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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Metastatic disease

Metastases at recurrence | Review

Talk to your doctor about other options after surgery.

You may be able to start follow-up care. Another

option may be a short course of chemotherapy.




Cancer in distant sites is called a metastasis.

Colon cancer most often spreads to the liver

and sometimes the lungs.



Metastases may be present when you first

learn that you have colon cancer. Metastases

may also occur if the cancer re-appears during

follow-up care.



Some colon cancers with metastases can be

treated with surgery. Local therapy may be

used along with surgery or be used by itself.

Chemotherapy should also be part of treatment.



Most colon cancers with metastases cannot

be treated with surgery. In most cases,

chemotherapy is advised. Targeted therapy

may be added.

Guide 15. Nonsurgical options

Chemotherapy history

What are the options?

Adjuvant FOLFOX or CAPEOX ≤12 months ago


• FOLFIRI + bevacizumab

• FOLFIRI + ziv-aflibercept

• FOLFIRI + ramucirumab

• Irinotecan

• Irinotecan + bevacizumab

• Irinotecan + ziv-aflibercept

• Irinotecan + ramucirumab

• If normal



◦◦ FOLFIRI + panitumumab

◦◦ FOLFIRI + cetuximab

• If dMMR or MSI-H:

◦◦ Nivolumab

◦◦ Pembrolizumab

Adjuvant FOLFOX or CAPEOX >12 months ago

• Treatments listed in Part 6

Prior 5-FU/LV or capecitabine

• Treatments listed in Part 6

Never had chemotherapy

• Treatments listed in Part 6