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