How Treatment Options Differ Between Early-Stage and Late-Stage Colorectal Cancer

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How Treatment Options Differ Between Early-Stage and Late-Stage Colorectal Cancer

If you or a loved one was diagnosed with colorectal cancer, understanding the stage of cancer is important because it influences the treatment plan recommended by your oncologist. Not only does the stage impact the type of treatments your colorectal cancer specialist will recommend, but it will also determine the order they’re given.  

If colorectal cancer is detected early, the treatment approach is quite different compared to when it's discovered at a later stage. Let's examine the differences between early- and late-stage colorectal cancer and the available treatments. 

Understanding Early-Stage vs. Late-Stage Colorectal Cancer

The stage of colorectal cancer gives the oncologist more detailed information about the size and spread of the disease. While there are five stages of colorectal cancer, ranging from 0 to IV, you may hear the oncologist refer to it as early-stage or late-stage colorectal cancer.

  • Early-stage colorectal cancer includes stages 0 and I. 
  • Stage II, also referred to as regional cancer, means that cancer has spread into the outer layers of the colon but has not yet reached the lymph nodes or other organs. Stage II is divided into IIa and IIb. Stage IIa is usually considered early-stage. 
  • Stages IIb, III, and IV are considered late-stage colorectal cancer. Patients with recurrent colorectal cancer are usually also considered late-stage.

Treatments for Early-Stage Colorectal Cancer 

As the stage of colorectal cancer progresses, there are more treatments typically required. Surgery for early-stage colorectal cancer gives the best chance for long-term survival. 

Stage 0 Colorectal Cancer Treatment

Stage 0 colorectal cancer means the cancerous cells are confined to the inner lining of the rectum or colon. It is often detected during routine screening tests, such as a colonoscopy. 

If your doctor finds a polyp (a growth of cells) in your colon, they’re likely to remove it and have it tested for cancer. Most polyps are not cancerous. But for those that are, the cancer is usually at a very early stage. Additional surgery may be recommended if the polyp is large to ensure all the cancer cells in the area are removed. They may also go back in to ensure no more polyps remain. For most Stage 0 patients, this is all that’s usually needed, along with regular screening in the future to watch for additional polyp development. 

Stage I Colorectal Cancer Treatment 

Stage I colorectal cancer has grown through the inner lining of the colon or rectum and has moved into the muscular layer. It has not yet spread beyond the colon or to the lymph nodes. If the cancer has not spread outside of the polyp where it started, removing the polyp may be enough. 

On the other hand, if the cancer has grown deeper into the wall of the colon or it is considered high-grade (aggressive), the GI surgeon may perform a partial colectomy, which involves removing a section of the colon to be sure there are no more cells.

For most stage I colorectal cancer patients, surgery is all that’s needed.

As with other cancers, the earlier you detect colorectal cancer, the easier it is to treat. This is why colorectal cancer screening is so important. Learn more about common types of screening for colorectal cancer. 

Treatments for Regional Colorectal Cancer

Stage II colorectal cancer, also known as regional colorectal cancer, means that the cancer has grown through the colon wall and potentially into nearby tissue but not to the lymph nodes. Surgery may be enough for these patients to remove the cancerous cells entirely.  However, patients who are at high risk for recurrence may also need chemotherapy after surgery. 

The risk of recurrence is higher if one or more of the following apply:

  • The cancer has grown through the colon wall or into nearby blood or lymph vessels.
  • The tumor was blocking the colon. 
  • The cancer caused a hole or tear, sometimes called a perforation, in the colon wall.
  • The surgeon did not remove at least 12 lymph nodes.
  • Cancer was found in or near the margin (edge) of the removed tissue, meaning that some cancer may have been left behind.

Treatments for Late-Stage Colorectal Cancer 

Late-stage colorectal cancer includes stages III and IV, as well as recurrent colorectal cancer. The cancer cells have spread to lymph nodes and possibly other organs.

  • Stage III colorectal cancer typically requires surgery followed by chemotherapy. If the tumor can’t be removed entirely with surgery because of its location or the patient’s overall health condition, chemotherapy before surgery is an option to shrink the cancer so that surgery is less invasive. This is called neoadjuvant therapy.
  • Stage IV colorectal cancer may not be operable because it’s moved beyond the colon to areas like the liver or lungs. These patients are likely to receive chemotherapy and possibly radiation therapy in the areas where cancer has developed outside the colon. Targeted therapies are also available to Stage IV and recurrent colorectal cancer patients. 

Using Biomarkers For Late-Stage Colorectal Cancer Treatment

In addition to chemotherapy and radiation therapy, stage IV and recurrent colorectal cancer patients can now be treated with FDA-approved targeted therapies and immunotherapies. Immunotherapy involves boosting the patient's immune system to fight cancer, while targeted therapies focus on genetic mutations that result in an overgrowth of proteins or cells that cause cancer. 

Your oncologist will request biomarker tests on the tumor. The test results will indicate if any gene mutations are present and if they can be treated with a specific targeted therapy or immunotherapy.

When is Radiation Therapy Used for Late-Stage Colon Cancer?

In addition to chemotherapy, those with late-stage colorectal cancer may have radiation therapy as part of their treatment. It can be used to treat tumors that have grown further away from the colon or if the cancer is found in the margins where surgery was performed.

It’s also an option for those who cannot undergo surgery because the cancer has spread too far into the colon or other areas. When treating distant areas where cancer appears, radiation therapy can relieve pain and bleeding in these areas. 

External Beam Radiation Therapy for Late-Stage Colorectal Cancer

When radiation therapy is used for colon cancer, it’s usually external beam radiation therapy. High-intensity radiation beams are aimed directly at the tumor from a machine outside the body called a linear accelerator. The radiation beams precisely target the treatment area. This can be in the colon, rectum, the nearby lymph nodes, or in an area of the body further away from the colon where the cancer has developed. 

Before radiation therapy treatment starts, the radiation oncologist will meet with you to discuss your treatment plan, including how often you need to come in for radiation therapy. For each treatment, images are used to be sure the tumor hasn’t moved or changed. This will ensure the treatment is directed precisely at the tumor, sparing healthy tissue nearby. The actual treatment, once you are carefully placed under the linear accelerator, takes only a few minutes and is painless. 

Most radiation therapy plans deliver treatment five days a week over a few weeks.

What Influences the Colorectal Cancer Treatment Plan?

Your exact treatment plan will vary depending on several factors, including:

  • Your age and overall health condition. Some patients are not able to undergo extensive surgery due to the presence of other conditions.  
  • The specific subtype of colorectal cancer, such as adenocarcinoma, carcinoid, GI stromal tumors, or lymphoma in the colon.
  • The goal of treatment can vary depending on the stage. Late-stage treatment plans are often designed to stop the cancer from continuing to grow and to relieve pain. Early-stage treatment plans are more focused on the complete removal of the cancer and treatments that will help keep it from recurring.
  • The presence of specific gene mutations. Some therapies are available to late-stage colorectal cancer patients.
  • Your personal preferences about treatment. This includes where you receive treatment. 

Individualized Colorectal Cancer Treatment Plans in the Atlanta Area

If radiation therapy is part of your colorectal cancer treatment plan, our oncologists will work with your medical oncologist to guide you through the entire process. You have the option of where you receive radiation. We recommend choosing a convenient location since you will need to go often to receive treatments. 

Our offices are located throughout the Atlanta area, including Blairsville, Conyers, Covington, Decatur, and Snellville, Georgia, allowing you to receive treatment close to home. We are also available to provide second opinions on colorectal cancer radiation treatment plans. Request an appointment at your nearest location for a consultation.

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