Colon Cancer Stages and Treatment

Getting diagnosed with colon cancer can be scary and overwhelming. One of the first questions patients ask is “What’s next?” Knowing the stages and treatment options can help you navigate this as it varies. Your treatment plan depends on your overall health, whether the cancer is reoccurrence, and the stage of cancer.

Cancer staging takes place after the initial diagnosis and may involve multiple tests. Each test will help your physician determine how much of your body the cancer has affected. After determining the stage, your physician will recommend a course of treatment.

Stage 0

Abnormal cells are found in the inner lining (mucosa) of the colon, known as carcinoma in situ.

Treatment: 

  • Polypectomy: removal of malignant cells during a colonoscopy
  • Excision: If the cells have affected a larger area, minor and minimally invasive surgery is often done during the colonoscopy

Stage I

Cancer has invaded the mucosa and submucosa, the inner and underlying layer of the colon wall.

Treatment: 

  • Partial Colectomy: Surgery to remove the affected area, sometimes involving rejoining healthy parts of the colon.

Stage II

Cancer has spread beyond the colon wall but hasn’t reached the lymph nodes. This stage has three subcategories:

  • Stage IIA: Spread to the outer colon wall (serosa) but not beyond the colon
  • Stage IIB: Spread past the serosa but not to nearby organs 
  • Stage IIC: Spread to the serosa and nearby organs

Treatment: 

  • Surgery: To remove the affected areas.
  • Chemotherapy: Sometimes recommended. High-grade or abnormal cancer cells or tumors that have caused blockage or perforation of the colon may warrant further treatment.
  • Radiation: If surgery doesn’t remove all cancer cells, radiation may be recommended to kill any remaining cancer cells and reduce the risk of recurrence.

Stage III

Cancer has spread past the colon lining to the lymph nodes but not other organs. This stage is divided into IIIA, IIIB, and IIIC based on a combination of which layers of the colon wall are affected and how many lymph nodes have been affected.

Treatment: 

  • Surgery and Chemotherapy: Surgery is performed to remove the affected areas and is followed by chemotherapy.
  • Radiation: For those who can’t have surgery or need additional treatment post-surgery, radiation may be recommended.

Stage IV

Cancer has spread to other organs in the body through the blood and lymph nodes.

Treatment:

  • Surgery: To remove small areas (metastases) in the organs that have been affected, if possible.In many cases, however, the areas are too large to be removed and the patients will need to undergo chemotherapy.
  • Chemotherapy: This may help shrink the tumors so that surgery is more effective or prolong a person’s life. Common Regimens may include:
      • FOLFOX: Leucovorin, 5-FU, and oxaliplatin
      • FOLFIRI: Leucovorin, 5-FU, and irinotecan
      • CapeOX: Capecitabine and oxaliplatin
      • Others: Combinations with bevacizumab, cetuximab, and panitumumab

Note: 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. Strategies may be better for different individuals. Patients faced with a stage IV diagnosis may find it helpful to seek out more than one opinion about treatment and to be aware of clinical trials.

Additional Available Treatment options for stage IV colon cancers.

To identify the most effective treatment method for your specific cancer, talk to your care team about understanding your biomarkers.

Targeted therapy uses drugs to target specific molecular abnormalities in cancer cells to slow or stop the growth of cancer cells, or to destroy them.

  • Cetuximab
  • Panitumumab
  • Bevacizumab

Immunotherapy uses the patient’s own immune system to recognize and attack the cancer cells

  • Nivolumab
  • Pembrolizumab

Combination therapy uses multiple treatments in combination to achieve the best possible results for an individual patient

Each stage of colon cancer comes with its own challenges and treatment plans. Early detection and tailored treatment can significantly improve outcomes. 

Before treatment begins talk to your care team about biomarker testing to help determine the best course of treatment for your specific cancer-type. Remember, you’re not alone in this. Understanding your diagnosis and treatment options can make a big difference. Stay positive, seek support, and keep informed.