Colorectal cancer may be cured, depending on the stage and whether the tumor has spread or returned.

Stages are used to describe how much the colorectal cancer has worsened or spread.

Stages and Treatments

Stages and treatments for colorectal cancer are:

Stage 0 – This stage of colorectal cancer is called carcinoma in situ, which means that abnormal cells may be found in the lining of the colon or rectum.

Treatment for Stage 0 colorectal cancer may include cryosurgery to remove a cancerous polyp, which is called a polypectomy, through the use of a colonoscope that allows the surgeon to see inside the colon. Polyps are small clumps of cells that form in the lining of the colon. Cryosurgery freezes the polyp to make it fall off.

Other surgeries performed for Stage 0 colorectal cancer may include local excision, which only removes the cancerous tissue, or transanal resection, in which surgery is performed through the anal opening.

Stage I – In this stage of colorectal cancer, the cancer has formed in the lining of the colon or the wall of the rectum and has spread to the outer layer of the colon or rectum, called the submucosa, or the muscle layer.

Treatment for Stage 1 colorectal cancer includes cryosurgery to remove a cancerous polyp, called a polypectomy, through the use of a colonoscope that allows the surgeon to see inside the colon. Polyps are small clumps of cells that form in the lining of the colon. Cryosurgery freezes the polyp to make it fall off. Polyps are small clumps of cells that form in the lining of the colon.

Other surgeries for Stage I colorectal cancer may include transanal resection, in which surgery is performed through the anal opening, or transanal endoscopic microsurgery.

Patients with colorectal cancer may also require surgery for a temporary or permanent colostomy, which is an opening made in the abdomen through which stool can pass into a colostomy bag.

Some patients with Stage 1 colorectal cancers may need more invasive surgery with low anterior resection; proctectomy with colo-anal anastomosis, in which the remaining edges of the colon and anus are rejoined after the cancer has been removed; or an abdominoperineal resection, which is a more extensive open surgery.

Some patients with Stage 1 colorectal cancer may also be treated with a combination of chemotherapy and radiation therapy using fluorouracil and capecitabine.

Patients with colorectal cancer may also require surgery for a temporary or permanent colostomy, which is an opening made in the abdomen through which stool can pass into a colostomy bag.

Stage II (IIA, IIB, IIC) – In this stage of colorectal cancer, the cancer has spread through the muscle of the colon or rectum to the outer layer, called the serosa; the cancer has spread through the outer layer, called the serosa, to the lining of the abdomen, called the peritoneum; or the cancer has spread through the outer layer, called the serosa, to other organs, such as the liver.

Treatment for Stage II colorectal cancer may include chemoradiation with fluorouracil and capecitabine; surgery with low anterior resection; proctectomy with colo-anal anastomosis, in which the remaining edges of the colon and anus are rejoined after the cancer has been removed; or an abdominoperineal resection, which is a more extensive open surgery.

After surgery, additional chemotherapy may be given with the use of the FOLFOX regimen (oxaliplatin, fluorouracil, and leucovorin); fluorouracil and leucovorin; CAPEOX (capecitabine plus oxaliplatin), or capecitabine alone.

Patients with colorectal cancer may also require surgery for a temporary or permanent colostomy, which is an opening made in the abdomen through which stool can pass into a colostomy bag.

Stage III (IIA, IIIB, IIIC) – In this stage of colorectal cancer, the cancer has spread through the inner lining, called the submucosa, or the muscle layer of colon or rectum, or through the colon or rectal wall to lymph nodes. Lymph nodes are part of the body’s immune system and filter lymph fluid that helps balance the body’s fluid levels. The colorectal cancer may also have spread through the colon or rectal wall to the inner lining of the abdomen, called the peritoneum, or to nearby organs.

Treatment for Stage III colorectal cancer may include chemoradiation, followed by surgery with low anterior resection; proctectomy with colo-anal anastomosis, in which the remaining edges of the colon and anus are rejoined after the cancer has been removed; or an abdominoperineal resection, which is a more extensive open surgery.

If the Stage III colorectal cancer is more widespread, a radical surgery called pelvic exenteration may be necessary, which means removal of the cancerous colon or rectum and all the organs in the pelvis.

After surgery, additional chemotherapy may be given for Stage III colorectal cancer with the use of the FOLFOX regimen (oxaliplatin, fluorouracil, and leucovorin); fluorouracil and leucovorin, CAPEOX (capecitabine plus oxaliplatin); or capecitabine alone.

Patients with colorectal cancer may also require surgery for a temporary or permanent colostomy, which is an opening made in the abdomen through which stool can pass into a colostomy bag.

Stage IV (IVA, IVB, IVC) – In this stage of colorectal cancer, the cancer has spread to an area or organ far from the colon or rectum, such as the liver, lung, ovary, or a distant lymph node; The cancer may also have spread to the inner lining of the wall of the abdomen, called the peritoneum.

Treatment for Stage IV colorectal cancer may include chemoradiation, followed by surgery with low anterior resection; proctectomy with colo-anal anastomosis, in which the remaining edges of the colon and anus are rejoined after the cancer has been removed; or an abdominoperineal resection, which is a more extensive open surgery.

If the Stage IV colorectal cancer is more widespread, a radical surgery called pelvic exenteration may be necessary, which means removal of the cancerous colon or rectum and organs in the pelvis.

Patients with colorectal cancer may also require surgery for a temporary or permanent colostomy, which is an opening made in the abdomen through which stool can pass into a colostomy bag.

After surgery, additional chemotherapy may be given for Stage IV colorectal cancer with the use of the FOLFOX regimen (oxaliplatin, fluorouracil, and leucovorin); fluorouracil and leucovorin; CAPEOX (capecitabine plus oxaliplatin); or capecitabine alone.

Additional treatments for Stage IV colorectal cancer may include chemotherapy given directly into the liver, called hepatic artery infusion, for cancer that has spread to the liver or targeted therapy with or without chemotherapy, using the following drugs:

• Aflibercept
• CAPEOX or CAPOX: capecitabine and oxaliplatin
• Capecitabine, with or without a targeted drug
• Cetuximab alone
• Fluorouracil and leucovorin, with or without a targeted drug
• FOLFIRI: leucovorin, fluorouracil, and irinotecan
• FOLFOX: leucovorin, fluorouracil, and oxaliplatin
• FOLFOXIRI: leucovorin, fluorouracil, oxaliplatin, and irinotecan
• Irinotecan, with or without a targeted drug
• One of the above combinations and bevacizumab, ziv-aflibercept, ramucirumab, cetuximab, or panitumumab
• Panitumumab alone
• Regorafenib alone
• Trifluridine and tipiracil

Other treatments for Stage IV colorectal cancer may include immunotherapy drugs, such as pembrolizumab or nivolumab. Immunotherapy uses the body’s immune system, or natural defenses, to kill cancer cells.

If Stage IV colorectal cancer has spread to the liver, treatments may include ablation, which destroys the cancer cells, or embolization, which cuts off the tumor’s blood supply, allowing it to shrink and die.

Types of Treatments

Usual treatments for colorectal cancer include surgery (resection), colostomy, radiation therapy, radiofrequency ablation, cryosurgery, chemotherapy, targeted drug therapy, and immunotherapy.

Polypectomy – The removal of polyps through a colonoscope through the use of cryosurgery which freezes the polyp, making it fall off.

Endoscopic Mucosal Resection – The removal of large polyps through a colonoscope, along with a small portion of the inner lining, called the mucosa, of the colon.

Laparoscopic Surgery – For polyps that cannot be removed with a colonoscope, laparoscopic surgery involves small incisions in the abdomen with the insertion of a scope. In addition to removal of polyps, small portions of nearby lymph nodes may also be removed.

Partial colectomy – Removal of the cancerous portion of the colon, often through laparoscopy, along with margins of normal tissue surrounding the cancer.

Colostomy – A colostomy, which can be temporary or permanent, is an opening through the abdomen to the remaining portion of the colon with the placement of a bag that fits over the opening for the elimination of stool.

Lymph Node Resection – Removal of lymph nodes surrounding the colorectal cancer.

Chemotherapy – Chemotherapy for colorectal cancer uses medications to kill cancer cells and may be given before surgery to decrease the size of a tumor, making it easier to remove. Chemotherapy is often also given after the cancer has been surgically removed, if the cancer is too large to be removed, or if the cancer has spread to lymph nodes. Chemotherapy may be combined with radiation therapy.

Radiation Therapy – Radiation therapy for colorectal cancer uses intense, directed X-rays and protons that either reduce the size of the cancer or kill it. Radiotherapy can also be used to stop cancer pain and is often combined with chemotherapy.

Radiofrequency Ablation – Radiofrequency ablation for colorectal cancer uses tiny electrodes to kill cancer cells.

Cryosurgery – Cryosurgery for colorectal cancer and cancerous polyps freezes the cancerous tissue and destroys it.

Targeted Drug Therapy – Targeted drug therapies, also called biologic or biotherapies, are used for advanced colorectal cancer to kill the cancer cells and are usually combined with chemotherapy.

Immunotherapy – Immunotherapy (immune checkpoint inhibitors) is used for advanced colorectal cancer and works by enlisting the body’s own immune system to attack the cancer cells.

Palliative Care

In addition to standard treatments, patients with Stage IV colorectal cancer may also be treated with palliative care. Palliative care is used to relieve pain and other symptoms to make a patient more comfortable.

Long-Term Follow-Up

Ongoing, long-term follow-up is an essential part of the treatment for patients with colorectal cancer because the cancer can reoccur even after it has been treated.

Sources

This content was written by the MediFind Medical Team. Last updated: 6/9/2022