Colon Cancer Treatment by Stage

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Colon cancer can be divided into 4 stages from 1 to 4. Treatment options vary depending on the stage of colon cancer along with other factors. Here, we will be discussing the treatment options depending on stage.

Stage 1 Colon Cancer Treatment

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Stage 1 colon cancer includes T1 and T2 disease.
In T1, the disease extends up to the submucosa.
T1b-infiltration into submucosa
And in T2, it extends upto the muscularis propria.
T2, extends up to 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, or transverse colectomy.
The figure below shows a simple diagram to understand the extent of colon removed in a colectomy. On the left side (lighter portion) shows the extent of colonic resection for right hemicolectomy, done for right sided and colonic tumors.
And the left side, dark portion shows the extent of colonic resection for left hemicolectomy, done for left sided colon tumors.
surgical resection of the colon hemicolectomy
Sometimes, the tumor may be located in the center of transverse colon, when the colonic resection is transverse colectomy, in which the transverse colon is removed.
These is no role of any adjuvant treatment (treatment given after surgery) in the form if radiation or chemotherapy, in stage 1 colon tumors. Patient can be kept on regular follow-up.

Stage 2 Colon Cancer Treatment

Now we come to the treatment of the stage 2 disease.
It includes cases of T3 and T4 disease.
In T3, cancer extends through the muscularis propria into the pericolorectal tissues.

Surgery of the colon is the mainstay of the treatment in these cases, as we have discussed previously for stage 1 disease, and chemotherapy may be added in selected patients, with high-risk disease.
Which patients will receive chemotherapy 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.
T4a disease extends up to the serosa.
T3 and T4a
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.
tumor from any part of colon can involve small intestine
Cancer in ascending colon may extend locally to involve right kidney.
ascending colon tumor infiltrating right kidney
And that in descending colon may extend to involve left kidney.
descending colon tumor infiltrating left kidney
Transverse colon cancer may extend locally to involve pancreas or the stomach.
transverse colon tumor infiltrating pancreas
transverse colon tumor infiltrating stomach
Surgery followed by chemotherapy is the standard treatment for most of the patients of T4b disease.

Stage 3 Colon Cancer Treatment

When colon cancer spreads to involve regional lymph nodes, it is called as stage 3 disease. In such cases, irrespective of the T status of the patient, chemotherapy should be added to surgery.
 spread to regional lymph nodes
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.
treatment of localised and locally advanced colon cancer

Stage 4 Colon Cancer Treatment

Now, we come to metastatic or stage 4 colon cancer treatment. It may present as metastasis to liver or lungs. colon cancer metastasis to liver metastasis to both lungs It may also present as metastasis to both, lungs and liver. spread to both liver and lungs To peritoneum in the form of peritoneal or omental deposits. spread to the peritoneum Very rarely, it may also spread to brain or bones. For most cases of metastatic disease, chemotherapy with/without targeted therapy is the treatment of choice.

treatment of unresectable metastatic colon cancer

Treatment of metastatic disease depends on whether it is resectable or non-resectable.

Non-Resectable Stage 4 Disease

Most cases of metastatic disease are treated with chemotherapy with/without targeted therapy. Immunotherapy is also an option for treatment of metastatic colon cancer.

Resectable Stage 4 Disease

In some selected cases, with limited metastasis to liver and/or lungs, tumor resection may be possible. Also in unresectable disease, it may become resectable if it responds nicely to treatment. When limited liver metastasis involves only a small part of liver, surgical resection may be tried. Similarly, if lung metastasis is localised to only a small part, that can be removed safely, resection may be done.

treatment of resectable metastatic colon cancer Other modalities like radiotherapy, surgery or bone-directed therapy, may also be used, for palliation or relief of symptom. Always remember that the treatment for metastatic colon cancer is not generally curative, so the main intent for the treatment is a prolongation of life, reduction of symptoms and improvement of the quality of life. With this, we come to the end of metastatic colon cancer treatment.

Role of Targeted Therapy

targeted therapy for colon cancer

  • Cetuximab and Panitumumab target epidermal growth factor receptor (EGFR) protein.
  • Bevacizumab targets vascular endothelial growth factor (VEGF) receptor.
  • They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.

Role of Immunotherapy

immunotherapy for colon cancerPembrolizumab and nivolumab have been approved as the second- or third-line therapy for patients with unresectable or advanced/metastatic, dMMR/MSI-H positive colorectal cancers that have progressed on prior treatment (except a checkpoint inhibitor).

Role of Chemotherapy

Chemotherapy may be used for colon cancer in adjuvant setting (after surgical resection of tumor) or metastatic setting (palliative intent). Various chemotherapy regimens have been approved for colon cancer treatment.

Some drugs that are a part of treatment regimens for colon cancer include-

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