Cancer staging plays a major role in how your colorectal cancer specialist will approach the treatment plan including the types of treatments needed and the right timing for surgery.
Colorectal cancer that is found in its early stages will be approached differently than it is when found in the later stages. Let’s look further into what determines whether colorectal cancer is early or late stage and how the treatments vary between the two.
What is Considered Early Stage and Late Stage Colorectal Cancer?
Colorectal cancer staging helps your doctor determine the extent of your cancer. Is it confined to the polyp where it started? Has it invaded the wall of the colon? Or perhaps it’s grown outside of the colon and is in the lymph nodes or other areas of the body.
Early stage colorectal cancer is either stage 0 or stage I. Late stage colorectal cancer usually means stages III or IV. Stage II is in the middle, referred to as regional cancer and hasn’t spread into the lymph nodes or distant organs of the body. The treatment plan for regional cancer is likely to be more intensive than early-stage colorectal cancer requires, but may not include as much as is needed for patients with stages III or IV.
Early Stage Colorectal Cancer Treatments
Treatment for stage 0 colorectal cancer
Stage 0 colon cancer is when the cancer is contained in the inner lining of the rectum or colon. Quite often, this is found through a routine colorectal cancer screening test called a colonoscopy.
If the doctor spots a polyp, or clump of cells, growing in the intestine that appears to be cancer, it will be removed during this procedure. The polyp is then tested by a pathologist to determine if cancer is present and if so, which type. For many this is the only treatment needed for stage 0 colorectal cancer. However, if the polyp was especially large or several polyps were found to be cancerous, further surgery to remove more of the affected area of the colon may be recommended.
Treatment for stage I colorectal cancer
Stage I colorectal cancer has grown into deeper layers of the colon but it has not yet spread outside of the colon or to the lymph nodes. If stage I colon cancer is part of a polyp and the entire polyp is removed through surgery with no other cancer cells along the edges; then surgery may be the only treatment needed. If the cancer is not in a polyp, then a partial colectomy may be needed, which is the removal of a section of the colon. Surgery is typically the main treatment approach for stage I colorectal cancer, but chemotherapy may also be recommended in some cases.
Colorectal cancer screening is key to early detection of colorectal cancer when it’s easier to treat. Learn more and see when you should start screening.
Stage II: Regional Colorectal Cancer Treatments
Stage II colorectal cancer has grown through the wall of the colon and possibly into some of the nearby tissue, but it has not yet reached the lymph nodes. Surgery to remove the part of the colon that contains the cancer and nearby lymph nodes will likely be recommended, and this may be the only treatment needed. For patients who have a higher risk of the cancer returning, the oncologist may recommend chemotherapy after surgery. Patients who are at a higher risk of cancer returning are those who have:
- More than 12 lymph nodes removed because cancer was seen or suspected in them
- Cancer that had grown and blocked the colon
- Cancer that caused a hole or tear in the wall of the colon
For these patients, there is a chance that the cancer cells have left the colon and need to be killed with a systemic drug like chemotherapy. A common type of chemotherapy that may be used for stage II colorectal cancer is FOLFOX, a combination of folinic acid also called leucovorin, calcium folinate, fluorouracil (also known as 5FU), and oxaliplatin.
Late Stage Colorectal Cancer Treatments
Your oncologist may also refer to late stage colorectal cancer (stages III or IV) as advanced cancer. Late stage also includes recurrent disease -- when colorectal cancer comes back in either the colon, rectum, or another area of the body.
For late stage patients, colorectal cancer has spread past the area where it originally started. In some cases this makes it difficult to perform surgery without removing a very large portion of the colon or causing the cancer to spread further during the procedure. For these patients, chemotherapy may be used first.
There are now additional therapies available to late stage colorectal cancer patients that are changing the way colorectal cancer is treated.
Biomarkers Can Drive Late Stage Colorectal Cancer
In addition to chemotherapies, there are other options that can be explored for Stage IV patients, often in combination with chemotherapy. Biomarker tests are performed to determine if there is a specific targeted therapy or immunotherapy that would be effective.
The results of the test will tell the oncologist if there is a specific genetic mutation or protein overgrowth that can be treated by a recently approved targeted therapy or immunotherapy such as:
- EGFR inhibitors, a type of targeted therapy, work best when gene mutations detected in the KRAS, NRAS, and BRAF are present.
- HER2-positive colorectal cancer can be treated with a targeted therapy to slow the overgrowth of the HER2 protein.
- NTRK gene mutations are less common than others, but if found can be treated with a specific type of targeted therapy.
- PD-1 is a protein found on immune system T cells that normally keeps them from attacking other cells in the body. By blocking PD-1 with immunotherapy drugs, the immune system is able to identify and attack cancer cells.
Radiation therapy may also be recommended to help relieve symptoms like pain, but it is unlikely to actually cure the cancer.
What Influences an Individual's Set of Treatment Options?
The exact treatment that is used for you will vary depending on a number of factors, including:
- Your overall health
- Your age
- The specific sub-type of colorectal cancer such as adenocarcinoma, carcinoid, GI stromal tumors, or lymphoma that appears in the colon
- The stage of cancer (early stage vs late stage)
- Whether you have certain gene mutations as a late stage colorectal cancer patient
- Your preference and goals for treatment
Creating Personalized Colorectal Cancer Treatment Plans
Treating colorectal cancer is going to look different from person to person based on several factors including whether it’s early stage or late stage. It’s important to spend plenty of time discussing treatment options and the goals of treatment with your colorectal cancer specialist before deciding on the best approach. They can share with you what they know is most likely to work best in your particular situation.
The colorectal cancer specialists at Rocky Mountain Cancer Centers are here to provide a consultation so they can develop a personalized treatment plan. The specialists are also available for second opinions. Schedule a consultation at a location in Denver, Colorado Springs, Boulder and throughout the Front Range that is convenient for you.