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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Nonmetastatic cancer

Stage I

Sessile polyps have worse outcomes than other

polyps when surgery isn’t received.

Either type of polyp may have high-risk features.

In this case, surgery is advised. The part of the

colon with cancer and some lymph nodes should be


Guide 5

lists the treatment options for tumors rated

as T2. These tumors haven’t grown beyond the third

layer of the colon wall. Treatment is needed.

If you are able to have surgery, a colectomy and

lymphadenectomy are advised. It is very rare that

surgery can’t be done. In this case, sometimes

chemotherapy is given if you’re healthy enough.

Radiation therapy may be added.

In very rare cases, a T2 tumor has grown so large

that it blocks the flow of stool. There are four options

when there is a blockage. One option is a colectomy

that unblocks your gut. Another option is removal

of the cancer and a diversion within one operation.

A diversion is a surgery that attaches the colon to

the surface of the abdomen, and a “bag” is needed.

A third option is a diversion followed by a second

operation to remove the cancer. Last, some people

can get a stent followed by a second operation to

remove the cancer.

The tissue that is removed from your body will be

sent to a pathologist. The pathologist will assess how

far the cancer has grown within the colon wall. He or

she will also test for cancer in your lymph nodes. If

the cancer stage doesn’t change, you will not need

more treatment. If the cancer is upstaged to stage

II or III, read

Guide 9

. This guide lists what further

treatment is advised.

Guide 6

lists follow-up testing for polyps with

cancer. Follow-up testing is started when there are

no signs of cancer after treatment. It can be helpful

for finding new cancer growth early.

A colonoscopy is recommended 1 year after

treatment has ended. If results are normal, the next

colonoscopy should be received in 3 years and then

every 5 years. If an advanced adenoma is found,

your next colonoscopy will be needed within 1 year.

Advanced adenomas include polyps with a ruffled

structure (villous), a polyp larger than the width of an

AAA battery (>1 cm), or a polyp with pre-cancerous

cells (high-grade dysplasia).