NCCN Guidelines for Patients
Colon Cancer, Version 1.2014
Stages I (T2), II, and III colon cancer
to pass. The third option involves a two-step process.
The first surgery is a diversion to allow stool to pass,
and the second surgery is to remove the cancer.
lists the adjuvant treatment options after
surgery. Adjuvant treatment is given when all visible
cancer has been removed by surgery but unseen
cancer cells may remain. The aim of this treatment is
to kill the unseen cancer cells.
The pathologic stage of cancer is used to recommend
which adjuvant treatment to receive. If adjuvant
treatment is right for you, it should be received as
soon as possible for the best results.
More treatment after surgery isn’t needed for stage I
(T2). These tumors didn’t grow far into the colon wall.
Thus, all of the cancer was likely removed.
Stage II colon cancer is more likely to return than
stage I. More than one option is given. Talk with your
doctors about the risks and benefits of each option.
Options should be discussed in light of your overall
health, personal wishes, and type of colon cancer.
It is important to know that chemotherapy may
have little, if any, benefit for stage II colon cancer.
If the tumor has high microsatellite instability, 5-FU
chemotherapy will not help. Microsatellite instability is
abnormal changes in DNA that happen when DNA is
making a copy of itself.
For stage IIA, options are based on pathologic stage
plus risk factors for recurrence. High-risk features
• High grade – A grade of 3 or 4 with low
• Positive margins – Cancer was found in the
• Unknown margins – The presence of cancer
in margins can’t be confirmed,
• Angiolymphatic invasion – Cancer has spread
into the lymph vessels or bloodstream,
• Bowel obstruction – The tumor has grown
large enough to block the gut,
• Limited lymphadenectomy – Fewer than 12
lymph nodes were examined,
• Perineural invasion – Cancer has spread
around or into the nerves, and
• Localized perforation – Holes have formed in
the colon from the tumor.
There are three options for stage IIA colon cancer
without high-risk features. First, you can enroll
in a clinical trial that is testing new treatments.
Second, you can start follow-up testing and wait
to see if the cancer will return. Third, you can talk
with your doctors about starting chemotherapy.
Capecitabine alone or 5-FU/LV is the only reasonable
chemotherapy for stage IIA without high-risk features.
High-risk stage IIA, stage IIB, and stage IIC cancers
have four options. You may start chemotherapy.
Capecitabine or 5-FU/LV is the first option. FOLFOX,
CapeOX, or FLOX is the second option. For T4
tumors, consider radiation therapy with chemotherapy
if the tumor has grown into a nearby organ or
structure. The third option is to join a clinical trial
testing new treatment. A third option is to start follow-
up testing to wait and see if the cancer will return.
For stage III, chemotherapy is the only suggested
option. The risk for recurrence is high. Recurrence is
more likely for stage III than for stage I and II because
cancer cells may have spread through lymph.
FOLFOX or CapeOX is often given for stage III. There
is also good research supporting the use of FLOX. If
oxaliplatin is not right for you, other options include
capecitabine alone or 5-FU/LV.