What is Colon Cancer Treatment?

Patients who are found to have stage 1 colon cancer by and large don’t require any other therapy besides surgery and the reason for that is that most patients with that stage of colon cancer are cured by the surgery.

Some patients with stage 2 disease may be offered chemotherapy. Why is this done? Well after surgery certainly your surgeon may have told you I got everything I can see and that is that is true, however we know that some patients will go on to develop recurrences of colon cancer in other parts of their body, in spite of having successful surgery. One way we can prevent this is via the administration of chemotherapy to, for example, kill any microscopic deposits of cancer that might have existed at the time of surgery.

Stage 3 colon cancer means that the cancer has spread from the site it began in the colon to lymph nodes nearby. Lymph nodes are like little filters the body uses to drain fluid out of organs. There are lymph nodes in many parts of your body and and your intestines are no exception. We find these lymph nodes by looking at the surgical specimen. When your surgeon removes your cancer he or she also removes part of the normal colon and what’s called the connective tissue around the colon and that connective tissue is where the lymph nodes are found. When your surgeon has taken the tumor and part of the colon out, it is given to a pathologist who then looks for lymph nodes in the connective tissue and examines those lymph nodes under the microscope to see if there’s any evidence of cancer in the lymph nodes. If that is the case, if there are tumor deposits or small tumors in the lymph nodes then your tumor would be characterized as stage 3. The implication of this is that the cancer is more likely to have spread to other parts of your body than if the lymph nodes are not involved by the cancer.

For example, if you take a patient with one or two or three positive lymph nodes in their colon cancer sample who is only treated with surgery, there’s about a 30% chance that the Cancer will recur at some point in the next few years, usually somewhere else in the body like the liver, other lymph nodes or perhaps even the lungs. We try to prevent this from happening with the use of chemotherapy. Chemotherapy simply means drugs that are given to you to try to attack any small or microscopic deposits of cancer, wherever they might be in your body. For most patients with stage 3 disease we use what is called combination chemotherapy meaning two or more drugs to treat the small deposits of cancer. 

One thing that’s important to understand is that it’s possible that your cancer has been cured by surgery alone and we don’t know who does and does not have these small deposits so there is a lot of uncertainty surrounding treatment and who needs to be treated with stage 3 cancer, but the frequency of recurrence is enough that we believe that essentially all patients who can tolerate chemotherapy should receive chemotherapy if they’ve been given this diagnosis.