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Treatments for stage II colon cancer
The following are treatment options for stage II colon cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Surgery is the primary treatment for stage II colon cancer. A bowel resection is the type of surgery done. Depending on the location of the tumour, the surgeon may do a right hemicolectomy, transverse colectomy, left hemicolectomy, sigmoid colectomy, subtotal colectomy or total colectomy.
The surgeon will remove at least 12 nearby lymph nodes (called lymph node dissection).
A colostomy may be done to allow the intestines to rest and heal after the bowel resection. The colostomy is usually temporary. The 2 ends of the colon are joined together after they have healed.
You may be offered chemotherapy after surgery (called adjuvant chemotherapy) for stage II colon cancer to reduce the risk of recurrence. Chemotherapy can be started 4–8 weeks after surgery and is usually given for 6 months.
Most people with stage II colon cancer will not need chemotherapy. Chemotherapy is only offered when there is a high risk that the colon cancer will recur (come back) and at least one of the following high-risk features is present:
- The tumour is T4 (stage IIB or IIC).
- Less than 12 lymph nodes were removed or could be assessed.
- The tumour has grown into nearby lymph nodes or blood vessels, the membrane that covers and supports most of the organs in the abdomen (called the visceral peritoneum) or the space surrounding nerves (called perineural invasion).
- The tumour is high grade, or poorly differentiated.
- A blockage in the intestine (called bowel obstruction).
- A tear or hole in the intestine (called bowel perforation).
- Not enough healthy tissue was removed along with the tumour.
- Cancer cells are found in the tissue removed along with the tumour (called positive surgical margins).
The chemotherapy drugs that may be given for stage II colon cancer include:
- capecitabine (Xeloda)
- 5-fluorouracil (Adrucil, 5-FU) with leucovorin (folinic acid)
- FOLFOX – leucovorin (folinic acid), 5-fluorouracil (Adrucil, 5-FU) and oxaliplatin (Eloxatin)
- CAPOX (also called XELOX) – capecitabine (Xeloda) and oxaliplatin (Eloxatin)
Microsatellite instability (MSI) is a change to the genetic material, or DNA, in a cell. Research has shown that tumours with high levels of microsatellite instability (MSI-H) have a favourable prognosis and do not benefit from chemotherapy with 5-fluorouracil (Adrucil, 5-FU). As a result, people with stage II colon cancer and high levels of MSI in the tumour are not usually offered chemotherapy. More research is needed to find out if doctors can use the presence of MSI alone to decide to offer chemotherapy for stage II colon cancer.
Doctors may offer FOLFOX or CAPOX when many high-risk features are present. But many oncologists have questioned using oxaliplatin to treat stage II colon cancer. This is because research has not shown that chemotherapy combinations with oxaliplatin improve survival for stage II colon cancer. More research is needed before these drug combinations can become standard treatment.
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 or is attached to nearby tissues or structures
- all the cancer couldn’t be removed with bowel resection
Radiation therapy isn’t a common treatment for stage II 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.
You may be asked if you want to join a clinical trial for colon cancer. Find out more about clinical trials.