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40

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

4

Nonmetastatic cancer

Stages II and III

Stages II and III

Guide 7

lists the options for neoadjuvant treatment

for stages II and III cancers. The aim of this treatment

is to shrink a tumor so it can be fully removed during

surgery. Less invasive cancers are often easier to

remove.

Neoadjuvant treatment is based on the T stage.

Tumors that are rated as T1, T2, T3, and T4a haven’t

grown through the colon wall to nearby organs. For

these tumors, neoadjuvant treatment isn’t advised.

Tumors rated as T4b have grown through the colon

wall to nearby structures. In this case, your doctor

may want to use chemotherapy before surgery.

FOLFOX or CAPEOX are advised.

Guide 8

lists the options for primary treatment.

Primary treatment is the main treatment used to rid

your body of cancer. Treatment options are based on

whether the tumor can be removed.

Surgery is an option

If you are able to have surgery, a colectomy and

lymphadenectomy are advised. In rare cases, a

Guide 7. Neoadjuvant treatment

T stage

What are the options?

Colon tumors haven’t grown to nearby sites (T1–T4a)

• Start primary treatment

Colon tumors have grown to nearby sites (T4b)

• Start primary treatment

• FOLFOX or CAPEOX

Guide 8. Primary treatment

Surgery status

What are the options?

The tumor can be treated with surgery

and isn’t blocking the gut

• Colectomy + lymphadenectomy

The tumor can be treated with surgery

and is blocking the gut

• Colectomy + lymphadenectomy

• Colectomy + lymphadenectomy + diversion

• Diversion followed by colectomy + lymphadenectomy

• In some cases, stent followed by colectomy + lymphadenectomy

The tumor can’t be treated with surgery

• Treatment listed in Part 6

• Infusional 5-FU + radiation therapy

• Capecitabine + radiation therapy

• Bolus 5-FU/LV + radiation therapy