A Study of Imaging, Blood, and Tissue Samples to Guide Treatment of Colon Cancer and Related Liver Tumors

Inclusion criteria

• Patients must be undergoing one of the following procedures as part of their routine care in order to meet the inclusion criteria:

• Operation for presumed stage I-IV colon cancer including colectomy, hepatectomy, or abdominal surgery (e.g. insertion of HAIP)
• Colectomy for presumed benign or pre-malignant colon tumors (e.g. large nonneoplastic polyps or adenomas)
• Open, laparoscopic, or robotic resections
• ≥18 years old

Exclusion criteria

• Extrahepatic CRC metastasis
• No preoperative portal venous phase CT scan performed up to two months prior to day of surgery Pathology demonstrating a malignant tumor other than colorectal adenocarcinoma.
• Stage IV colon cancer with resectable hepatic disease undergoing hepatectomy with active primary colon tumor still in place (despite chemo-radiation therapy) and no plans for colectomy.
• Receipt of experimental therapies for colon cancer (e.g. checkpoint inhibitors or novel targeted agents). Of note, approved targeted agents (such as anti-angiogenic agents, EGFR inhibitors etc) are not an exclusion criterion.
• History of non-colonic malignancy w/in 5 years (except non-melanomatous skin cancer)
• Colon cancer with microsatellite instability (MSI-high) if known preoperatively
• Known hereditary colon cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC)
• Known liver disease (e.g. non-alcoholic steatohepatitis, cirrhosis, viral or other form of hepatitis, etc)
• INR >2 or known clotting factor deficiency
• Anticipated need for full anticoagulation during hospitalization
• Receipt of medications that increase significantly the risk of bleeding after liver biopsy (at the surgeon"s discretion)
• Intraoperative discovery of pathology that precludes the planned surgical resection or liver biopsy, or makes resection futile (such as peritoneal carcinomatosis or other extrahepatic metastatic disease)
• Operating surgeon deems research interventions to be more than a minimal risk for the patient