What Are Colorectal Cancer Treatments by Stage?

The treatment you get for your colorectal cancer may depend on the “stage” of the disease. For all except stage IV, you’ll first get surgery to remove the tumor. You may also get other treatments.

Stage 0 Colorectal Cancer Treatment

Stage 0 colorectal cancer is found only in the innermost lining of the colon. Surgery should be able to take it out.

Your procedure will depend on how big the cancer is.

Your surgeon may be able to remove the tumor and a little tissue near it. He may call this procedure a polypectomy.

If you have larger tumors, your surgeon may need to remove the diseased part of the colon and reattach the healthy tissue so that your bowels still work. Doctors call this procedure an anastomosis.

Stage I Colorectal Cancer Treatment

Stage I tumors have spread beyond the inner lining of the colon, to the second and third layers, and involve the inside wall of the colon. The cancer hasn’t spread to the outer wall of the colon or outside the colon.

You can expect to have surgery to remove the cancer and a small amount of tissue around the tumor. Most people don’t need additional treatments.

Stage II Colorectal Cancer Treatment

Stage II colorectal cancers are larger and go through the muscular wall of the colon. But there is no cancer in the lymph nodes (small structures that are found throughout the body that make and store cells that fight infection).

You’ll probably have surgery to remove the cancer and an area surrounding the cancer.

You may also get chemotherapy as a precaution to help prevent the cancer from coming back. Doctors usually do this only for people who are likely to get the disease, because there aren't a lot of advantages of chemotherapy in this stage of colon cancer. An oncologist (a doctor who specializes in cancer treatment) should help decide whether chemotherapy is needed for your stage II colon cancer.

Stage III Colorectal Cancer Treatment

Stage III colorectal cancers have spread outside the colon to one or more lymph nodes.

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Your doctor may talk about stage lIl A, B, or C tumors. Here’s what that means:

Stage lIlA: Tumors are within the colon wall and also involve the lymph nodes.

Stage lIlB: Tumors have grown through the colon wall and have spread to one to four lymph node.

Stage lIlC: Tumors have spread to more than four lymph nodes.

Treatment involves:

  • Surgery to remove the tumor and all involved lymph nodes if possible
  • Chemotherapy after surgery
  • Radiation if the tumor is large and invading the tissue surrounding the colon

Stage IV Colorectal Cancer Treatment

Stage IV colorectal cancers have spread outside the colon to other parts of the body, such as the liver or the lungs. You may also hear the cancer called "metastatic,” which means that it has spread.

The tumor can be any size and may or may not include affected lymph nodes.

Treatment may include:

Surgery. You may need an operation to remove the cancer, both in the colon and in other places where it has spread. Or you may need surgery to bypass the cancer and hook back up the healthy parts of the colon.

Chemotherapy . Along with chemotherapy, you may get:

  • Bevacizumab (Avastin), cetuximab (Erbitux), or panitumumab (Vectibix). These drugs work on your immune system. Your doctor may call them “monoclonal antibodies.” Whether you get them depends on certain aspects of your tumor.
  • Ziv-Aflibercept (Zaltrap), if your cancer has worsened or doesn’t respond to other treatment.

Targeted therapy: Your doctor may consider regorafenib (Stivarga) if your metastatic colorectal cancer has progressed despite other treatment.

Radiation to ease symptoms.

You may also want to consider joining a clinical trial. These are studies that test new drugs or treatments to see if they are safe and if they work. They often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.

If Your Colorectal Cancer Comes Back

Doctors call colorectal cancer “recurrent” if it comes back (recurs) after treatment. It may come back in or near the same area, or in a different part of your body.

Recurrence is most likely in people who had more advanced colorectal cancer the first time.

Treatment may involve:

  • Surgery to remove the recurrences
  • If all the cancer can't be removed in an operation, chemotherapy is the main treatment.
  • Clinical trials are another option.
WebMD Medical Reference Reviewed by Sujana Movva, MD on July 27, 2014

Sources

SOURCES:

American Cancer Society.

FDA.

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