A colon cancer diagnosis can be terrifying. One of the first questions that patients usually ask is “what’s next?” The plan for treatment depends on a number of factors. Determining the best course of action is affected by your general health, whether or not the cancer is a recurrence of a cancer that was treated in the past, and on the stage of the cancer.
Cancer staging takes place after the initial diagnosis and may involve a number of tests. Each test will help your physician to determine how much of your body the cancer has affected. After determining the stage, your physician will recommend a course of treatment.
Stage 0 Colon Cancer
When abnormal cells are found in the wall, or mucosa, of the colon, it is considered stage 0 colon cancer. This is also called carcinoma in situ.
Treatment: A polypectomy is performed during a colonoscopy and may remove all of the malignant cells. If the cells have affected a larger area, an excision may be performed. An excision is simply a minor, minimally invasive surgery that can often be performed during the colonoscopy.
Stage I Colon Cancer
Cancer which has invaded the mucosa and the submucosa is considered stage I colon cancer. The submucosa is the underlining of the large intestine and it lies beneath the mucosa. In stage I colon cancer, malignant cells may have also affected the deeper muscle layer of the colon wall, but have not invaded any areas outside of the colon.
Treatment: Surgery is performed to remove the affected area. This is called a partial colectomy and may involve rejoining the parts of the colon that are still healthy.
Stage II Colon Cancer
When cancer has spread past the colon wall, but has not affected the lymph nodes, it is considered stage II colon cancer. This condition is subdivided into three stages.
- Stage IIA Cancer has spread to the serosa, or outer colon wall, but not beyond that outer barrier.
- Stage IIB Cancer has spread past the serosa but has not affected nearby organs.
- Stage IIC Cancer has affected the serosa and the nearby organs.
Treatment: Stage II cancers are treated with surgery to remove the affected areas. Chemotherapy may also be recommended in some cases. High grade or abnormal cancer cells, or tumors that have caused a blockage or perforation of the colon may warrant further treatment. If the surgeon was not able to remove all of the cancer cells, radiation may also be recommended to kill any remaining cancer cells and reduce the risk of a recurrence.
Stage III Colon Cancer
Cancer that has spread past the lining of the colon and has affected the lymph nodes is considered stage III colon cancer. In this stage, even though the lymph nodes are affected, the cancer has not yet affected other organs in the body. This stage is further divided into three categories: IIIA, IIIB and IIIC. Where your cancer is staged in these categories depends on a complex combination of which layers of the colon wall are affected and how many lymph nodes have been attacked.
Treatment: The course of action for all categories of stage III colon cancer involves surgery to remove the affected areas, and chemotherapy. Radiation treatment may also be recommended for patients who are not healthy enough for surgery or for patients who may still have cancer cells in their bodies after surgery has taken place.
Stage IV Colon Cancer
In stage IV colon cancer, the cancer has spread to other organs in the body through the blood and lymph nodes.
Treatment: Patients with stage IV colon cancer may undergo surgery to remove small areas, or metastases, in the organs which have been affected. In many cases, however, the areas are too large to be removed. Chemotherapy may help to shrink the tumors so that surgery is more effective or to prolong life.
Chemotherapy treatments for stage IV colon cancer may include:
- FOLFOX (leucovorin [folinic acid], 5-FU, and oxaliplatin)
- FOLFIRI (leucovorin, 5-FU, and irinotecan)
- CapeOX (capecitabine and oxaliplatin)
- 5-FU and leucovorin, with or without bevacizumab
- Capecitabine, with or without bevacizumab
- FOLFOXIRI (leucovorin, 5-FU, oxaliplatin, and irinotecan)
- Irinotecan, with or without cetuximab
Researchers acknowledge that even though advances in treating metastatic colon cancer are moving along at a rapid pace, there is no standard recommended treatment for the disease at this level. Different strategies may be better for different individuals. Patients who are faced with a stage IV diagnosis may find it helpful to seek out more than one opinion about treatment and also to be aware of clinical trials.
Information on these pages is provided for informational purposes only. Consult your own physician before making any medical decisions.