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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Nonmetastatic cancer

Stages II and III



Limited lymphadenectomy means fewer than

12 lymph nodes were examined.



Bowel obstruction means the tumor has grown

large enough to block the gut.



Localized perforation is the presence of holes in

the colon caused by the tumor.

Treatment options

If stage II, talk to your doctor about the pros and

cons of treatment. It is important to know that

chemotherapy may have little, if any, benefit.

Treatment decisions should be based on science,

side effects, cancer features, and your wishes.

If a stage II tumor is MSI-H or dMMR, no further

treatment is advised. The outlook (prognosis) of the

cancer is good. Also, 5-FU chemotherapy will not

help. You can start follow-up testing.

There are three options for stage IIA cancer that isn’t

MSI-H or dMMR and without high-risk features. First,

you can enroll in a clinical trial. Second, you can

start follow-up testing. Third, you can talk with your

doctors about starting chemotherapy. Capecitabine

alone or 5-FU/LV is advised.

High-risk stage IIA without MSI-H or dMMR, stage

IIB, and stage IIC cancers have four options.

Capecitabine or 5-FU/LV is one option. FOLFOX

or CAPEOX is another option. A T4 tumor that has

grown to a nearby structure may be treated with both

radiation and chemotherapy. The third option is to

join a clinical trial. A fourth option is to start follow-up


For stage III, chemotherapy is advised. The risk for

cancer returning after treatment is high. FOLFOX or

CAPEOX is often given for stage III. If oxaliplatin is

not right for you, other options are capecitabine alone

or 5-FU/LV.

I always tell people going through

treatment two things: to get

themselves a "chemo buddy" like

a stuffed animal. It's not only

therapeutic for them, but other

patients and even the staff! And I

also tell people to let others help

you with things so you can focus on

getting through the treatment!


Survivor, Stage III