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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017

Part 4 is a treatment guide for colon

cancer that hasn’t spread to distant sites.

The cancer is confined within the colon,

has grown to nearby structures, or has

spread to nearby lymph nodes. Treatment

options are partly based on cancer stage.

Stage I

Guide 4

lists the treatment options for tumors rated

as T1. These tumors haven’t grown beyond the

second layer of the colon wall. They are sometimes

called “polyps with cancer” because the cancer

hasn’t grown far.

Some people with T1 tumors will need treatment.

Treatment is based on the shape of the polyp and

whether cancer will likely return after a polypectomy.

Shapes of polyps are shown in

Figure 14

. The

cancer is more likely to return if these high-risk

features are present:



Fragmented specimen

is a tumor that was

removed in pieces.



Positive surgical margin

is cancer within the

normal-looking tissue around the tumor.



Unknown surgical margin

is unclear results of

the normal-looking tissue around the tumor.



Cancer grade 3 or 4

means cancer cells don’t

look much like normal cells.



Angiolymphatic invasion

is cancer spread

into the tumor’s lymph and blood vessels.



Tumor budding

is a group of 5 or fewer cancer

cells separate from the main tumor.

A polypectomy likely removed all the cancer if you

had a pedunculated polyp without high-risk features.

No more treatment is advised. You can start follow-

up testing.

For a sessile polyp without high-risk features, there

are two options if the polyp was fully removed. You

may start follow-up testing. Surgery is also an option.


Nonmetastatic cancer

Stage I

Guide 4. Treatment for T1 tumors

Test results

What are the options?

Pedunculated polyp

without high-risk features • Start follow-up testing

Sessile polyp without

high-risk features

• Start follow-up testing

• Colectomy +


Any polyp with high-risk


• Colectomy +


Figure 14

Shapes of polyps

Treatment for stage I, T1 tumors is partly

based on the shape of the polyp. A

pedunculated polyp has a stalk and round

top. A sessile polyp doesn’t have a stalk.

Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved.