colon cancer treatment | Treatment of Colon Cancer by Stage

Treatment of Colon Cancer by Stage


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Surgery is usually the initial treatment for colon tumors that have not spread to other organs, and adjuvant chemotherapy may also be given. Most adjuvant treatments are given for about 6 months.

Stage 0

If the disease did not develop beyond the lining of the colon, treatment is surgical. In most cases it is performed by polypectomy (removal of the polyp) or local excision through a colonoscope. Resection of the colon (colectomy) may occasionally be necessary if the tumor is too large to be removed by local excision.

Stage 1

At this stage, the tumor developed through several layers of the colon, but did not spread beyond the wall, or to adjacent lymph nodes. Partial colectomy, surgery to remove part of the colon that has the disease and nearby lymph nodes, is the standard treatment. There is no need for any additional therapy.

Stage 2

Many of the tumors at this stage have developed through the wall of the colon and may have invaded adjacent tissue. At this stage, they have not yet spread to the lymph nodes.

Colectomy may be the only treatment needed. However, adjuvant chemotherapy may be recommended if there is a high risk of relapse due to factors such as:

Tumor in advanced stage.
The disease has spread to adjacent organs.
It was not possible to remove at least 12 lymph nodes.
Disease was found beyond the surgical margins.
The tumor was clogging the colon.
The tumor caused a perforation in the wall of the colon.

Not all physicians agree on the timing of chemotherapy for colon cancer tumors at this stage. It is important to discuss the pros and cons of chemotherapy with your doctor, including how much this can reduce the risk of relapse and possible side effects.

The main options for chemotherapy at this stage include 5-FU and leucovorin or capecitabine, but other combinations may also be given.

Stage 3

At this stage, the tumor has spread to nearby lymph nodes, but has not yet spread to other organs.

Surgery (partial colectomy) followed by adjuvant chemotherapy is the standard treatment at this stage.

For chemotherapy, the chemotherapy regimens FOLFOX (5-FU, leucovorin and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) are used more frequently, but some patients may, depending on their age and general health, receive the 5 -FU with leucovorin or capecitabine.

For patients without physical conditions to undergo surgery, radiation therapy or chemotherapy may be good treatment options.

Stage 4
At this stage, the tumor has already spread to other organs and tissues. Most often, colon cancer spreads to the liver, but can also spread to other organs such as the lungs, peritoneum, or distant lymph nodes.

In most cases, it is unlikely to cure the disease with surgery. However, if only a few small areas of the disease have spread and are present in the liver or lungs, they can be completely removed. In these cases, the chemo can be given before and / or after surgery. On the other hand, if the disease has spread to the liver, the infusion is performed through the hepatic artery.

If metastases can not be surgically removed by size or quantity, chemotherapy can be performed with the goal of reducing tumors prior to surgery. Another option may be the destruction of tumors with radiofrequency ablation or embolization.

In some cases, if the disease is too widespread for surgery, other procedures such as a colectomy or colostomy can be performed. These procedures can relieve or prevent colon obstruction.

In case surgery is indicated, it is important to understand the purpose of this procedure, whether it is to try to cure the disease or prevent or alleviate the symptoms of the disease.

Most patients with stage IV colon cancer will receive chemotherapy or target therapy to control the disease. Some of the most commonly used schemes include:

FOLFOX: leucovorin, 5-FU and oxaliplatin.
Folfiri: leucovorin, 5-FU and irinotecan.
CapeOX: capecitabine and oxaliplatin.
FOLFOXIRI: leucovorin, 5-FU, oxaliplatin and irinotecan.
Any of the above combinations plus a medicine targeting VEGF (bevacizumab, ziv-aflibercept or ramucirumab), or a medicine targeting EGFR (cetuximab or panitumumab).
5-FU and leucovorin, with or without target therapy.
Capecitabine, with or without target therapy.
Irinotecan, with or without target therapy.
Cetuximabe.
Panitumumab.
Regorafenibe.
Trifluridine and tipiracil.

The choice of treatment regimen may depend on several factors, such as previous treatments performed and the patient's general health. If one of these schemes is no longer effective, another can be administered.

For some tumors, radiation therapy may also be given to help prevent or relieve symptoms, such as pain. While it may reduce the size of the tumor for a while, it is very unlikely to result in a cure. If radiotherapy is indicated, it is important to understand the purpose of the treatment.

Rectal Cancer of the Colon

Recurrence means that the cancer has returned after treatment. Relapse may be local or may affect other organs.

If relapse is local, surgery, sometimes followed by chemotherapy, may increase survival or even be curative. If the tumor can not be removed surgically, treatment will be initiated with chemotherapy. If the tumor decreases in size, surgery can be performed, followed by chemotherapy.

If the disease has recurred in another organ, the most likely site is the liver. In some cases, surgery may be a treatment option. Ablation or embolization techniques may also be an option to treat some liver tumors.

If the disease is too generalized to undergo surgery, treatments with target chemotherapy or therapy may be performed. Treatment regimens are the same as those used for stage IV disease.

For patients whose tumors are diagnosed with certain traits in laboratory tests, another option may be treatment with an immune control point inhibitor, such as pembrolizumab or nivolumabe.

The options depend on what treatments have been performed previously, the time spent since these treatments, as well as the overall health of the patient. However, surgery may still be needed at some point to relieve or prevent colon obstruction and avoid other local complications. Radiation therapy may also be an option to relieve symptoms.

Often, these cancers can be difficult to treat, so consideration should be given to participating in a clinical trial.