Colorectal Cancer Treatment by Stage

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 (Dukes A) 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 (Dukes B) 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: A person with Dukes B colorectal cancer may also be a candidate for a clinical trial looking at the use of adjuvant immunotherapy or chemotherapy. Chemotherapy may also be given as a precaution against cancer recurrence.

The five-year survival rate for Dukes B colon cancer is 78%.

Stage III (Dukes C) 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 Dukes Stage C1, while tumors that have grown through the colon wall and have spread to one to four lymph nodes, are called Dukes Stage C2 cancers. Those tumors which have spread to more than four lymph nodes are classified as Dukes stage C3 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 and leucovorin.
• Radiation may be needed if the tumor is large and invading the tissue surrounding the colon

The five-year survival rate for Dukes C 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.

Stage IV (Dukes D) Colorectal Cancer

Stage IV colorectal cancers have spread outside the colon to other parts of the body, such as the liver or the lungs. The tumor can be any size and may or may not include affected lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

Treatment may include:

• Removal the cancer surgically or another surgical procedure to bypass the colon cancer and hook up healthy colon (an anastomosis).
• Surgery to remove parts of other organs such as the liver, lungs, and ovaries, where the cancer may have spread.
• Chemotherapy to relieve symptoms
• Erbitux, Avastin, or Vectibix in combination with standard chemotherapy
• Clinical trials of new chemotherapy regimens, or immunological therapy.
• Radiation to relieve symptoms.

The five-year survival rate for Dukes D Colon Cancer is about 8%.

Recurrent Colorectal Cancer

Recurrent colorectal cancer is cancer that returns after treatment. The recurrence can be local or near the area of the initial cancer, or the cancer can return in distant organs.

The liver is involved in up to 2/3 of patients who die from colorectal cancer.

Recurrence is most likely in patients with more advanced colorectal cancer.

Treatment may involve:

• Surgery to remove the recurrences. This may lengthen lifespan and in some cases, this is curative when given with chemotherapy.
• If the metastases can't be removed, chemotherapy is the main treatment.
• Clinical trials are another option.