Understand your condition when you have a stage III colon cancer

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The meaning and the severity of Stage III should be fully understood by the patient for 2 reasons. First, because ‘it’s not that bad’, in fact 50% of  patients are already cured by surgery alone without doing anything else. Second, because the benefit of preventive chemotherapy is very high : it increases the chances of cure by about 20%.

This means that out of 100 patients with stage III colon cancer

  • 50 get chemotherapy unnecessarily because they’re already cured by surgery alone
  • 30 get it unnecessarily because they will fall back anyway 
  • 20 get  it with great benefit because instead of falling back and going wrong, they will be cured by  chemotherapy.  

Actually the situation is more complex than that. In fact,the chances of cure after surgery alone are not 50% for every patient with stage 3 , but vary from 5% to 80% depending on the size of the removed tumor and on how many local nodes are invaded by the tumor.  Their combinations give the conditions shown in the graph. 

The first set of blue bars describes the chances of cure after surgery , without any preventive therapy. 

The second set of red bars, indicates the increase in the probability of cure thanks to one preventive drug, fluorouracil.

The third set of yellow bars, report the additional benefit of chemotherapy with two drugs (FOLFOX or CAPOX).

It is intuitive that the “price to pay” (i.e. the toxicity and inconveniencies) of the two different therapies is very different. Getting only one drug is relatively simple and not very toxic. Getting two of them is more complex and more toxic. Under certain special conditions of very low risk , it is possible that a patient may even decide not to get preventive chemotherapy , whereas in general , if the risk is high , two drugs are chosen, because of their huge benefit. 

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