抗击结直肠癌，与我们的 医学顾问委员会, has taken the time to break down colorectal cancer treatment by stage, which includes both colon cancer treatment by stage and rectal cancer treatment by stage. For detailed information about stage III and stage IV colon and rectal cancer treatment, check out Your Guide in the Fight.

• 0期和I期结肠癌
• I期直肠癌
• II期结肠癌
• 第二期直肠癌
• 第三期结肠癌
• 第三期直肠癌
• 第四阶段（转移性或复发性）CRC

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0期和I期结肠癌

Patients diagnosed with stage 0 and stage I colon cancer are highly likely to be cured (>90% cure rate) by a procedure (polypectomy) or surgery (colon resection) that removes the cancerous polyps or tumor.

0期（原位）结肠癌

Surgery or polypectomy is usually the only recommended treatment for stage 0 colon cancer.

• 息肉切除术 - 在结肠镜检查中捕捉和切除含有癌症的息肉
• 局部切除 - 在结肠镜检查中 "零碎地 "切除平坦的结肠生长物
• 开腹手术 — remove cancer, part of colon, and nearby lymph nodes in high-risk situations

第一期结肠癌

For stage I colon cancer, surgery is often the only recommended initial treatment. It will typically be either:

• 结肠切除术(切除) — removal of all or part of your colon through an incision or incisions (laparoscopic surgeries often require several small incisions while open surgery is usually done using a single, larger incision).
• 腹腔镜结肠切除术 - 外科医生在你的腹部做几个小切口，通过这些小切口，他们将一个微小的摄像头和工具送入你的结肠。

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I期直肠癌

有各种不同的手术用于治疗I期直肠癌。

• 通过肛门进行局部切除
• 低位前切除术（LAR），适用于直肠内足够高的肿瘤，允许将结肠或直肠与肛门重新连接（吻合）。
• Abdominoperineal resection with permanent colostomy when the distance between tumor and anus is too short to allow safe anastomosis (reconnection).

Tumor Imaging

Endorectal ultrasound (a procedure where an ultrasound probe is inserted into the rectum), MRI scans, or CT scans are commonly used to make images of rectal tumors to assess the depth of tumor invasion and whether there are signs of lymph node invasion by the tumor. If the tumor has invaded through the rectal wall or has spread to lymph nodes it is not a Stage I tumor and its treatment is covered elsewhere.

可能的化疗

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 preoperative chemotherapy and 化疗 may be recommended to reduce the size of the tumor and increase the likelihood of avoiding a permanent colostomy. In some cases, chemotherapy and/or chemoradiotherapy (if no radiation was administered before surgery) may be recommended after surgery as well. This is generally done when the tumor is felt to have progressed beyond Stage I based on examination and tumor imaging.

可能的观察和等待

For some stage I rectal cancers, there may be the option to watch and wait after removal of the tumor via a polypectomy or after a surgical procedure where the tumor is removed through the anus when that is possible. In all cases surveillance for local or distant tumor recurrence is critical so that any recurrence can be addressed quickly and examinations and/or imaging is often done every 3-6 months for several years.

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II期结肠癌

II期结肠癌的初步治疗是通过手术切除含有肿瘤的结肠部分和周围组织及其血管和淋巴结。这可能是其中之一。

• 开放式结肠切除术 — when a surgeon makes a long incision in your abdomen so that they can access and remove a portion of your colon
• 腹腔镜结肠切除术 — 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

化疗

The potential benefits of treatment of node-negative stage II colon cancer with 化学治疗 after surgery is controversial. While surgery to remove the tumor in the colon is universally accepted as an initial treatment, the value of chemotherapy after that surgery (adjuvant chemotherapy) to keep cancer from recurring (coming back) has been tested in many trials and the outcome has shown that it does not improve outcomes except in some cases which are judged to carry a higher risk of recurrence. 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.

临床试验

经常有 临床试验 available for stage II colon cancer patients.

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第二期直肠癌

对于在医学上适合并能够接受综合治疗方法的患者，II期和III期直肠癌的治疗可能包括：。

• Chemotherapy and/or Chemoradiation before surgery
• 腹部手术
• 辅助性化疗

有医疗问题导致化疗放疗困难的患者可以直接进行手术，然后再进行。

• 如果他们的肿瘤没有通过直肠壁或扩散到淋巴结，则无需进一步治疗
• 如果有穿墙（T3）或进入淋巴结（N1或N2）的扩散，则要重新考虑辅助化疗和化放疗。

第三期结肠癌

Most stage III colon cancer patients will receive a recommendation of surgery, followed by chemotherapy.

联合化疗

Patients who are able to tolerate combination chemotherapy that includes Oxaliplatin (Eloxatin®) are often prescribed:

• Folfox - 输液5-FU（氟尿嘧啶）、亮菌甲素和奥沙利铂联合治疗
• CapeOx — combination treatment with capecitabine (a chemotherapy pill similar to 5-FU) and oxaliplatin.

替代化疗

Patients who have medical reasons not to use combination chemotherapy may be prescribed chemotherapy with a single drug:

• Xeloda® (卡培他滨) — an oral “prodrug” which is converted to 5-FU in the tissues
• 5-FU和Leucovorin — an intravenous chemotherapy drug given with a vitamin (leucovorin) that enhances the effect of 5-FU.

你的医生可以根据你的个人需要讨论不同化疗方案的优缺点。

辐射

If surgery reveals the tumor has spread outside the colon so that the tumor extends into other tissues such as the lining of the abdomen (the peritoneum), follow-up radiation may be recommended. 辐射 is not a routine treatment for stage III colon cancer.

临床试验

经常有 可提供的临床试验 为III期结肠癌。

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第三期直肠癌

Most stage III rectal cancer patients will receive a recommendation that their tumor be treated with a combination of chemotherapy, chemoradiation, and 外手术.

化疗组合

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 (adjuvant therapy), abdominal surgery, and/or adjuvant chemotherapy after surgery. When chemotherapy and/or radiation are administered before surgery this approach is known as neoadjuvant therapy. In some cases, doctors will recommend total neoadjuvant therapy where a full course of chemotherapy and radiation are administered prior to surgery. In other cases, chemotherapy may be recommended without radiation and radiation may be reserved for after surgery in cases with high-risk features in their tumors noted when the pathologist examines the surgical specimen.

一开始不能耐受化疗的患者，可以直接进行手术，不需要额外的治疗，术后再进行辅助化疗和/或化放疗。

For a list of chemoradiation options, adjuvant chemotherapy options, and adjuvant chemotherapy options (a “sandwich” of chemo-chemoradiation-chemo), download 你在战斗中的指南.

手术

对于直肠癌，通常需要进行腹部手术来切除肿瘤。在手术前，你可能会接受放疗和/或化疗的治疗。

• 低位前部切除术（LAR）
• 腹股沟切除术(APR)

Medically reviewed by Dr. Richard Goldberg, Director Emeritus, West Virginia University Cancer Institute, 3/24/2024 

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第四阶段（转移性或复发性）CRC

Treatment for stage IV or recurrent colorectal cancer is complex, and generally requires consultation with medical, surgical and radiological doctors.

花时间从一个多学科团队那里获得尽可能好的信息和建议。这个过程是非常重要的。确保获得第二个意见，即使需要额外的时间。

手术

如果肝脏、肺部或腹部内膜（腹膜）受到影响，你可能要接受多次手术来清除转移性疾病。通常，化疗和放疗与手术相结合以缩小肿瘤。

• 部分肝切除术 - 也被称为肝脏切除术，这种手术旨在切除肝脏中的肿瘤。
• 肺转移瘤切除术 - 一种手术，将已转移到肺部的肿瘤切除。
• 化疗栓塞手术 - 有时被称为经动脉化疗栓塞术（TACE），它是一种栓塞手术（一种减少肝脏血流的手术）和化疗的结合。
• 腹腔内高热化疗 - 又称HIPEC，这种手术是在腹腔内注入加热的化疗药物。

化疗组合

可能会有各种化疗组合的处方。

• Capox或Xelox - 卡培他滨（Xeloda®）加奥沙利铂（Eloxatin®）。卡培他滨是一种口服药物，在癌细胞内的作用方式与5-FU相同。
• Folfox - 5-FU、奥沙利铂（Eloxatin®）和白藜芦醇。
• 芙菲丽 - 5-FU、伊立替康（Camptosar®）和Leucovorin

这些治疗方案可与贝伐珠单抗（Avastin®）、西妥昔单抗（Erbitux®）或帕尼单抗（Vectibix®）等靶向治疗相结合。

不能耐受强化治疗的病人还有其他选择。医生可能会建议。

• 5-FU加白藜芦醇，含或不含贝伐单抗（Avastin®）。
• 卡培他滨（Xeloda®）与或不与贝伐珠单抗（Avastin®）一起使用

单独使用capectiabine (Xeloda®)治疗，只应被认为是不适合使用奥沙利铂(Eloxatin®)或伊立替康(Camptosar®)等更积极的联合治疗方案的特定患者的合理选择。

其他选择

对其他治疗不再有反应或不能接受某些化疗药物的患者还有其他选择，如三氟利丁和蒂皮拉西尔（Lonsurf®），一种核苷类似物药物。

靶向治疗

目前有获批准的结直肠癌靶向治疗方法，包括。

免疫疗法

免疫疗法利用一个人的免疫系统的某些部分来对抗疾病。结直肠癌的免疫疗法已被证明对具有某种生物标志物、微卫星不稳定性（MSI）或错配修复缺陷（MMR）的一小部分病人有效。 所有结直肠癌患者都应该知道他们的 MSI/MMR状态!

Pembrolizumab (Keytruda ®)

这是具有微卫星不稳定-高（MSI-H）或错配修复缺陷（d-MMR）生物标志物的患者的一种选择。这种治疗方法适用于被确认为具有MSI-H或dMMR生物标志物的不可切除或转移性实体瘤的成人和儿童患者，包括先前治疗后出现进展且没有其他治疗方案的实体瘤患者。

Nivolumab (Opdivo ®)

该疗法用于微卫星不稳定性高（MSI-H）或错配修复缺陷（dMMR）的转移性结直肠癌（mCRC）。Nivolumab已被批准用于癌症在接受氟嘧啶、奥沙利铂和伊立替康治疗后出现进展，或对这些治疗没有反应的mCRC患者。

伊匹木单抗 (Yervoy®)

该药物可与nivolumab联合使用，作为使用氟嘧啶、奥沙利铂和伊立替康治疗进展后的微卫星不稳定性高（MSI-H）或错配修复缺陷（dMMR）的转移性结直肠癌（mCRC）的一种治疗方案。

Colorectal cancer treatment by stage can be straightforward in the early stages, but it can become incredibly complicated once the cancer progresses.

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NCCN 患者指南

国家综合癌症网络是一个 "非营利性的中心联盟，制定实践指南以帮助做出明智的治疗决定"。NCCN Guidelines for Patients®是易于理解的资源，可以帮助你做出治疗决定。