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Colorectal Cancer Treatment by Stage

For all stages of colorectal cancer, except stage IV, surgery to remove the tumor is the initial treatment. For some cancers, additional treatments, called adjuvant therapy, may be recommended.

Colorectal Cancer: See How It Starts and How It Is Treated

Stage 0 Colorectal Cancer

Stage 0 colorectal cancer is found only in the innermost lining of the colon. Treatment usually involves one of the following:

  • Polypectomy or local excision to remove the tumor and a small amount of surrounding tissue, or
  • More extensive surgery (resection) to remove larger colon cancers. This may require a procedure called an anastomosis to remove the diseased part of the colon and reattach the healthy tissue to maintain bowel function

Surgery to remove all of the cancer is considered curative.

Stage I Colorectal Cancer

Stage I tumors have spread beyond the inner lining of the colon to the second and third layers and involves the inside wall of the colon. The cancer has not spread to the outer wall of the colon or outside the colon.

Standard treatment involves surgery to remove the cancer and a small amount of tissue around the tumor. Additional treatments are not usually needed.

Aggressive surgery to remove all of the cancer offers a great potential for cure. The five-year survival rate for stage I colorectal cancer is 93% according to the American Cancer Society.

Stage II Colorectal Cancer

Stage II colorectal cancers are larger and extend 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 produce and store cells that fight infection).

Standard treatment is surgical removal of the cancer and an area surrounding the cancer:  Chemotherapy may also be given as a precaution against cancer recurrence. This is usually restricted to persons with high-risk disease, as the advantages of chemotherapy in this stage of colon cancer are minimal. An oncologist should help in making the decision as to whether chemotherapy is necessary for stage II colon cancers.

The five-year survival rate for stage II colon cancer is 78%.

Stage III Colorectal Cancer

Stage III colorectal cancers have spread outside the colon to one or more lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection). Tumors within the colon wall, which also involve the lymph nodes are classified as stage IIIA, while tumors that have grown through the colon wall and have spread to one to four lymph nodes are classified as stage IIIB cancers. Those tumors, which have spread to more than four lymph nodes are classified as stage IIIC colon cancers.

Treatment involves:

  • Surgery to remove the tumor and all involved lymph nodes if possible.
  • After surgery, the patient will receive chemotherapy with 5-FU, leucovorin and oxaliplatin, capecitabine with oxaliplatin or capecitabine alone.
  • Radiation may be needed if the tumor is large and invading the tissue surrounding the colon.

The five-year survival rate for stage III colon cancer is about 64%. Patients with one to four positive lymph nodes have a higher survival rate than people with more than five positive lymph nodes.

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