• Stage 0
  
• Stage I
  
• Stage II
  
• Stage III
  
• Stage IV
  
• Recurrent colon cancer
  

In general, the treatment guidelines listed below were adapted from the National Cancer Institute's State-of-the-Art Treatment Statement for physicians as of July 1999. Not all surgical oncologists, colon and rectal surgeons, medical oncologists, and radiation oncologists agree on all of these points for all patients, however. When differences of opinion were presented by our medical reviewers, their viewpoints were included below.

You should discuss your specific treatment options with your own oncology treatment team. You should consider calling the NCI periodically at (800) 4-CANCER or visiting their web site at http://cancernet.nci.nih.gov/clinpdq/soa.html to obtain updated standards of care.

Stage 0 colon cancer

Treatment options:

• Local excision or simple removal of polyps using a flexible colonoscope, always with the goal of achieving clear outer margins showing only normal cells on the removed tissue, indicating that all of the tumor has been removed.

• Removal of the section of diseased colon and rejoining (anastomosis) of the remaining colon using open abdominal surgery, again striving for clear outer margins showing only normal cells on the removed tissue, indicating that all of the tumor has been removed. This more extensive, invasive surgical procedure is for larger tumors or other tumors that cannot be treated with local excision: tumors that have invaded the box or stalk of the polyp, or polyps that lie flat (sessile).

Stage I colon cancer

Surgery for stage I cancer is intended to be curative, but also is a means of obtaining tissue for biopsy to confirm whether disease is truly confined to the bowel, and to what degree the tumor may have penetrated the bowel wall. Lymph nodes also are removed and analyzed in the pathology laboratory to assess whether microscopic disease has spread beyond the colon.

Stage II colon cancer

Stage II colon cancer is treated in the following ways:

• Open abdominal surgery that permits removal of the section of diseased colon, removal of certain key lymph nodes, examination of other abdominal organs, and either the rejoining of the remaining sections of colon, or the creation of one of a variety of means to capture and pass feces, if necessitated by removal of the rectum and anus. The goal is the achievement of clear outer margins on all removed tissue, showing only normal cells, indicating that the entire tumor visible under a microscope has been removed.

• The National Cancer Institute recommends that, following surgery, patients at stage II should consider clinical trials of systemic or regional chemotherapy, radiotherapy, or biological therapy.

• Medical reviewers as well as several published articles note that only certain stage II patients will benefit from systemic chemotherapy. Please discuss your own prognostic features with your oncology team in order to understand fully what benefits and risks are involved.

Stage III colon cancer

• Open abdominal surgery that permits removal of the section of diseased colon with wide margins, along with certain key lymph nodes, and the rejoining of the remaining sections of colon, or the creation of one of a variety of means to capture and pass feces, if necessitated by removal of the rectum and anus.

• Surgery is followed by chemotherapy. As of July 1999, usually fluorouracil (5-FU) and leucovorin are used.

• The National Cancer Institute recommends that, following surgery, patients at stage III should consider clinical trials of newer systemic or regional chemotherapy, radiotherapy, or biological therapy. The NCI treatment statement says, for example, "Improved local control with postoperative radiation therapy has been suggested in patients with adherence or fixation to adjacent structures."

Stage IV colon cancer

Patients diagnosed at this stage are encouraged by the National Cancer Institute to join a clinical trial. Treatment within a clinical trial may give you access to better treatment prior to FDA approval, before it becomes available to the general public.

Treatment options recommended by the National Cancer Institute and by our medical reviewers follow. Clinicians expressed differing beliefs regarding the order in which these treatment options should be recommended. The National Cancer Institute lists surgical options at the top of the list; others listed chemotherapy and radiation therapy as first choices:

• Chemotherapy to control painful or uncomfortable symptoms (palliative chemotherapy), or to prolong the patient's life span. Although chemotherapeutic agents in use at this time for stage IV disease are not curative, chemotherapy might prolong the life span of certain patients with stage IV disease.

• Narrowly targeted radiotherapy to control painful or uncomfortable symptoms, known as palliative radiotherapy.

• Select patients with stage IV disease benefit from surgery:
  • Patients with symptoms of pain or blockage from a tumor in the bowel may benefit from its resection.

  • Some patients with solitary tumors in other organs can in some cases be cured by their surgical removal.

Recurrent colon cancer

Patients diagnosed at this stage are encouraged by the National Cancer Institute to join a clinical trial. Treatment within a clinical trial may give you access to better treatment prior to FDA approval, before it becomes available to the general public.

Treatment options recommended by the National Cancer Institute and by our medical reviewers follow. Clinicians expressed differing beliefs regarding the order in which these treatment options should be recommended. The National Cancer Institute lists surgical options at the top of the list; others listed chemotherapy and radiation therapy as first choices:

• Chemotherapy to control painful or uncomfortable symptoms (palliative chemotherapy), or to prolong the patient's life span. Although chemotherapeutic agents in use at this time for recurrent disease are not curative, chemotherapy might prolong the life span of certain patients with recurrent disease.

• Radiotherapy to control painful or uncomfortable symptoms, such as pain from a tumor that has spread to the bone. This is known as palliative radiotherapy.

• Select patients with recurrent disease benefit from surgery:
  • Patients with symptoms of pain or blockage from a tumor in the bowel may benefit from its resection.

  • Some patients with solitary tumors in other organs can be cured by their surgical removal. The five-year cure rate for complete removal of certain liver tumors, for example, is 20 to 30 percent in carefully selected patients.

  • Surgical removal, if feasible, of single lung or ovarian metastases can lead to long-term cure in a small percentage of patients, especially if the recurrence comes more than two years after the original surgical treatment.

  • Surgical removal of recurrent cancer very near the site of the original tumor (locally recurrent tumor), such as a recurrence at the site where remaining bowel was rejoined (anastomosis).