Broadly, colon cancer may be divided into localized or locally advanced disease, and metastatic disease.
First, we will discuss the localized or locally advanced colon cancer treatment.
In T1, the disease extends up to the submucosa. And in T2, it extends upto the muscular propria.
Now, we will discuss the treatment of T1 or T2 disease, without any lymph node involvement.
Surgical resection of the colon is the treatment in these cases, which may be in the form of right or left hemicolectomy.
Now we come to the treatment of the T3 disease, that is, the disease involving the pericolorectal tissue.
Without the involvement or regional lymph nodes.
Surgery of the colon is the mainstay of the treatment in these cases, as we have discussed previously, and chemotherapy may be added in selected patients, with hight high-risk disease.
CancerBro, how is it decided which patients will receive chemotherapy for T3 disease?
It is decided by the oncologist, depending upon the clinical presentation of the patient, tumor marker levels, imaging findings, his pathological report, and performance status of the patient.
Next comes the T4a disease, which extends up to the serosa.
Surgery, followed by chemotherapy is the standard treatment for T4a disease.
Now we come to the treatment for T4b disease, that is, the disease which extends through the wall of the colon to involve the adjacent structures.
In this figure, the tumor extends to involve the small intestine. Cancer in ascending colon may extend locally to involve right kidney. And that in descending colon may extend to involve left kidney.
Transverse colon cancer may extend locally to involve pancreas or the stomach.
Surgery and chemotherapy is the standard treatment for most of the patients of T4b disease.
If cancer involves regional lymph nodes, then irrespective of the T status of the patient, chemotherapy should be added to surgery.
But again, the final decision is taken by the oncologist on an individual patient basis, after assessing the performance status and the disease of the patient.
With this, we come to the end of localized or locally advanced colon cancer treatment.
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