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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65880_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65880_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65880_"><span class="title" itemprop="name">Colon Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: March 21, 2016.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062954__289">This PDQ cancer information summary has current information about the treatment of colon cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062954__290">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062954__93"><h2 id="_CDR0000062954__93_">General Information About Colon Cancer </h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062954__94">Colon cancer is a disease in which malignant (cancer) cells
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form in the tissues of the colon.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__97">Health history can affect the risk of developing colon
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cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__101">Signs of colon cancer include blood in the stool or a change in bowel habits.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__105">Tests that examine the colon and rectum are
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used to detect (find) and diagnose colon cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__109">Certain factors affect prognosis
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(chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062954__94"><h3>Colon cancer is a disease in which malignant (cancer) cells
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form in the tissues of the colon.</h3><p id="CDR0000062954__96">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> is part of the
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body’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046446/" class="def">digestive system</a>. The
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digestive system removes and processes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">minerals</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285960/" class="def">carbohydrates</a>, fats, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, and water) from foods and helps pass waste
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material out of the body. The digestive system is made up of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, and the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045097/" class="def">large
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intestines</a>. The colon (large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a>) is the first part of the large intestine and is about 5 feet long. Together, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044185/" class="def">anal</a> canal make up the last part of the large intestine and are about 6-8 inches long. The anal
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canal ends at the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> (the opening
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of the large intestine to the outside of the body).<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954212" co-legend-rid="figlgndCDR0000062954212"><a href="/books/NBK65880.2/figure/CDR0000062954__212/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954212" rid-ob="figobCDR0000062954212"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415499.gif" src-large="/books/NBK65880.2/bin/CDR0000415499.jpg" alt="Anatomy of the lower digestive system, showing the colon and other organs" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954212"><h4 id="CDR0000062954__212"><a href="/books/NBK65880.2/figure/CDR0000062954__212/?report=objectonly" target="object" rid-ob="figobCDR0000062954212">Figure</a></h4><p class="float-caption no_bottom_margin">Anatomy of the lower digestive system, showing the colon and other organs. </p></div></div></p><p id="CDR0000062954__270"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044998/" class="def">Gastrointestinal stromal tumors</a> can occur in the colon. See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000658500/">Gastrointestinal Stromal Tumors Treatment</a> for more information. </p><p id="CDR0000062954__272">See the PDQ summary about <a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__122">Unusual Cancers of Childhood Treatment</a> for information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444983/" class="def">colorectal cancer</a> in children.</p></div><div id="CDR0000062954__97"><h3>Health history can affect the risk of developing colon
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cancer.</h3><p id="CDR0000062954__99">Anything that increases your chance of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors include the following:</p><ul id="CDR0000062954__100"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of cancer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>.</div></li><li class="half_rhythm"><div>Certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045983/" class="def">hereditary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045100/" class="def">familial adenomatous polyposis</a> and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044884/" class="def">hereditary nonpolyposis colon
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cancer</a> (HNPCC; Lynch Syndrome).</div></li><li class="half_rhythm"><div>A history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045493/" class="def">ulcerative
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colitis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390317/" class="def">ulcers</a> in the lining of the large
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intestine) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045661/" class="def">Crohn disease</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of cancer of the colon, rectum,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046108/" class="def">endometrium</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a>.</div></li><li class="half_rhythm"><div>A personal history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyps</a> (small areas of bulging <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>) in the
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colon or rectum.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954213" co-legend-rid="figlgndCDR0000062954213"><a href="/books/NBK65880.2/figure/CDR0000062954__213/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954213" rid-ob="figobCDR0000062954213"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415500.gif" src-large="/books/NBK65880.2/bin/CDR0000415500.jpg" alt="Polyps in the colon" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954213"><h4 id="CDR0000062954__213"><a href="/books/NBK65880.2/figure/CDR0000062954__213/?report=objectonly" target="object" rid-ob="figobCDR0000062954213">Figure</a></h4><p class="float-caption no_bottom_margin">Polyps in the colon. Some polyps have a stalk and others do not. Inset shows a photo of a polyp with a stalk. </p></div></div></div></li></ul></div><div id="CDR0000062954__101"><h3>Signs of colon cancer include blood in the stool or a change in bowel habits.</h3><p id="CDR0000062954__103">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by colon cancer or by other conditions. Check with your doctor if you have any of the following:</p><ul id="CDR0000062954__104"><li class="half_rhythm"><div>A change in bowel
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habits.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a> (either bright red or very dark) in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>, or feeling that the bowel does not
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empty all the way.</div></li><li class="half_rhythm"><div>Stools that are narrower than usual.</div></li><li class="half_rhythm"><div>Frequent gas pains, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476585/" class="def">bloating</a>,
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fullness, or cramps.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">Vomiting</a>.</div></li></ul></div><div id="CDR0000062954__105"><h3>Tests that examine the colon and rectum are
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used to detect (find) and diagnose colon cancer.</h3><p id="CDR0000062954__107">The following tests and procedures may be used:</p><ul id="CDR0000062954__108"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal exam</a></b>: An exam of the rectum. The doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> inserts a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046302/" class="def">lubricated</a>, gloved finger into the rectum to feel for lumps or anything else that seems unusual.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045050/" class="def">Fecal occult
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blood test</a></b>: A test to check stool (solid waste) for blood that can only be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing. <div id="CDR0000062954__214" class="figure bk_fig"><div class="graphic"><img src="/books/NBK65880.2/bin/CDR0000415502.jpg" alt="Fecal Occult Blood Test (FOBT) kit; shows card, applicator, and return envelope." /></div><div class="caption"><p>Fecal Occult Blood Test (FOBT) kit to check for blood in stool.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046513/" class="def">Barium
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enema</a></b>: A series of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> of the lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a>. A liquid that contains barium (a silver-white <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463718/" class="def">metallic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000422394/" class="def">compound</a>) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954215" co-legend-rid="figlgndCDR0000062954215"><a href="/books/NBK65880.2/figure/CDR0000062954__215/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954215" rid-ob="figobCDR0000062954215"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415505.gif" src-large="/books/NBK65880.2/bin/CDR0000415505.jpg" alt="Barium enema procedure" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954215"><h4 id="CDR0000062954__215"><a href="/books/NBK65880.2/figure/CDR0000062954__215/?report=objectonly" target="object" rid-ob="figobCDR0000062954215">Figure</a></h4><p class="float-caption no_bottom_margin">Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas. </p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045880/" class="def">Sigmoidoscopy</a></b>: A procedure to look inside the rectum and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357588/" class="def">sigmoid (lower) colon</a> for polyps (small areas of bulging tissue), other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas, or cancer. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046680/" class="def">sigmoidoscope</a> is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954216" co-legend-rid="figlgndCDR0000062954216"><a href="/books/NBK65880.2/figure/CDR0000062954__216/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954216" rid-ob="figobCDR0000062954216"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415503.gif" src-large="/books/NBK65880.2/bin/CDR0000415503.jpg" alt="Sigmoidoscopy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954216"><h4 id="CDR0000062954__216"><a href="/books/NBK65880.2/figure/CDR0000062954__216/?report=objectonly" target="object" rid-ob="figobCDR0000062954216">Figure</a></h4><p class="float-caption no_bottom_margin">Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas. </p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045648/" class="def">Colonoscopy</a></b>: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046463/" class="def">colonoscope</a> is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954217" co-legend-rid="figlgndCDR0000062954217"><a href="/books/NBK65880.2/figure/CDR0000062954__217/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954217" rid-ob="figobCDR0000062954217"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415504.gif" src-large="/books/NBK65880.2/bin/CDR0000415504.jpg" alt="Colonoscopy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954217"><h4 id="CDR0000062954__217"><a href="/books/NBK65880.2/figure/CDR0000062954__217/?report=objectonly" target="object" rid-ob="figobCDR0000062954217">Figure</a></h4><p class="float-caption no_bottom_margin">Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas. </p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044973/" class="def">Virtual colonoscopy</a></b>: A procedure that uses a series of x-rays called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045560/" class="def">computed tomography</a> to make a series of pictures of the
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colon. A computer puts the pictures together to create detailed images that may
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show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or tissues so they can be viewed under a microscope by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer.</div></li></ul></div><div id="CDR0000062954__109"><h3>Certain factors affect prognosis
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(chance of recovery) and treatment options.</h3><p id="CDR0000062954__188">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>
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(chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000062954__189"><li class="half_rhythm"><div>The
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer (whether the
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cancer is in the inner lining of the colon only or has spread through the colon wall, or has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or other
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places in the body).</div></li><li class="half_rhythm"><div>Whether the cancer has blocked or made a hole in the colon.</div></li><li class="half_rhythm"><div>Whether there are any cancer cells left after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div>Whether the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>. </div></li><li class="half_rhythm"><div>The patient’s general health.</div></li></ul><p id="CDR0000062954__273">The prognosis also depends on the blood levels of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046474/" class="def">carcinoembryonic antigen</a> (CEA) before treatment begins. CEA is a substance in the blood that may be increased when cancer is present. </p></div></div><div id="CDR0000062954__112"><h2 id="_CDR0000062954__112_">Stages of Colon Cancer</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062954__113">After colon cancer has been diagnosed, tests are done
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to find out if cancer cells have spread within the colon or to other parts of
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the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__227">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__286">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__116">The following stages are used for colon cancer:</a></div></li></ul></div><div id="CDR0000062954__113"><h3>After colon cancer has been diagnosed, tests are done
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to find out if cancer cells have spread within the colon or to other parts of
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the body.</h3><p id="CDR0000062954__115">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> or to other parts of the body
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is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045669/" class="def">disease</a>. It is important
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to know the stage in
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order to plan treatment. </p><p id="CDR0000062954__274">The following tests and procedures may be used in the staging process:</p><ul id="CDR0000062954__192"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or chest, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the colon. A substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597153/" class="def">gadolinium</a> is injected into the patient through a vein. The gadolinium collects around the cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> cells in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a></b>: A procedure to remove the tumor and see how far it has spread through the colon.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph node</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a></b>: The removal of all or part of a lymph node. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">Complete blood
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count</a> (CBC)</b>: A procedure in which a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> is drawn and
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checked for the following:
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<dl id="CDR0000062954__24" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in
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the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood
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cells.</p></dd></dl></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046475/" class="def">Carcinoembryonic antigen (CEA) assay</a></b>: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">sign</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon cancer</a> or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>.</div></li></ul></div><div id="CDR0000062954__227"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062954__227_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062954__227_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062954__286"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000062954__286_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062954__286_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062954__288">The metastatic tumor is the same type of cancer as the primary tumor. For example, if colon cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually colon cancer cells. The disease is metastatic colon cancer, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung cancer</a>.</p></div><div id="CDR0000062954__116"><h3>The following stages are used for colon cancer:</h3><div id="CDR0000062954__118"><h4>Stage 0 (Carcinoma in Situ)</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954259" co-legend-rid="figlgndCDR0000062954259"><a href="/books/NBK65880.2/figure/CDR0000062954__259/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954259" rid-ob="figobCDR0000062954259"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688354.gif" src-large="/books/NBK65880.2/bin/CDR0000688354.jpg" alt="Stage 0 (colon carcinoma in situ)" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954259"><h4 id="CDR0000062954__259"><a href="/books/NBK65880.2/figure/CDR0000062954__259/?report=objectonly" target="object" rid-ob="figobCDR0000062954259">Figure</a></h4><p class="float-caption no_bottom_margin">Stage 0 (colon carcinoma in situ). Abnormal cells are shown in the mucosa of the colon wall. </p></div></div><p id="CDR0000062954__120">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352147/" class="def">stage 0</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall. These abnormal cells may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread. Stage 0 is also called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046488/" class="def">carcinoma
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in situ</a>.</p></div><div id="CDR0000062954__121"><h4><div class="milestone-start" id="CDR0000062954__122"></div>Stage I<div class="milestone-end"></div></h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954260" co-legend-rid="figlgndCDR0000062954260"><a href="/books/NBK65880.2/figure/CDR0000062954__260/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954260" rid-ob="figobCDR0000062954260"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688427.gif" src-large="/books/NBK65880.2/bin/CDR0000688427.jpg" alt="Stage I colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954260"><h4 id="CDR0000062954__260"><a href="/books/NBK65880.2/figure/CDR0000062954__260/?report=objectonly" target="object" rid-ob="figobCDR0000062954260">Figure</a></h4><p class="float-caption no_bottom_margin">Stage I colon cancer. Cancer has spread from the mucosa of the colon wall to the muscle layer. </p></div></div><p id="CDR0000062954__248">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045890/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall and has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> under the mucosa). Cancer may have spread to the muscle layer of the colon wall.</p></div><div id="CDR0000062954__124"><h4>Stage II</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954261" co-legend-rid="figlgndCDR0000062954261"><a href="/books/NBK65880.2/figure/CDR0000062954__261/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954261" rid-ob="figobCDR0000062954261"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688428.gif" src-large="/books/NBK65880.2/bin/CDR0000688428.jpg" alt="Stage II colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954261"><h4 id="CDR0000062954__261"><a href="/books/NBK65880.2/figure/CDR0000062954__261/?report=objectonly" target="object" rid-ob="figobCDR0000062954261">Figure</a></h4><p class="float-caption no_bottom_margin">Stage II colon cancer. In stage IIA, cancer has spread through the muscle layer of the colon wall to the serosa. In stage IIB, cancer has spread through the serosa but has not spread to nearby organs. In stage IIC, cancer has spread through the serosa <a href="/books/NBK65880.2/figure/CDR0000062954__261/?report=objectonly" target="object" rid-ob="figobCDR0000062954261">(more...)</a></p></div></div><p id="CDR0000062954__193"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045891/" class="def">Stage II colon cancer</a> is divided into stage IIA, stage IIB, and stage IIC. </p><ul id="CDR0000062954__249"><li class="half_rhythm"><div>Stage IIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread through the muscle layer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the colon wall. </div></li><li class="half_rhythm"><div>Stage IIB: Cancer has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall but has not spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. </div></li><li class="half_rhythm"><div>Stage IIC: Cancer has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. </div></li></ul></div><div id="CDR0000062954__127"><h4>Stage III</h4><p id="CDR0000062954__197"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">Stage III colon cancer</a> is divided into stage IIIA, stage IIIB, and stage IIIC.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954262" co-legend-rid="figlgndCDR0000062954262"><a href="/books/NBK65880.2/figure/CDR0000062954__262/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954262" rid-ob="figobCDR0000062954262"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688429.gif" src-large="/books/NBK65880.2/bin/CDR0000688429.jpg" alt="Stage IIIA colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954262"><h4 id="CDR0000062954__262"><a href="/books/NBK65880.2/figure/CDR0000062954__262/?report=objectonly" target="object" rid-ob="figobCDR0000062954262">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IIIA colon cancer. Cancer has spread through the mucosa of the colon wall to the submucosa and may have spread to the muscle layer, and has spread to one to three nearby lymph nodes or tissues near the lymph nodes. OR, cancer has spread through <a href="/books/NBK65880.2/figure/CDR0000062954__262/?report=objectonly" target="object" rid-ob="figobCDR0000062954262">(more...)</a></p></div></div><p id="CDR0000062954__238">In stage IIIA:</p><ul id="CDR0000062954__250"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> under the mucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to at least one but not more than 3 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in tissues near the lymph nodes; or</div></li><li class="half_rhythm"><div>Cancer has spread through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue under the mucosa). Cancer has spread to at least 4 but not more than 6 nearby lymph nodes. </div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954263" co-legend-rid="figlgndCDR0000062954263"><a href="/books/NBK65880.2/figure/CDR0000062954__263/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954263" rid-ob="figobCDR0000062954263"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688430.gif" src-large="/books/NBK65880.2/bin/CDR0000688430.jpg" alt="Stage IIIB colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954263"><h4 id="CDR0000062954__263"><a href="/books/NBK65880.2/figure/CDR0000062954__263/?report=objectonly" target="object" rid-ob="figobCDR0000062954263">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IIIB colon cancer. Cancer has spread through the muscle layer of the colon wall to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to one to three nearby lymph nodes or to tissues near the lymph nodes. OR, <a href="/books/NBK65880.2/figure/CDR0000062954__263/?report=objectonly" target="object" rid-ob="figobCDR0000062954263">(more...)</a></p></div></div><p id="CDR0000062954__241">In stage IIIB:</p><ul id="CDR0000062954__251"><li class="half_rhythm"><div>Cancer has spread through the muscle layer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the colon wall or has spread through the serosa but not to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. Cancer has spread to at least one but not more than 3 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> near the lymph nodes; or</div></li><li class="half_rhythm"><div>Cancer has spread to the muscle layer of the colon wall or to the serosa (outermost layer) of the colon wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or</div></li><li class="half_rhythm"><div>Cancer has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the colon wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of tissue under the mucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to 7 or more nearby lymph nodes.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954264" co-legend-rid="figlgndCDR0000062954264"><a href="/books/NBK65880.2/figure/CDR0000062954__264/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954264" rid-ob="figobCDR0000062954264"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688436.gif" src-large="/books/NBK65880.2/bin/CDR0000688436.jpg" alt="Stage IIIC colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954264"><h4 id="CDR0000062954__264"><a href="/books/NBK65880.2/figure/CDR0000062954__264/?report=objectonly" target="object" rid-ob="figobCDR0000062954264">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IIIC colon cancer. Cancer has spread through the serosa of the colon wall but not to nearby organs; cancer has spread to four to six nearby lymph nodes. OR, cancer has spread through the muscle layer to the serosa or has spread through the serosa <a href="/books/NBK65880.2/figure/CDR0000062954__264/?report=objectonly" target="object" rid-ob="figobCDR0000062954264">(more...)</a></p></div></div><p id="CDR0000062954__243">In stage IIIC:</p><ul id="CDR0000062954__252"><li class="half_rhythm"><div>Cancer has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall but has not spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. Cancer has spread to at least 4 but not more than 6 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or</div></li><li class="half_rhythm"><div>Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or</div></li><li class="half_rhythm"><div>Cancer has spread through the serosa (outermost layer) of the colon wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> near the lymph nodes. </div></li></ul></div><div id="CDR0000062954__130"><h4>Stage IV</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954265" co-legend-rid="figlgndCDR0000062954265"><a href="/books/NBK65880.2/figure/CDR0000062954__265/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954265" rid-ob="figobCDR0000062954265"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000688442.gif" src-large="/books/NBK65880.2/bin/CDR0000688442.jpg" alt="Stage IV colon cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954265"><h4 id="CDR0000062954__265"><a href="/books/NBK65880.2/figure/CDR0000062954__265/?report=objectonly" target="object" rid-ob="figobCDR0000062954265">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IV colon cancer. The cancer has spread through the blood and lymph nodes to other parts of the body, such as the lung, liver, abdominal wall, or ovary. </p></div></div><p id="CDR0000062954__245"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045893/" class="def">Stage IV colon cancer</a> is divided into stage IVA and stage IVB.</p><ul id="CDR0000062954__246"><li class="half_rhythm"><div>Stage IVA: Cancer may have spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall and may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer has spread to one organ that is not near the colon, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, or to a distant lymph node.</div></li><li class="half_rhythm"><div>Stage IVB: Cancer may have spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> wall and may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer has spread to more than one organ that is not near the colon or into the lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall.</div></li></ul></div></div></div><div id="CDR0000062954__133"><h2 id="_CDR0000062954__133_">Recurrent Colon Cancer</h2><p id="CDR0000062954__134"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon cancer</a> is
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after it has been treated. The
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cancer may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> or in other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, or both.</p></div><div id="CDR0000062954__135"><h2 id="_CDR0000062954__135_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062954__136">There are different types of treatment for patients with colon
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cancer. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__140">Six types of standard treatment are used:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__155">New types of treatment are being tested in clinical trials.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__229">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__231">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062954__233">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062954__136"><h3>There are different types of treatment for patients with colon
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cancer. </h3><p id="CDR0000062954__138">Different types of treatment are available for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon
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cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some
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are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help
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improve current treatments or obtain information on new treatments for patients
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. </p></div><div id="CDR0000062954__140"><h3>Six types of standard treatment are used:</h3><div id="CDR0000062954__142"><h4>Surgery</h4><p id="CDR0000062954__144"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (removing the cancer
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in an operation) is the most common treatment for all
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a> of colon cancer. A doctor may
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remove the cancer using one of the following types of surgery:</p><ul id="CDR0000062954__145"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a>: If the
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cancer is found at a very early stage, the doctor may remove it without cutting
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through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall. Instead,
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the doctor may put a tube with a cutting tool through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> and cut the cancer out. This
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is called a local excision. If the cancer is found in a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyp</a> (a small bulging area of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>), the operation is called a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270865/" class="def">polypectomy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> of the colon with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a>: If the cancer is
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larger, the doctor will perform a partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045647/" class="def">colectomy</a> (removing the cancer and a small amount
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of healthy tissue around it). The
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doctor may then perform an anastomosis (sewing the healthy parts of the colon
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together). The doctor will also usually remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> near the colon and examine them under
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a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to see whether they contain cancer.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954219" co-legend-rid="figlgndCDR0000062954219"><a href="/books/NBK65880.2/figure/CDR0000062954__219/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954219" rid-ob="figobCDR0000062954219"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415507.gif" src-large="/books/NBK65880.2/bin/CDR0000415507.jpg" alt="Resection of the colon with anastomosis" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954219"><h4 id="CDR0000062954__219"><a href="/books/NBK65880.2/figure/CDR0000062954__219/?report=objectonly" target="object" rid-ob="figobCDR0000062954219">Figure</a></h4><p class="float-caption no_bottom_margin">Resection of the colon with anastomosis. Part of the colon containing the cancer and nearby healthy tissue is removed, and then the cut ends of the colon are joined. </p></div></div></div></li><li class="half_rhythm"><div>Resection of the colon with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046464/" class="def">colostomy</a>: If the doctor is not
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able to sew the 2 ends of the colon back together, a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045104/" class="def">stoma</a> (an opening) is made on the
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outside of the body for waste to pass through. This procedure is called a
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colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is
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needed only until the lower colon has healed, and then it can be reversed. If
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the doctor needs to remove the entire lower colon, however, the colostomy may
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be permanent. <div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062954220" co-legend-rid="figlgndCDR0000062954220"><a href="/books/NBK65880.2/figure/CDR0000062954__220/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062954220" rid-ob="figobCDR0000062954220"><img class="small-thumb" src="/books/NBK65880.2/bin/CDR0000415506.gif" src-large="/books/NBK65880.2/bin/CDR0000415506.jpg" alt="Colon cancer surgery with colostomy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062954220"><h4 id="CDR0000062954__220"><a href="/books/NBK65880.2/figure/CDR0000062954__220/?report=objectonly" target="object" rid-ob="figobCDR0000062954220">Figure</a></h4><p class="float-caption no_bottom_margin">Colon cancer surgery with colostomy. Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma. </p></div></div></div></li></ul><p id="CDR0000062954__146">Even if the doctor removes all the cancer that can be seen at the
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time of the operation, some patients may be given <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> after surgery to kill any cancer cells
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that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant
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therapy</a>.</p></div><div id="CDR0000062954__275"><h4>Radiofrequency ablation</h4><p id="CDR0000062954__277"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044865/" class="def"> Radiofrequency ablation</a> is the use of a special probe with tiny <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454755/" class="def">electrodes</a> that kill cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. Sometimes the probe is inserted directly through the skin and only <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044523/" class="def">local anesthesia</a> is needed. In other cases, the probe is inserted through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. This is done in the hospital with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044561/" class="def">general anesthesia</a>.</p></div><div id="CDR0000062954__278"><h4>Cryosurgery</h4><p id="CDR0000062954__280"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">Cryosurgery</a> is a treatment that uses an instrument to freeze and destroy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> tissue. This type of treatment is also called cryotherapy.</p></div><div id="CDR0000062954__147"><h4>Chemotherapy</h4><p id="CDR0000062954__149">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the abdomen, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). </p><p id="CDR0000062954__203"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> may be used to treat cancer that has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>. This involves blocking the hepatic artery (the main <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">artery</a> that supplies <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044564/" class="def">hepatic portal vein</a>, which carries blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>.</p><p id="CDR0000062954__207">The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p><p id="CDR0000062954__266">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#dal1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a> for more information.</p></div><div id="CDR0000062954__150"><h4>Radiation therapy</h4><p id="CDR0000062954__152">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation</a> therapy uses a machine outside the body to send radiation toward the cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation</a> therapy uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.</p></div><div id="CDR0000062954__253"><h4>Targeted therapy</h4><p id="CDR0000062954__255"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. </p><p id="CDR0000062954__271">Types of targeted therapies used in the treatment of colon cancer include the following:</p><ul id="CDR0000062954__281"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibodies</a>: Monoclonal antibodies are made in the laboratory from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">Angiogenesis inhibitors</a>: Angiogenesis inhibitors stop the growth of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> need to grow. </div></li></ul><p id="CDR0000062954__267">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#dal1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a> for more information.</p></div></div><div id="CDR0000062954__155"><h3>New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000062954__226">Information about clinical trials is available from the
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<a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062954__229"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062954__229_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062954__229_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000062954__229_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000062954__231"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062954__231_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062954__231_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000062954__233"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062954__233_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062954__233_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000062954__162"><h2 id="_CDR0000062954__162_">Treatment Options for Colon Cancer</h2><div id="CDR0000062954__163"><h3>Stage 0 (Carcinoma in Situ)</h3><p id="CDR0000062954__164">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352147/" class="def">stage 0</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046488/" class="def">carcinoma in
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situ</a>) may include the following types of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>:</p><ul id="CDR0000062954__165"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a> or simple
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270865/" class="def">polypectomy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a>. This is done when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is
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too large to remove by local excision.</div></li></ul><p id="CDR0000062954__TrialSearch_163_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=42420&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage 0 colon cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062954__166"><h3>Stage I Colon Cancer</h3><p id="CDR0000062954__167">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045890/" class="def">stage I colon
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cancer</a>usually includes the following:</p><ul id="CDR0000062954__283"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a>.</div></li></ul><p id="CDR0000062954__TrialSearch_166_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43664&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage I colon cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062954__169"><h3>Stage II Colon Cancer</h3><p id="CDR0000062954__170">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045891/" class="def">stage II colon
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cancer</a> may include the following:</p><ul id="CDR0000062954__171"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a>.</div></li></ul><p id="CDR0000062954__TrialSearch_169_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=37761&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage II colon cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062954__173"><h3>Stage III Colon Cancer</h3><p id="CDR0000062954__174">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">stage III colon
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cancer</a> may include the following:</p><ul id="CDR0000062954__175"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a> which may be followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">Clinical trials</a> of new chemotherapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li></ul><p id="CDR0000062954__TrialSearch_173_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38379&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage III colon cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062954__177"><h3>Stage IV and Recurrent Colon Cancer</h3><p id="CDR0000062954__178">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045893/" class="def">stage IV</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon
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cancer</a> may include the following:</p><ul id="CDR0000062954__284"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> that have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove parts of other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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may have recurred or spread. Treatment of cancer that has spread to the liver may also include the following:<dl id="CDR0000062954__285" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> given before surgery to shrink the tumor, after surgery, or both before and after. </p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044865/" class="def">Radiofrequency ablation</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">cryosurgery</a>, for patients who cannot have surgery.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a>.</p></dd></dl></div></li></ul><ul id="CDR0000062954__179"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may be offered to some patients as
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div>Chemotherapy and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> or an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitor</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">Clinical trials</a> of chemotherapy and/or targeted therapy.</div></li></ul><p id="CDR0000062954__TrialSearch_177_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38760&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IV colon cancer</a> and <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43425&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent colon cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062954__221"><h2 id="_CDR0000062954__221_">To Learn More About Colon Cancer</h2><p id="CDR0000062954__222">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about colon cancer, see the following:</p><ul id="CDR0000062954__223"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Colorectal Cancer Home Page</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258007/">Colorectal Cancer Prevention</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258008/">Colorectal Cancer Screening</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/colorectal/screening-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Tests to Detect Colorectal Cancer and Polyps</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__122">Unusual Cancers of Childhood Treatment</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cryosurgery in Cancer Treatment</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#dal1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Genetic Testing for Hereditary Cancer Syndromes</a></div></li></ul><p id="CDR0000062954__221_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000062954__221_41"><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062954__AboutThis_1"><h2 id="_CDR0000062954__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062954__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062954__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062954__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062954__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062954__AboutThis_6">This PDQ cancer information summary has current information about the treatment of colon cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062954__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062954__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000062954__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062954__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062954__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062954__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062954__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062954__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062954__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062954__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Colon Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389319]</p><p id="CDR0000062954__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000062954__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062954__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062954__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062954__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65880</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389319" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389319</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65880.2/?report=reader">PubReader</a></li><li><a href="/books/NBK65880.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65880" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65880" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Colon Cancer Treatment (PDQ®): Patient Version. 2016 Mar 21. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65880.21/">NBK65880.21</a></span> September 13, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65880.20/">NBK65880.20</a></span> April 30, 2024</li><li><span class="bk_col_itm"><a 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Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062954__93" ref="log$=inpage&link_id=inpage">General Information About Colon Cancer </a></li><li><a href="#CDR0000062954__112" ref="log$=inpage&link_id=inpage">Stages of Colon Cancer</a></li><li><a href="#CDR0000062954__133" ref="log$=inpage&link_id=inpage">Recurrent Colon Cancer</a></li><li><a href="#CDR0000062954__135" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062954__162" ref="log$=inpage&link_id=inpage">Treatment Options for Colon Cancer</a></li><li><a href="#CDR0000062954__221" ref="log$=inpage&link_id=inpage">To Learn More About Colon Cancer</a></li><li><a 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