Stage II Colon Cancer
Sub-stages
Doctors break stage II colon cancer into three sub-stages, based on how deep the tumor has grown:
- Stage 2A — grown into the outer layer of the colon wall
- Stage 2B — grown through the colon wall into the lining of the abdomen
- Stage 2C — grown into nearby organs or structures
No matter which sub-stage you have, the cancer hasn’t spread to lymph nodes or other parts of the body — that’s what makes it stage II. Your care team will use your sub-stage, along with other test results, to help decide whether chemotherapy after surgery makes sense for you.
Surgery
You will need surgery to remove the section of colon that contains the tumor and surrounding tissue with its blood vessels and lymph nodes. It could be either:
Open Colectomy: When a surgeon makes a long incision in your abdomen so that they can access and remove a portion of your colon.
Laparoscopic Colectomy: When a surgeon makes a few small incisions in your abdomen through which they pass a tiny camera and tools to access and remove a portion of your colon.
Chemotherapy
Surgery to remove the tumor is the accepted first step for stage II colon cancer. Whether you’ll also need chemotherapy after surgery is less clear-cut — researchers have studied this question in many trials, and the answer really depends on your specific situation.
Your care team will look at a few things together: your sub-stage (2A, 2B, or 2C), your tumor’s mismatch repair status, and whether any high-risk features were found during surgery. These factors help you and your doctor decide together whether chemotherapy makes sense for you.
New techniques such as blood tests looking for circulating tumor DNA (ctDNA) are being tested to help determine the risk for recurrence, and to help doctors to determine if chemotherapy after surgery may be warranted.
Aspirin after surgery
Some stage II tumors have changes in a set of genes called the PI3K pathway. If your tumor has these changes, your doctor may recommend a daily aspirin for 3 years after surgery — research shows this can help lower the chance of the cancer coming back.
Ask your care team if your tumor has been tested for this, and whether daily aspirin could be part of your plan.
