Treatment for Stage III Colon Cancer

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


Surgery Options

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.

Colectomy

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.

Colostomy

A colostomy surgery creates a way for stool to be removed from the body when part of the colon is removed. In this procedure, a stoma (an opening) is made to the outside of the body and an ostomy pouch is placed around the stoma to collect and remove waste. An ostomy refers to the opening in the body for waste; while the stoma is the actual end of the intestine seen peeking through the abdominal wall. Learning how to care for your ostomy is essential for your well being after this procedure. A colostomy can be temporary and reversed, or be permanent.


Chemotherapy

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.

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

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.


Clinical Trial

Another important option for treating stage III colon cancer is to enroll in a clinical trial. Learn more through Fight Colorectal Cancer’s Clinical Trials Matching Service.

 

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