Colorectal Cancer

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Treating Colon/Rectum Cancer TOPICS

Treatment of colon cancer by stage

For colon cancers that have not spread to distant sites, surgery is usually the primary or first treatment. Adjuvant (additional) chemotherapy may also be used. Most adjuvant treatment is given for about 6 months.

Stage 0

Since these cancers have not grown beyond the inner lining of the colon, surgery to take out the cancer is all that is needed. This may be done in most cases by polypectomy (removing the polyp) or local excision through a colonoscope. Colon resection (colectomy) may occasionally be needed if a tumor is too big to be removed by local excision.

Stage I

These cancers have grown through several layers of the colon, but they have not spread outside the colon wall itself (or into the nearby lymph nodes). Stage I includes cancers that were part of a polyp. If the polyp is removed completely, with no cancer cells in the edges (margins), no other treatment may be needed. If the cancer in the polyp was high grade (see “How is colorectal cancer staged?”) or there were cancer cells at the edges of the polyp, more surgery may be advised. You may also be advised to have more surgery if the polyp couldn’t be removed completely or if it had to be removed in many pieces, making it hard to see if cancer cells were at the edges.

For cancers not in a polyp, partial colectomy ─ surgery to remove the section of colon that has cancer and nearby lymph nodes ─ is the standard treatment. You do not need any additional therapy.

Stage II

Many of these cancers have grown through the wall of the colon and they may extend into nearby tissue. They have not yet spread to the lymph nodes.

Surgery to remove the section of the colon containing the cancer along with nearby lymph nodes (partial colectomy) may be the only treatment needed. But your doctor may recommend chemotherapy (chemo) after surgery (adjuvant chemo) if your cancer has a higher risk of coming back because of certain factors, such as:

  • The cancer looks very abnormal (is high grade) when viewed under a microscope.
  • The cancer has grown into nearby organs.
  • The surgeon did not remove at least 12 lymph nodes.
  • Cancer was found in or near the margin (edge) of the surgical specimen, meaning that some cancer may have been left behind.
  • The cancer had blocked off (obstructed) the colon.
  • The cancer caused a perforation (hole) in the wall of the colon.

Not all doctors agree on when chemo should be used for stage II colon cancers. It is important to discuss the pros and cons of chemo with your doctor, including how much it might reduce your risk of recurrence and what the likely side effects will be.

The main options for chemo for this stage include 5-FU and leucovorin (alone) or capecitabine, but other combinations may also be used.

If your surgeon is not sure all of the cancer was removed because it was growing into other tissues, he or she may advise radiation therapy to try to kill any remaining cancer cells. Radiation therapy can be given to the area of your abdomen where the cancer was growing.

Stage III

In this stage, the cancer has spread to nearby lymph nodes, but it has not yet spread to other parts of the body.

Surgery to remove the section of the colon containing the cancer along with nearby lymph nodes (partial colectomy) followed by adjuvant chemo is the standard treatment for this stage. Either the FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens are used most often, but some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs.

Your doctors may also advise using radiation therapy if your surgeon thinks some cancer cells might have been left behind after surgery.

In people who aren't healthy enough for surgery, radiation therapy and/or chemo may be options.

Stage IV

The cancer has spread from the colon to distant organs and tissues. Colon cancer most often spreads to the liver, but it can also spread to other places such as the lungs, peritoneum (the lining of the abdominal cavity), or distant lymph nodes.

In most cases surgery is unlikely to cure these cancers. However, if only a few small areas of cancer spread (metastases) are present in the liver or lungs and they can be completely removed along with the colon cancer, surgery may help you live longer and may even cure you. This would mean a partial colectomy to remove the section of the colon containing the cancer along with nearby lymph nodes, plus surgery to remove the areas of cancer spread. Chemo is typically given as well, before and/or after surgery. In some cases, hepatic artery infusion may be used if the cancer has spread to the liver.

If the metastases cannot be surgically removed because they are too large or there are too many of them, chemo may be given before any surgery. Then, if the tumors shrink, surgery may be tried. Chemo would then be given again after surgery. Another option may be to destroy tumors in the liver with ablation or embolization.

If the cancer is too widespread to try to cure it with surgery, chemo is the main treatment. Surgery is sometimes needed if the cancer is blocking the colon (or is likely to do so). Sometimes, such surgery can be avoided by inserting a stent (a hollow metal or plastic tube) into the colon during colonoscopy to keep it open. Otherwise, operations such as a colectomy or diverting colostomy (cutting the colon above the level of the cancer and attaching the end to an opening in the skin on the abdomen to allow waste out) may be used.

If you have stage IV cancer and your doctor recommends surgery, it is very important to understand the goal of the surgery ─ whether it is to try to cure the cancer or to prevent or relieve symptoms of the disease.

Most patients with stage IV cancer will get chemo and/or targeted therapies to control the cancer. The most commonly used regimens include:

  • FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
  • FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
  • CapeOX: capecitabine (Xeloda) and oxaliplatin
  • Any of the above combinations plus either bevacizumab (Avastin) or cetuximab (Erbitux) (but not both)
  • 5-FU and leucovorin, with or without bevacizumab
  • Capecitabine, with or without bevacizumab
  • FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
  • Irinotecan, with or without cetuximab
  • Cetuximab alone
  • Panitumumab (Vectibix) alone
  • Regorafenib (Stivarga) alone

The choice of regimens may depend on several factors, including any previous treatments you've had and your overall health. If one of these regimens is no longer effective, another may be tried.

For advanced cancers, radiation therapy can also be used to help prevent or relieve symptoms such as pain. While it may shrink tumors for a time, it is very unlikely to result in a cure. If your doctor recommends radiation therapy, it is important that you understand the goal of treatment.

Recurrent colon cancer

Recurrent cancer means that the cancer has returned after treatment. The recurrence may be local (near the area of the initial tumor), or it may affect distant organs.

If the cancer comes back locally, surgery (often followed by chemo) can sometimes help you live longer and may even cure you. If the cancer can't be removed surgically, chemo may be tried first. If it shrinks the tumor enough, surgery may be an option. This would again be followed by more chemo.

If the cancer comes back in a distant site, it is most likely to appear first in the liver. Surgery may be an option in some cases. If not, chemo may be tried first to shrink the tumor(s), which may then be followed by surgery. If the cancer is too widespread to be treated surgically, chemo and/or targeted therapies may be used. Possible regimens are the same as for stage IV disease. Your options depend on which, if any, drugs you received before the cancer came back and how long ago you received them, as well as on your health. Surgery may still be needed at some point to relieve or prevent blockage of the colon and to prevent other local complications. Radiation therapy may be an option to relieve symptoms in some cases as well. For more on dealing with a recurrence, you may also want to look at our document When Your Cancer Comes Back: Cancer Recurrence.

These cancers can often be difficult to treat, so you may also want to ask your doctor if you might be eligible for clinical trials of newer treatments.


Last Medical Review: 10/15/2014
Last Revised: 11/01/2014