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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Nonmetastatic cancer

Stages II and III

tumor has grown so large that it blocks the flow

of stool. There are four options when there is a


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



The tissue that will be 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. Based on test results, a pathologic stage will

be assigned.

Surgery isn’t an option

It is very rare but you may be unable to have surgery.

Surgery may not be possible because of where the

cancer is. Some health issues also exclude surgery.

In this case, sometimes chemotherapy is given if you

are healthy enough. The chemotherapy listed in Part

6 may be used. Other preferred options are radiation

therapy with either infusional 5-FU or capecitabine.

If neither is an option, a third option is bolus 5-FU/LV

with radiation therapy.

For very invasive tumors, chemotherapy may shrink

the tumor enough for surgery. IORT may be added.

If you’re still unable to have surgery, you may be

treated with more cycles of chemotherapy.