Colon Cancer Treatment by Stage
The recommended treatment for stage I colon cancer is usually resection/anastomosis surgery. No chemotherapy or radiation therapy is needed for the treatment of stage I colon cancer.
Treatment for stage II colon cancer may include resection/anastomosis surgery.
The potential benefits of chemotherapy for patients with stage II (also known as Dukes' B or MAC B2 or B3) colon cancer remain controversial. Although subgroups of patients with stage II colon cancer may be at higher-than-average risk for recurrence, evidence is inconsistent that 5-fluorouracil (5-FU)-based chemotherapy is associated with an overall improved survival rate compared to surgery alone.
Radiation therapy is not considered beneficial for treating stage II colon cancer.
Stage III colon cancer involves the lymph nodes. Studies have indicated that the number of lymph nodes involved affects the prognosis for those with this stage of cancer. Patients with 1 to 3 involved nodes have a significantly better survival rate than those with 4 or more involved lymph nodes.
Surgical treatment of stage III colon cancer may include resection/anastomosis surgery.
Following surgery, chemotherapy with fluorouracil (5-FU)-leucovorin for 6 months may be recommended. This type of chemotherapy has demonstrated prolonged 3-year survival but did not demonstrate an advantage in overall survival rates.
Radiation therapy is not considered beneficial for treating stage III colon cancer.
Treatment of patients with recurrent or advanced colon cancer depends on the location of the disease. For patients with locally recurrent and/or liver-only and/or lung-only metastatic disease, resection surgery, if feasible, is the only treatment with the potential to cure the disease. Patients with cancer that cannot be treated surgically are treated with systemic chemotherapy.
Treatment of stage IV and recurrent colon cancer may include the following:
- Resection/anastomosis (surgery to remove the cancer or bypass the tumor and join the cut ends of the colon)
- Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread.
Radiation therapy or chemotherapy may be offered to some patients as palliative therapy to relieve symptoms and improve quality of life.
Special treatments of cancer that has spread to or recurred in the liver may include the following:
- Radiofrequency ablation (a technique that uses a special probe with tiny electrodes that kill cancer cells)
- Cryosurgery (using an instrument to freeze and destroy abnormal tissues).
New regimens of chemotherapy have improved the response rate, time-to-tumor progression, and median survival of patients with advanced disease, with tolerable side effects. The median survival of these patients has improved from approximately 12 months in the mid-1990s to over 20 months in 2003.