Stage

Stage Definition

Treatment

0

Cancer is restricted to the inner lining of the colon.

In most of these cases, the small tumor is removed by performing a polypectomyPolypectomy is the procedure where precancerous or cancerous polyps are removed during colonoscopy. A biopsy forceps is inserted through a colonoscope. Electric current can be passed through the forceps to “burn off” the polyps, or a lasso-like instrument is used to “snare” the polyp. through the colonoscopeColonoscope is a device used for examination of the inside of the colon and lowest part of the small intestine. A camera is mounted on a flexible tube that is passed through the anus and into the colon. This device permits visual diagnosis of problems in the colon as well as biopsy and removal of suspect polyps via polypectomy.. If the tumor is too big to be removed by polypectomty, colon resection may be necessary.

I

Cancer has grown through several layers of the colon wall but not outside the wall.

The tumor is removed by surgical resectionResection is a surgical term for removal of part of an organ. In the case of colon resection, the surgeon removes the part of the colon containing the tumor as well as some of the bordering region (called the margin). The remaining healthy ends are then reattached. For cancer in general, a doctor will refer to a tumor as “resectable” if it can be completely removed by surgery.. Additional therapy (i.e. chemotherapy and radiation) is usually not needed.

II

Cancer has grown through the colon wall. It has not spread to lymph nodes or other organs.

Surgical resection of the tumor is typically the only treatment you will need. Your doctor may recommend chemotherapy or localized radiation based on the pathology reportA Pathology report comes from looking at material from a biopsy under a microscope. For colon cancer patients, this information yields cell type and grade. These factors influence treatment decisions. There are other tumor characteristics that cannot be seen under a microscope. Gathering this information requires molecular tests. Ask your doctor if you would benefit from knowing the molecular status of your tumor. from a sample of your tumor.

III

Cancer has grown through the colon wall and has spread to nearby lymph nodes.

Surgical resection of the primary tumor is the first treatment. The surgeon will try to remove the effected lymph nodes during the same surgery. After recovery from surgery, you will receive chemotherapy with the most common drug regimen being 5-fluorouracil (5FU) and Leucovorin (folinic acid).

IV

The cancer has spread to other organs or tissues such as the liver, peritoneum, ovaries, lungs etc.

Because the cancer exists beyond the colon, surgical resection of the primary tumor, or a diverting colostomyA colostomy is a surgical procedure where the healthy end of the large intestine is attached to the front inside part of the body wall. An appliance, which lies on the outside of the patient, is attached to the large intestine. This ultimately provides an alternative pathway (besides the anus) for feces to leave the body. Thus, the procedure can bypass blockages “downstream” of the opening or provide a way for patients who have had their rectum removed to eliminate waste. will not cure the disease.  However, in stage IV cases, these surgeries are often performed to relieve colon blockages and prevent other complications. Many liver metastases can be surgically removed and chances for long term survival are improved in these cases. The FOLFOXFOLFOX is a combination of three chemotherapy drugs that are standard treatment for metastatic (stage IV) colon cancer:
·FOL = Folinic acid (leucovorin)
·F = Fluorouracil (5-FU)
·OX = Oxaliplatin (Eloxatin) chemotherapy regimen is standard in treating stage IV colon cancer. If a patient does not respond to these drugs, there are othersRecent research has shown that drugs additional to the FOLFOX regimen can help patients with advanced colon cancer.·Irinotecan: Given to patients that do not respond to FOLFOX treatment. It is used in combination with 5FU and leucovorin to make up the FOLFIRI regimen.
·Cetuximab (Erbitux) and panitumumab (Vectibix): These are both antibody drugs that target the Epidermal Growth Factor Receptor (EGFR). Clinical trials have shown that in order for a patient to benefit from Erbitux or Vectibix treatment, he/she must have overexpression of the EGF receptor and not have a mutated KRAS gene. Obtaining this information requires testing for some molecular features of the tumor.
·Bevacizumab (Avastin): An antibody drug that blocks the Vascular Endothelial Growth Factor (vEGF). This drug works by "starving" tumors of blood supply. that could prevent or delay symptoms, increase life expectancy, or be curative. Radiation is also effective in shrinking tumors that cannot be surgically removed.

Rectal

Staging of rectal cancer is the same as above for colon cancer. The difference lies in the fact that the tumor is close to the rectrum.

As with colon cancer, treatment of rectal cancer is stage dependent. Early detection and surgery give the best chance for cure. Surgical resection of rectal cancer is more complicated because tumors sometimes encroach on the anus. Thus, it is sometimes not possible to remove the tumor and preserve normal function of the anus. In these cases, permanent colostomy is necessary. However, surgical procedures that are effective while maintaining function (i.e. Transanal ExcisionTransanal excision is a surgical technique for removing rectal tumors and small amounts of surrounding tissue while leaving the anus and anal sphincter intact. This allows the patient to retain all colon function and a colostomy bag is not necessary., and Mesorectal ExcisionTotal Mesorectal Excision (TME) is a surgical technique to treat more advanced cases of rectal cancer. In most cases this procedure leaves normal colon function intact. This procedure involves removing the tumor as well as the mesorectum, a fatty tissue adjacent to the rectum that contains blood vessels and lymph nodes. Rectal cancer recurrences normally occur in the lymph nodes. Removing the lymph nodes reduces this possibility.) are being performed at more and more hospitals.