What is the recommended initial management for Duke's C2 caecal cancer?

The recommended initial management for Duke's C2 caecal cancer is to proceed directly to surgery. This is because Duke's C2 indicates that the cancer has invaded through the muscularis propria and is confined to the bowel wall, but it does not show signs of distant metastases. Surgical intervention, typically involving a right hemicolectomy, is required to remove the primary tumor effectively and facilitate a complete pathological assessment.

Surgery is the cornerstone treatment for localized colorectal cancer, as it offers the best chance for a cure by removing the tumor and surrounding tissues where cancerous cells may be present. Following surgical excision, additional treatments such as chemotherapy or radiotherapy may be considered in certain contexts, but they are not the initial treatment. The focus on surgery first is crucial in managing localized cancer effectively, as it addresses the source of the malignancy directly.

In contrast, chemotherapy is typically reserved for cases where there is advanced disease, and radiotherapy is not a standard upfront treatment for colon cancer. Palliative care is utilized for patients with advanced disease or those who are not surgical candidates, emphasizing quality of life rather than curative intent.