Treatments for colon cancer

The following are treatment options for colon cancer. Treatments offered depend on the stage and location of the tumour. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the standard treatment for stage 0 colon cancer.

Surgery usually involves a local excision (local resection) to remove the tumour or polyp and a small amount of tissue around it. The type of local excision used is often a polypectomy and it is done during a colonoscopy. If cancer cells are found in the tissue removed with the tumour, a bowel resection is done. The type of bowel resection depends on the location of the tumour.

Surgery is the main treatment for stage 1 colon cancer.

Surgery usually involves a bowel resection with a lymph node dissection. The type of bowel resection depends on the location of the tumour. A colostomy or ileostomy may be done after the bowel resection, depending on the location of the cancer and how healthy the remaining colon is after bowel resection. The colostomy creates an opening from the colon to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum to the outside of the body through the abdominal wall. It creates a new path for food waste (stool or poop) to leave the body. The colostomy or ileostomy can be temporary to allow the intestine to rest and heal after surgery.

If the cancer was part of a polyp and the polyp is completely removed during a colonoscopy, no further surgery may be needed.

Surgery is the main treatment for stage 2 colon cancer. Chemotherapy and radiation therapy may also be used.

Surgery usually involves a bowel resection with a lymph node dissection. The type of bowel resection depends on the location of the tumour. A colostomy or ileostomy may be done after the bowel resection, depending on the location of the cancer and how healthy the remaining colon is after bowel resection. The colostomy creates an opening from the colon to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum to the outside of the body through the abdominal wall. It creates a new path for stool to leave the body. The colostomy or ileostomy can be temporary to allow the intestine to rest and heal after surgery.

Chemotherapy may be offered after surgery if there is a high risk that the cancer will come back (recur) and at least one of the following high-risk features is present:

• The tumour is T4 (stage 2B or 2C).
• Fewer than 12 lymph nodes were removed or could be assessed.
• The tumour has grown into nearby lymph nodes, blood vessels or the space surrounding nerves.
• The tumour is high grade.
• There is a blockage in the intestine (bowel obstruction) or a tear or hole in the intestine (bowel perforation).
• Not enough healthy tissue was removed along with the tumour, or cancer cells are found in the tissue removed with the tumour.

The chemotherapy drugs that may be given for stage 2 colon cancer include:

• capecitabine (Xeloda)
• 5-fluorouracil (Adrucil, 5-FU) with leucovorin (folinic acid)
• oxaliplatin (Eloxatin)
• FOLFOX – leucovorin, 5-fluorouracil and oxaliplatin
• CAPOX (also called XELOX) – capecitabine and oxaliplatin

Chemotherapy may be given with or without radiation therapy to people who are not healthy enough for surgery.

Radiation therapy may be offered after surgery to help prevent cancer from coming back in the same area (called a local recurrence). It may be offered if the tumour has grown into nearby tissues or structures or if all the cancer couldn't be removed with bowel resection.

Radiation therapy may be given with or without chemotherapy to people who are not healthy enough for surgery.

Surgery is the main treatment for stage 3 colon cancer. Chemotherapy and radiation therapy may also be used.

Surgery usually involves a bowel resection with a lymph node dissection. The type of bowel resection depends on the location of the tumour. A colostomy or ileostomy may be done after the bowel resection, depending on the location of the cancer and how healthy the remaining colon is after bowel resection. The colostomy creates an opening from the colon to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum to the outside of the body through the abdominal wall. It creates a new path for stool to leave the body. The colostomy or ileostomy can be temporary to allow the intestine to rest and heal after surgery.

Chemotherapy is usually given after surgery for stage 3 colon cancer to reduce the risk of recurrence. Chemotherapy can be started 4 to 8 weeks after surgery and is usually given for 6 months.

The types of chemotherapy drugs used include:

• capecitabine
• 5-fluorouracil with leucovorin
• oxaliplatin
• FOLFOX – leucovorin, 5-fluorouracil and oxaliplatin
• CAPOX – capecitabine and oxaliplatin

Radiation therapy may be offered after surgery to help prevent cancer from coming back in the same area. It may be offered if the tumour has grown into nearby tissues or structures or if all the cancer couldn’t be removed with bowel resection.

Radiation therapy isn’t a common treatment for stage 3 colon cancer because colon cancer doesn’t usually spread locally. If it spreads, it is more likely to spread to distant organs such as the liver.

Treatment options are often the same for both stage 4 and recurrent colon cancer. Stage 4 means that the cancer has spread to one or more other organs. If colon cancer recurs, it usually comes back in a distant site such as the liver.

Treatments and the order they are used depend on if the cancer can be removed with surgery (resectable) or can’t be removed with surgery (unresectable).

Chemotherapy is usually offered for stage 4 or recurrent colon cancer. It may be used as the main treatment for unresectable tumours in the colon or metastases in the liver. It may also be given before surgery to shrink tumours to make them easier to remove. If the cancer is resectable, chemotherapy is usually given after surgery to kill any cancer cells that may be left behind and prevent the cancer from coming back.

How long chemotherapy is given depends on the drugs used, the cancer’s response to the drug or drug combination and if surgery is done. If the cancer is resectable, chemotherapy is usually given for 6 months. If the cancer is unresectable, chemotherapy may be used as long as the cancer responds or until the disease progresses.

When deciding which chemotherapy drug or drug combination to use, your overall health and the possible side effects of the drugs will be considered. A targeted therapy drug may be given with the chemotherapy.

Common chemotherapy drugs include:

• capecitabine
• irinotecan (Camptosar)
• oxaliplatin
• 5-fluorouracil with leucovorin
• raltitrexed (Tomudex)
• trifluridine and tipiracil (Lonsurf)

Common chemotherapy drug combinations include:

• FOLFIRI – leucovorin, 5-fluorouracil and irinotecan
• FOLFOX – leucovorin, 5-fluorouracil and oxaliplatin
• FOLFOXIRI – leucovorin, 5-fluorouracil, oxaliplatin, irinotecan
• CAPOX (XELOX) – capecitabine and oxaliplatin
• CAPIRI – capecitabine and irinotecan

Hepatic arterial infusion may be used to treat liver metastases when cancer has only spread to the liver and it can’t be removed with surgery. It delivers chemotherapy directly to liver tumours through the main artery of the liver (called the hepatic artery). Floxuridine (FUDR) is the most common chemotherapy drug used for hepatic arterial infusion.

Targeted therapy is usually offered for stage 4 or recurrent colon cancer. It is usually given with chemotherapy, but it may be used alone. Targeted therapy drugs used for stage 4 or recurrent colon cancer include:

• bevacizumab (Avastin, Mvasi) is usually given with FOLFIRI or FOLFOX or CAPOX
• cetuximab (Erbitux) is usually given alone or with irinotecan or FOLFIRI
• panitumumab (Vectibix) is usually given alone or with FOLFIRI or FOLFOX
• encorafenib (Braftovi) is given with cetuximab
• regorafenib (Stivarga) may be given if the cancer progresses after other treatments

Immunotherapy may be offered for stage 4 or recurrent colon cancer. Immune checkpoint inhibitors, ipilimumab (Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda), are used for metastatic colorectal cancer which has a high microsatellite instability (changes to DNA in the cells).

Surgery may be offered for stage 4 or recurrent colon cancer. Whether or not surgery is an option will depend on the location of the tumour and your overall health.

Surgery to remove metastatic tumours is done when the cancer has spread to only one distant organ, such as the liver or lung. The type of surgery done will depend on where the cancer has spread.

A bowel resection is done to remove cancer in the colon. It may also be used to treat a blockage in the intestine (bowel obstruction). The type of bowel resection depends on the location of the tumour or blockage.

A colostomy creates an opening from the colon to the outside of the body through the abdominal wall. It creates a new path for stool to leave the body and may be done after a bowel resection. The colostomy may be temporary or permanent.

An ileostomy creates an opening from the ileum to the outside of the body through the abdominal wall. It creates a new path for stool to leave the body and may be done after a bowel resection. The ileostomy may be temporary or permanent.

A diverting colostomy is a colostomy that doesn’t remove part of the intestine. It may be used to treat a bowel obstruction by creating a passage so stool can leave the body before it reaches the blocked part of the intestine.

A stent placement may be done to treat or prevent bowel obstruction. The doctor can place a mesh-like metal tube (called a stent) in the intestine to open it so stool can flow normally. Stents are often used to relieve symptoms of advanced cancer.

Radiofrequency ablation (RFA) may be used to treat liver metastases that can’t be removed with surgery. RFA uses a high-frequency electrical current to destroy cancer cells. Find out more about radiofrequency ablation.

Radiation therapy may be offered for stage 4 or recurrent colon cancer. It is used most often as palliative therapy to control symptoms such as pain. Radiation therapy to the abdomen or pelvis may be used for unresectable colon cancer. It may also be used to treat bone or brain metastases.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with colon cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.