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Testing for microsatellite instability (MSI) has gained acceptance in guidelines as part of the standard workup for patients with colorectal cancer (CRC). Reflexive MSI testing for patients with CRC varies among institutions. While the age to begin testing can very, it remains essential that patients with familial syndromes are followed closely. It is important to work with the pathology department, in order to fully utilize the testing method that has been operationalized and standardized, explains Herbert Hurwitz, MD.

It is a major challenge for primary care physicians to stay up to date on survivorship recommendations for every disease and the concern is that a lot of these patients may be lost to follow up. Patients with familial MSI-high CRC require follow up for the rest of their lives and are at risk for other cancers as well, notes Axel Grothey, MD.

MSI-high results can be utilized to guide treatment decisions regarding adjuvant therapy in stage II disease. Whether to give adjuvant chemotherapy in a patient with intermediate-risk stage II CRC is a complex decision that can be aided with the use of MSI testing.