Understand your condition when you have colon cancer

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The patient with colon cancer wants to know how 2 things: severe it is and what can be done . The histology report and the CT scan help to define the severity because the histology report gives the local spread of the disease and the CT scan allows to see if other organs of the body are invaded by the tumor.

If the CT scan shows invasion of  other organs , we speak of stage IV which is the most severe condition. In fact  chemotherapy and biologics can control the disease  for long periods of time, but  cure is  rarely possible.  

If the CT scan shows no spread to other organs,  the patient is usually operated and the histology report tells us if the tumor  has already invaded  the local lymph nodes  or not. If invaded , we speak of  Stage 3, which means a 50 percent chance of cure with surgery alone. This leaves a  a 50 % chance of falling back and going wrong. Therefore, preventive chemotherapy is indicated in stage III, because it generally increases the chances of cure by 20%. And it is really a rare event that a patient refuses such a huge benefit.

If the CT scan is negative and the local lymph nodes are not invaded with cancer, we look again at the histology report to see if the tumor is large or small.

If the tumor is large, indicated by the abbreviations T3 or T4 , we speak of stage II with high chances of cure with surgery alone, in the range of 70-80%. Here, preventive chemotherapy increases the chances of cure by only 1-5 %. Therefore each patient should be given the opportunity to express his or her preference about doing or not doing preventive chemotherapy. 

If the tumor is small, indicated by the abbreviations T1  or T2 we speak of  stage 1 and the chances of cure are 95% , not needing  preventive therapy after surgery.

Therefore, we proceed by exclusion: first the presence of metastases with CT scans is excluded, then the presence of tumor in the local nodes is excluded and finally the size of the tumor is evaluated. 

As a general comment, in the last 5 years there has been only modest progress in the treatment of colon cancer except for a small proportion of tumors, around 4%, with particular characteristics that benefit enormously from immunotherapy (the “MSI” cases).