Treating Colon Cancer at Every Stage

While there’s no one-size-fits-all treatment for colon cancer, the course of action generally depends on its stage. “Colorectal cancer treatment is guided by the stage of cancer,” says Stacey Cohen, M.D., medical oncologist at Seattle Cancer Care Alliance and associate professor in the Division of Oncology at the University of Washington. “The stage is determined by a combination of imaging–such as CT scans, colonoscopy, MRI–and pathology.” (And, as always, your provider will be your go-to source for learning about your most viable treatment options.)

If your cancer is categorized as a stage 1 tumor, that means it’s located in one specific spot on your colon and has not spread anywhere else in your body. Dr. Cohen explains that in this case, doctors will often do a simple polyp removal during a colonoscopy. If the cancer is removed completely, you may not need any further intervention at this point. Your doctor will, however, want to monitor the area closely to make sure you stay cancer-free for months and even years afterward.

If the cancer is unable to be completely removed via a colonoscopy, your doctor may advise a surgical resection surgery. In this procedure, the piece of your colon with cancerous cells is removed and then the two healthy ends are sewn back together. “If we catch the cancer early enough and can do this surgery, the prognosis is often good,” says Daniel Albo, M.D., Ph.D., director of surgical oncology services at Georgia Cancer Center at Augusta University in Augusta, GA. The surgery may be open (via a cut into your stomach) or laparoscopic (done with a tiny incision and tube).

For stage 3 tumors, in which the lymph nodes are affected, Dr. Cohen explains that doctors recommend three to six months of chemotherapy after surgery to try to decrease the likelihood of recurrence. For stage 2 cancer, chemotherapy is less common, and not all doctors recommend it. “It depends on the different risk factors that are seen, either on the scans at the time of surgery or under a microscope,” Dr. Cohen says. This is decided on a case-by-case basis.

If your cancer has spread to other organs, your doctors may flip the plan and suggest chemotherapy before surgery so that they can first see how the tumor responds, explains Jeff Nelson, M.D., colorectal surgeon and Surgical Director of the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore. At this point, surgery is unlikely to be able to remove all cancerous cells, so chemo is a way to target your entire body at once.

Whereas chemotherapy is more of a blanket approach, biological therapies are more selective and targeted—think of it like putting a key in a keyhole, Dr. Albo says. These drugs are designed to target specific pathways in the body that can ultimately help shrink the tumor. You would typically do these in tandem with a chemotherapy treatment, attacking the cancer from multiple angles at once. “In stage 4 cancer, there is clear benefit from combining chemotherapy with targeted therapy,” Dr. Cohen explains.

“An advanced patient might want to understand the different gene mutation their tumor has, and how this provides them more or less drug options,” Dr. Cohen notes. There are three main categories of biologicals, all used in different cases: one that targets blood vessel formation, one that targets the EGFR protein that helps cancers grow, and one that targets an abnormal BRAF protein. (Side effects of these drugs can include headaches, fatigue, diarrhea, and nausea.)

Depending on where the cancer has spread, you may need other specific treatment options to target the metastases. If the cancer has spread to your liver, which is common in colon cancer, ablation or embolization is sometimes used to remove it. This involves injecting a substance to help stop blood flow to the tumor, or using heat, cold, or radiofrequency to kill the tumor. “It gets to the tumor without destroying what you don’t want to destroy from the process,” Dr. Albo says. Along with chemotherapy, this can help remove the cancerous cells that have spread beyond your colon.

This is complicated stuff, and it’s impossible to know for sure which treatment option is best for you without a serious conversation with your doctor. “My hope is that each patient has a partnership with their provider to help them understand their cancer individually and how this might impact their treatment options,” Dr. Cohen says. Together with the experts, you can determine a course of action to help you tackle your colon cancer as quickly and efficiently as possible.

Additional reporting by Eric Butterman.