Chemotherapy improves survival by preventing the cancer from coming back (recurring) after surgery for stage III colon cancer, and is generally recommended for stage III colon cancer patients. Elderly people benefit from chemotherapy and are able to tolerate it as well as younger patients, unless they have other serious medical problems.
Like stage II colon cancer, initial treatment for stage III colon cancer is surgery to remove the section of colon that contains the tumor and the surrounding tissue with its blood vessels and lymph nodes.
A colectomy or colon resection is abdominal surgery to remove the section of colon where the tumor is located, tissue containing blood and lymph vessels surrounding the colon (mesentery), healthy tissue margins on either side, and, if possible, at least 12 lymph nodes. Then the remaining ends of colon are reconnected with sutures or staples. This reconnection is called an anastomosis. There are two types of surgery:
- Open colectomy: An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.
- Laparoscopic colectomy: Three small keyhole incisions are made in the abdomen to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen. Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy. This is also known as minimally invasive surgery.
The tumor, tissue on either side of it (the margins), and fat and lymph nodes attached to the colon are removed for further study by a pathologist. The pathologist evaluates the cancer cells in the tumor itself, looks for cancer in the margins and other tissue, and studies as many lymph nodes as possible in order to provide an accurate diagnosis.
For patients able to tolerate combination chemotherapy that includes Eloxatin®
- FOLFOX: combination treatment with infusional 5-FU (fluorouracil), leucovorin, and oxaliplatin.
- FLOX: combination with bolus 5-FU, leucovorin, and oxaliplatin. Severe diarrhea is more common with FLOX than FOLFOX but outcomes are similar.
For patients who have medical reasons not to use combination chemotherapy
- Xeloda® (capecitabine): oral “prodrug” which is converted to 5-FU in the tissues.
- 5-FU and leucovorin
Your doctor can discuss the advantages and disadvantages of the different chemotherapy regimens for your individual needs.
Sometimes if surgery finds that the tumor has spread outside the colon and adhered to the wall of the abdomen or other nearby tissues, follow-up radiation treatment is recommended. However, radiation is not routine for stage III colon cancer.
Another important option for treating stage III colon cancer is to enroll in a clinical trial.