NCCN Guidelines for Patients
Colon Cancer, Version 1.2017
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
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.