Fight CRC, along with our Medical Advisory Board, has taken the time to break down colorectal cancer treatment by stage. For detailed information about stage III and stage IV, check out Your Guide in the Fight.

Download Your Guide in the Fight

 

Stage 0 and Stage I Colon Cancer

Patients diagnosed with stage 0 and stage I colon cancer are often cured by the surgery that removes the cancerous polyps or tumor. 

STAGE 0 (IN SITU)

Surgery for Colon Cancer

  • Polypectomy — snaring and removing polyps containing cancer during a colonoscopy.
  • Local excision — removal of flat colon growths “piecemeal” during colonoscopy.
  • Open abdominal surgery — remove cancer, part of colon, and nearby lymph nodes in high risk situations.

Chemotherapy

  • Not recommended for stage 0 colon cancer.

STAGE I

Surgery

  • Colectomy (resection) or laparoscopic colectomy

Chemotherapy

  • Not recommended for stage I colon cancer.

Medically reviewed by Dr. Al Benson, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 9/23/13

Stage 0 and Stage I Rectal Cancer


STAGE 0 (IN SITU)

Surgery

  • Often, surgery is recommended to remove the cancerous tissue and surrounding healthy margins.

STAGE I

Surgery

  • Local excision through the anus.
  • Low anterior resection (LAR) for tumors that are high enough in the rectum to permit reconnecting the colon or rectum to the anus (anastomosis).
  • Abdominoperineal resection with permanent colostomy when the distance between tumor and anus is too short to allow safe anastomosis.

Possible Chemotherapy

If the tumor has gone through the outer layer of the rectum (T3) or there are cancer cells in lymph nodes (N1 or N2) then follow-up chemotherapy and chemoradiation may be recommended.

Stage II Colon Cancer


Surgery

Initial treatment for stage II colon cancer is surgery to remove the section of colon that contains the tumor and surrounding tissue with its blood vessels and lymph nodes.

  • Open colectomy
  • Laparoscopic colectomy

*If your lymph nodes are cancer-free (node-negative), your diagnosis is stage II colon cancer.

Chemotherapy

Treatment of node-negative stage II colon cancer is controversial. While surgery to remove the tumor in the colon is universally accepted as initial treatment, the value of chemotherapy after that surgery to keep cancer from recurring (coming back) is hard for patients and doctors to judge.

It’s estimated that between 4-5% of patients with stage II colon cancer will benefit from chemotherapy. However, there are side effects, some severe, associated with chemotherapy.

Clinical Trials

There are often clinical trials available for stage II colon cancer patients.

Medically reviewed by Dr. Al Benson, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 9/23/13

Stage II Rectal Cancer


For patients who are medically fit and able to undergo combined methods of therapy, treatment for stage II and III rectal cancer may consist of:

  • Chemoradiation before surgery
  • Abdominal surgery
  • Adjuvant chemotherapy

Patients with medical issues that make chemoradiation difficult may go directly to surgery, followed by:

  • No further treatment if their tumor hasn’t spread through the rectal wall or to lymph nodes.
  • A reconsideration of adjuvant chemotherapy and chemoradiation if there is spread through the wall (T3) or into lymph nodes (N1 or N2).

Stage III Colon Cancer


Most stage III colon cancer patients will receive a recommendation of surgery, chemotherapy and possibly radiation.

  • Surgery
  • Colostomy
  • Chemotherapy

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.

(“Bolus dose” – is the administration of a medication that is given to raise its concentration in the blood to an effective level.)

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.

Radiation

If surgery reveals the tumor has spread outside the colon, follow-up radiation may be recommended.  Radiation is not routine for stage III colon cancer.

Clinical Trials

There are often clinical trials available for stage III colon cancer.


Stage III Rectal Cancer

Most stage III rectal cancer patients will receive a recommendation of surgery, chemotherapy and chemoradiation combinations.

Surgery

For rectal cancer, abdominal surgery is often required to remove tumors. You may be treated with radiation and chemotherapy before surgery.

  • Low Anterior Resection (LAR)
  • Abdominoperineal Resection (APR)

Chemotherapy Combinations

For stage III rectal cancer patients who are medically fit and can tolerate combined methods of therapy, treatment can consist of chemoradiation (chemotherapy and radiation) before surgery, abdominal surgery, and/or adjuvant chemotherapy after surgery.

Patients who cannot tolerate chemoradiation at first, may go directly to surgery with no additional treatment, and then onto adjuvant chemotherapy and/or chemoradiation after surgery.

For a list of chemoradiation options, adjuvant chemotherapy options, and adjuvant chemotherapy options (a “sandwich” of chemo-chemoradiation-chemo), download Your Guide in the Fight.


Stage IV, Metastatic Cancer or Recurrent CRC

Take time to get the best information and advice possible from a multidisciplinary team. This process is vitally important. Make sure to get a second opinion, even if it takes extra time.

Treatment for stage IV or recurrent colorectal cancer is complex, and generally requires consultation with medical, surgical and radiological doctors. For a list of questions to ask if you have stage IV or recurrent CRC, and for examples of treatment options combined to treat metastatic disease over time, download Your Guide in the Fight.

Surgery

If the liver, lungs, or the lining of the abdomen (peritoneum) are affected, you may undergo multiple surgeries to remove metastatic disease. Often, chemotherapy and radiation are combined with surgery to shrink tumors. To learn more, download Your Guide in the Fight.

  • Partial Hepatectomy
  • Pulmonary Metastasectomy
  • Chemoembolization Surgery
  • Hyperthermic Intraperitoneal Chemotherapy

Chemotherapy Combinations

Capox or Xelox

  • Capecitabine (Xeloda®) plus oxaliplatin (Eloxatin®)
  • Capecitabine is an oral drug that works the same way as 5-FU inside the cancer cell.

Folfox

  • 5-FU, Oxaliplatin (Eloxatin®), and Leucovorin

Folfiri

  • 5-FU, Irinotecan (Camptosar®), and Leucovorin

These regimens may be combined with targeted therapies such as bevacizumab (Avastin®), cetuximab (Erbitux®), or panitumumab (Vectibix®). Patients who are not able to tolerate intensive therapy have other options. Doctors may recommend:

  • 5-FU plus leucovorin with or without bevacizumab (Avastin®).
  • Capecitabine (Xeloda®) with or without bevacizumab (Avastin®). Treatment with capectiabine (Xeloda®) alone should only be considered a reasonable option for selected patients who are not candidates for more aggressive combination regimens with oxaliplatin (Eloxatin®) or irinotecan (Camptosar®).

Targeted Therapies

There are approved targeted therapies for colorectal cancer.

Targeted Therapies include:  

Patients who cannot tolerate intensive therapy have other options, like Tas-102 (Lonsurf®). For a list of other therapies, download the GITF.


NCCN Patient’s Guide

The National Comprehensive Cancer Network is a “not-for-profit alliance of centers that develops practice guidelines to help in making informed treatment decisions.” NCCN Guidelines for Patients® are easy-to-understand resources and may help you with treatment decision making.

 Download the NCCN Patient’s Guide 

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