Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for Colon Cancer
Table 6. Standard Treatment Options for Stages 0–III Colon Cancer
|Stage (TNM Staging Criteria)||Standard Treatment Options|
|Stage 0 Colon Cancer||Surgery|
|Stage I Colon Cancer||Surgery|
|Stage II Colon Cancer||Surgery|
|Stage III Colon Cancer||Surgery |
Table 7. Treatment Options for Stage IV and Recurrent Colon Cancer
|Stage (TNM Staging Criteria)||Treatment Options|
|Treatment of Liver Metastasis||Surgery|
|Treatment of Stage IV and Recurrent Colon Cancer||Surgery|
|Chemotherapy and targeted therapy|
Primary Surgical Therapy
Standard treatment for patients with colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease.
The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer has been examined in two studies.
Evidence (laparoscopic techniques):
- A multicenter, prospective, randomized, noninferiority trial (NCCTG-934653) compared laparoscopic-assisted colectomy (LAC) with open colectomy in 872 patients.
- At a median follow-up of 4.4 years, 3-year recurrence rates (16% LAC vs. 18% open colectomy; hazard ratio [HR] for recurrence, 0.86; 95% confidence interval [CI], 0.63–1.17; P = .32) and 3-year overall survival (OS) rates (86% LAC vs. 85% open colectomy; HR for death in LAC, 0.91; 95% CI, 0.68–1.21; P = .51) were similar in both groups for all stages of disease evaluated. Tumor recurrence in surgical incisions was less than 1% for both groups.[Level of evidence: 1iiA]
- Decreased hospital stay (5 days LAC vs. 6 days open colectomy, P < .001) and decreased use of analgesics were reported in the LAC group. A 21% conversion rate from LAC to open procedure was shown.
- This study excluded patients with locally advanced disease, transverse colon and rectal tumor locations, and perforated lesions. Each of the 66 surgeons participating in the trial had performed at least 20 LACs and were accredited for study participation after independent videotape review assured appropriate oncologic and surgical principles were maintained. The quality-of-life component of this trial was published separately and minimal short-term quality-of-life benefits with LAC were reported.[Level of evidence: 1iiC]
- One small, single-institution randomized study of 219 patients showed that the LAC procedure was independently associated with reduced tumor recurrence on multivariate analysis.[Level of evidence: 1iiB]
Surgery is curative in 25% to 40% of highly selected patients who develop resectable metastases in the liver and lung. Improved surgical techniques and advances in preoperative imaging have allowed for better patient selection for resection.
The potential value of adjuvant chemotherapy for patients with stage II colon cancer is controversial. Pooled analyses and meta-analyses have suggested a 2% to 4% improvement in OS for patients treated with adjuvant fluorouracil (5-FU)–based therapy compared with observation.[8,9,10] (Refer to the Stage II Colon Cancer Treatment section of this summary for more information.)