Colon Cancer: Once diagnosed, what are the next steps? | Norton Cancer Institute

Michael F. Driscoll, M.D., medical oncologist answers the question, once colon cancer is diagnosed, what are the next steps?

For cancers that seem local/regional meaning contained in one area potentially maybe there's some lymph nodes that look suspicious on the CT scan but no evidence of any spread to let's say the liver or the lungs which would be more of a distant spread and denote a late stage such as stage four.

It's usually stage 1, 2, 3 we would go for surgery as the first option and surgery is really your best chance of cure.

Oftentimes the final stage is not known until the pathology comes back. Sometimes we would look at a colon cancer and say this looks relatively early stage maybe this is a stage one, potentially a stage 2 and we may get the pathology back which shows that the cancer has maybe invaded deeper into the colon or maybe in the pericolorectal tissues which are just outside of the colon or has maybe spread to the lymph nodes and if that's the case then that changes what we're going to do after the surgical resection.

As a general rule with the different stages of colon cancer typically stage 1 people just need a surgical resection and that is generally curative.

Stage 2 depending on your risk factors you may need chemotherapy after the fact.

Stage 3 tends to involve the lymph nodes and we know from clinical trials that people that have lymph node involvement with colon cancer definitively benefit from chemotherapy it decreases their risk of recurrence gives them a better overall survival.

So, those folks definitively need chemotherapy and then stage 4 is spread outside in the colon so it's a distant platastocyst or spread somewhere else most often times its to the liver.

Colon cancer’s a little bit different cancer than some of the other solid tumor malignancies. When we look at other cancers such as let’s say pancreatic cancer or Cholangiocarcinoma which is a cancer of the biliary tract maybe even with cancer that starts in the liver and then spreads somewhere else, cellular carcinoma, or even lung cancer or breast cancer that tend to be stage four meaning distant metastasis oftentimes these are very difficult to cure.

Colon cancer is a little bit different in that when folks present with a single isolated metastasis or cancer to the liver from the colon and there's no evidence of any spread anywhere else we can still cure some of the stage 4 colon cancers with surgical resection or ablation of the liver metastases in addition to the chemotherapy.
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