Stage IV colorectal cancers have spread outside the colon to other parts of the body, such as the liver or the lungs.  When cancer is “metastatic” this means it has spread.”

Memorial Sloan Kettering Cancer Center

Colorectal Cancer Treatments from stages I to IV.

Stage II colorectal cancer is divided into three subcategories: IIA, IIB and IIC.

The difference between the categories lies in the extent to which the cancer has spread.

  • Stage IIA (T3, N0, M0): The cancer has grown into the outermost layers of the colon or rectum, but has not grown through them. It has not reached nearby organs or lymph nodes, and has not spread to distant organs.
  • Stage IIB (T4a, N0, M0): The cancer has grown through all of the layers of the colon or rectum, but has not grown into other organs or tissues.
  • Stage IIC (T4b, N0, M0): The cancer has grown through all of the layers of the colon or rectum, and has grown into nearby organs or tissues. The cancer has not spread to the lymph nodes Surgery
  • Initial treatment for stage II colon cancer is surgery to remove the section of colon that contains the tumor and surrounding tissue with its blood vessels and lymph nodes.
  • The most commonly recommended protocols for patients diagnosed with stage II colon cancer:


A colectomy (or colon resection) is abdominal surgery that removes the section of colon where the tumor is located, tissue containing blood and lymph vessels surrounding the colon (mesentery), healthy tissue margins on either side and, if possible, at least 12 lymph nodes.  Then the remaining ends of colon are reconnected with sutures or staples.  This connection is called an anastomosis.

There are two types of surgery:

  • Open colectomy:  An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.
  • Laparoscopic colectomy:  Three small keyhole incisions are made in the abdomen to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen.  Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy. This is also known as minimally invasive surgery.If your lymph nodes are cancer-free (also known as node-negative), your diagnosis is stage II colon cancer
  • The tumor, tissue on either side of it (the margins), and fat and lymph nodes attached to the colon are removed for further study by a pathologist.  The pathologist evaluates the cancer cells in the tumor itself, looks for cancer in the margins and other tissue, and studies as many lymph nodes as possible in order to provide an accurate diagnosis.


Treatment of node-negative stage II colon cancer is controversial. While surgery to remove the tumor in the colon is universally accepted as initial treatment, the value of chemotherapy after that surgery to keep cancer from recurring (coming back) is hard for patients and doctors to judge.

It’s estimated that between four and five percent of patients with stage II colon cancer will benefit from chemotherapy. However, there are also side effects, some severe, associated with chemotherapy. Very few patients will die as a result of chemotherapy.

Because of the risks of treatment, researchers are looking for ways to identify patients who are at higher risk for recurrence, who are most likely to benefit from chemotherapy.

Some factors have been identified that lead to higher risk for stage II patients including:

  • T4 tumors that extend beyond the outer wall of the colon into adjacent tissues and organs
  • Too few lymph nodes removed and examined (less than 12)
  • Cancer cells in blood and lymph vessels surrounding the tumor (not the same as lymph nodes)
  • Undifferentiated or poorly differentiated tumors
  • Perforation (a hole) of the colon by the tumor
  • A tumor that obstructs (closes off) the colonFor high-risk stage II patients, the number needed to prevent one recurrence or death is smaller, probably 15 to 30 patients.
  • It may help your decision to think about the problem in terms of numbers:  In order to prevent one recurrence or death from all cases of stage II colon cancer, 25 to 50 patients need to receive chemotherapy. One in six of those patients will have a severe side effect; one in 100 to 200 will die as a result of treatment.

Chemotherapy regimens for high-risk stage II colon cancer:

  • FOLFOX:  combination treatment with infusional 5-FU (fluorouracil), leucovorin, and oxaliplatin
  • FLOX: combination with bolus 5-FU, leucovorin, and oxaliplatin (severe diarrhea is more common with FLOX than FOLFOX but outcomes are similar)
  • Xeloda (capecitabine): oral “prodrug” which is converted to 5-FU in the tumor
  • 5-FU and leucovorinThere are some indicators of a patient’s risk of recurrence of their cancer, but no clear information that higher risk means they may benefit from therapy  — thus there are research efforts underway to better define “risk” and develop treatments that will benefit the higher risk patient in a predictable way.
  • Stage III colorectal cancer treatments:In this article
  • Your doctor can discuss the advantages and disadvantages of the different chemotherapy regimens if you decide to proceed with chemotherapy after your surgery.  Chemotherapy usually lasts about six months.

Stage III Colorectal Cancer Treatments

Stage III colorectal cancers have spread outside the colon to one or more lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection). Tumors within the colon wall, which also involve the lymph nodes are classified as stage IIIA, while tumors that have grown through the colon wall and have spread to one to four lymph nodes are classified as stage IIIB cancers. Those tumors, which have spread to more than four lymph nodes are classified as stage IIIC colon cancers.

Treatment involves:

  • Surgery to remove the tumor and all involved lymph nodes if possible.
  • After surgery, the patient will receive chemotherapy with 5-FU, leucovorin and oxaliplatin, capecitabine with oxaliplatin or capecitabine alone.
  • Radiation may be needed if the tumor is large and invading the tissue surrounding the colon.

The five-year survival rate for stage III colon cancer is about 64%. Patients with one to four positive lymph nodes have a higher survival rate than people with more than five positive lymph nodes.

 Stage IV Colorectal cancer treatments:

Stage IV colorectal cancers have spread outside the colon to other parts of the body, such as the liver or the lungs. Cancer that has spread is also called “metastatic.” The tumor can be any size and may or may not include affected lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

Treatment may include:

  • Removal of the cancer surgically or another surgical procedure to bypass the colon cancer and hook up healthy colon (an anastomosis).
  • Surgery to remove parts of other organs such as the liver, lungs, and ovaries, where the cancer may have spread.
  • Chemotherapy to relieve symptoms and improve survival.
  • Erbitux, Avastin, or Vectibix in combination with standard chemotherapy, depending upon tumor characteristics.
  • Zaltrap is a drug also approved for use with chemotherapy in cases where the cancer has progressed or is resistant to treatment.
  • Stivarga is a targeted therapy approved in patients whose cancer has progressed after previous therapy.
  • Clinical trials of new chemotherapy regimens, or immunological therapy.
  • Radiation to relieve symptoms.

The five-year survival rate for stage IV colon cancer is nearly 8% or less.


“Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancer.  The symptoms at the start of colon cancer are frequently asymtomatic for many.”


Symptoms and Diagnosing of Colon Cancer


Signs and symptoms of colon cancer include:

  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn’t empty completely
  • Weakness or fatigue
  • Unexplained weight loss

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they’ll likely vary, depending on the cancer’s size and location in your large intestine.


Screening for colon cancer

Doctors recommend certain screening tests for healthy people with no signs or symptoms in order to look for early colon cancer. Finding colon cancer at its earliest stage provides the greatest chance for a cure. Screening has been shown to reduce your risk of dying of colon cancer.

 People with an average risk of colon cancer can consider screening beginning at age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner. African-Americans and American Indians may consider beginning colon cancer screening at age 45.

Several screening options exist — each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you. If a colonoscopy is used for screening, polyps can be removed during the procedure before they turn into cancer.

Diagnosing colon cancer

  • Using a scope to examine the inside of your colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis and remove polyps.
  • Blood tests. No blood test can tell you if you have colon cancer. But your doctor may test your blood for clues about your overall health, such as kidney and liver function tests.

    Your doctor may also test your blood for a chemical sometimes produced by colon cancers (carcinoembryonic antigen or CEA). Tracked over time, the level of CEA in your blood may help your doctor understand your prognosis and whether your cancer is responding to treatment.


“To understand colorectal cancer, it helps to understand the parts that make up the colon and rectum. The colon and rectum make up the large intestine (or large bowel), which is part of the digestive system, also called the gastrointestinal (GI) system.”

NIH National Cancer Institute

March is Colorectal Cancer Awareness Month


National Colorectal Cancer Awareness Month

This is held in March each year, offers healthcare providers who care for patients with diseases of the colon and rectum a valuable opportunity to educate their community about these diseases and promote awareness of the importance of colorectal cancer screening, prevention, and treatment. These efforts may also provide a window into the profession and encourage others to consider careers in the field of colon and rectal surgery.

Colorectal cancer is the third most common cancer in the United States and the second leading cause of death from cancer. Colorectal cancer affects people in all racial and ethnic groups and is most often found in people age 50 and older.

The good news? If everyone age 50 and older were screened regularly, 6 out of 10 deaths from colorectal cancer could be prevented. Communities, health professionals, and families can work together to encourage people to get screened.

How can Colorectal Cancer Awareness Month make a difference?

We can use this month to raise awareness about colorectal cancer and take action toward prevention. Communities, organizations, families, and individuals can get involved and spread the word.

Here are just a few ideas:

  • Encourage families to get active together – exercise may help reduce the risk of colorectal cancer.
  • Talk to family, friends, and people in your community about the importance of getting screened for colorectal cancer starting at age 50.
  • Encourage people over 50 to use this interactive tool to decide which colorectal cancer screening test they prefer.
  • Ask doctors and nurses to talk to patients age 50 and older about the importance of getting screened

Among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans get colorectal cancer, and more than 50,000 people die from it.

  • Risk increases with age. More than 90% of colorectal cancers occur in people aged 50 and older.
  • Precancerous polyps and colorectal cancer don’t always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it. That is why having a screening test is so important. If you have symptoms, they may include—
    • Blood in or on the stool (bowel movement).
    • Stomach pain, aches, or cramps that do not go away.
    • Losing weight and you don’t know why.

    These symptoms may be caused by something other than cancer. If you have any of them, see your doctor.

  • There are several screening test options. Talk with your doctor about which is right for you.



“Dealing with a hangover and searching for a cure can be pretty depressing. But that doesn’t mean nothing works.”

Kevin Loria (Business Insider)

Dealing with the St. Patrick’s Day Hangover!

Dr. Hensrud adds that, as we age, we get dehydrated more. Our liver doesn’t work as efficiently, and our bodies don’t fight inflammation as well so it takes longer to recover.

Speaking of recovering, are there really any proven ways to get rid of a hangover?

According to Healthline.com, it is recommended to drink a glass of water after every drink to stay hydrated. If it’s too late for that, drink plenty of water the next day.

What about having a drink in the morning? Healthline says it’s largely a myth, but there is some evidence to support having a drink can lessen hangover symptoms.

The best thing to do? Sleep, and once you sleep, get up and eat a hearty breakfast. It boosts your blood sugar levels and makes you feel better.

That’s verified.

1. Drink water between every alcoholic drink you consume. The water will keep you hydrated since alcohol tends to dehydrate us. It will also help to flush the alcohol out of your system.

2. Do not opt for the “hair of the dog” that bit you the next day! That’s the old belief that if you have a little bit of alcohol the next morning that it will act as a cure for your hangover.

After all, that IS what Sunday brunches are built on, right? Well, new evidence from a study suggests recently that this is not the way to cure a hangover and it actually can just prolong the onset of that “crappy feeling.”

3. Be mindful about what you drink! Darker liquor tends to give you the worst hangovers. Stick with vodka and stay away from any mixed drink that is full of sugar as that too can just make you feel worse tomorrow morning.

4. Eat a big meal! If you’re hitting up an Irish Pub for some Guinness today order some Shephard’s Pie with it. All those carbs will help prevent being hungover and read meat is full of amino acids which can also aid in preventing tomorrow’s possible doom!

5. Just limit how much you drink or don’t drink at all! Just because it’s one of the biggest drinking holidays of the year doesn’t mean you have to go crazy or even participate for that matter. Sometimes it’s the best to be the only sober one in a bar full of crazy drunks.

Of course, whatever you do this St. Patrick’s Day, make sure you drink responsibly. Never drink and drive.