Treatment of Colon Cancer, by Stage
People who have inflammatory bowel disease (IBD) are at an increased risk of developing colorectal cancer. While colon and rectal cancers are among the most preventable of cancers, they are often not diagnosed until symptoms become apparent or bothersome. By that time, the colon cancer may be in a more advanced stage.The good news is, the vast majority of people with IBD will never develop colorectal cancer. Removing polyps during routine colonoscopy is the best way to prevent colon cancer. Seeing a gastroenterologist on a regular basis and getting a colonoscopy on schedule (sometimes twice a year, yearly, or every 2 years) is the best way to prevent colorectal cancer. If you have concerns about your individual risk of colon cancer and how to prevent it, talk to your gastroenterologist or your colorectal surgeon about screening and cancer prevention. Colorectal cancer has four distinct stages, along with a fifth stage that is called “recurring.” Each stage has different treatment options and five-year survival rates. The stages and substages below are from the American Joint Committee on Cancer (AJCC) staging system, which may also be called the TNM system.
Stage 0 (Carcinoma In Situ)
This is the earliest stage of colorectal cancer. The cancer only involves the lining, or mucosa, of the colon or rectum and is confined to polyp(s) (tissue bulging from the surface of an organ). When the polyps are removed during a colonoscopy (a procedure known as a polypectomy), the chance of them progressing to later stages of cancer is eliminated.
Stage I colon cancer involves more than just the inner lining of the colon. The polyp has progressed to a tumor and extends into the wall of the colon or rectum. Treatment can include surgery to remove the section of the colon that is cancerous. This type of surgery is called a resection. The healthy, non-cancerous sections of the colon are reconnected again. The five-year survival rate is 95 percent.
Stage II colorectal cancer is when the cancer has spread beyond the colon to the tissue that surrounds the colon but has not spread to lymph nodes. Cancer spreading in this manner from one part of the body to another is called metastasis. A resection surgery may also be used to treat this stage of cancer. The five-year survival rate for Stage II colon cancer is 60 percent.
Stage II colon cancer is further subdivided into IIA, IIB, and IIC:
- Stage IIA. The cancer has grown through the muscle layer of the colon wall but has not gone outside the colon.
- Stage IIB. The cancer has grown through the outermost layer of the colon wall but has not gone outside the colon.
- Stage IIC. The cancer has grown through the outermost layer of the colon wall and into nearby tissues.
Cancer that has spread outside the colon and on to the lymph nodes in the area surrounding the colon is known as Stage III. In this stage, the cancer has not spread to other organs in the body, and treatment is more aggressive. Surgical resection of the colon, chemotherapy, and other medical therapies may be necessary. The five-year survival rate is 35 to 60 percent.
Stage III colon cancer is further subdivided into IIIA, IIIB, and IIIC:
- Stage IIIA. This substage can describe one of two situations: 1) the cancer is in the inner and middle layers of the colon wall; it may have spread to the muscle layer, and it affects between one and three lymph nodes or fat tissues near a lymph node or 2) the cancer is in the inner and middle layers of the colon wall and affects between four and six lymph nodes.
- Stage IIIB. This substage can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between one and three lymph nodes or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects between four and six lymph nodes or 3) the cancer is in the inner and middle layers of the colon wall, it could be in the muscle layer, and it affects seven or more lymph nodes.
- Stage IIIC. This substage can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between four and six lymph nodes or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects seven or more lymph nodes or 3) the cancer is in all layers of the colon wall, has spread to adjacent organs, and could affect lymph nodes or fat tissue near the lymph nodes.
In this stage, the cancer had spread to other organs in the body such as the lungs, ovaries, or liver. In addition to a surgical resection and chemotherapy, radiation treatment and surgery to remove other affected parts of the body may be necessary. At this stage, there is only a 3 percent chance of reaching the five-year survival mark.
Stage IV colon cancer is further subdivided into IVA and IVB:
- Stage IVA. In this substage the cancer may have gone through the colon wall, possibly affecting nearby lymph nodes or organs, and has spread to one organ that is not adjacent to the colon.
- Stage IVB. In this substage the cancer may have gone through the colon wall, possibly affecting nearby lymph nodes or organs, and has spread to more than one organ that is not adjacent to the colon or the abdominal wall.
Cancer that comes back again after treatment, either in the colon or in some other part of the body, is called recurrent. Even after successful treatment of colon cancer, regular check-ups are necessary to catch any recurrent cancer early.In the early stages, colon cancer is one of the most curable cancers. In the later — it is the second most deadly. Colon cancer is the second leading cause of death from cancer in America (lung cancer is the first). Contrary to popular belief, only 15 percent of colon cancer patients must have a permanent colostomy.
Please talk to your doctor about your risk factors for colon cancer, and get screened when appropriate. People with IBD are at increased risk, but getting regular care for the IBD from a gastroenterologist and keeping colonoscopy appointments will go a long way towards removing any polyps and in keeping an eye on what is going on in the colon. Everyone over the age of 50 should be screened for colorectal cancer. Some discomfort and embarrassment during a colonoscopy is a small price to pay for your life.