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Cancer is the biggest menace humans have to encounter at this point in time. It is an issue that afflicts thousands of people worldwide and to this day this is no particular cure for this epidemic affliction. It’s an ugly disease that makes people suffer, drains every resource they own and puts a humongous strain not only on the patient, but also on everyone surrounding them, and interpersonal relationships. Cancer is a disease that progresses in stages and that is why it is important to get checked regularly. In case you are unfortunate enough to have been diagnosed with colorectal cancer, or colon cancer, as it is commonly known, here is a quick guide to the different stages and how to proceed.
Stage Zero: It is also called carcinoma in situ. This is the earliest stage where the cancerous cells have not spread beyond the inner lining of the rectum or colon.
What to do: Stage zero colon cancer means that it hasn’t spread beyond the colon to other organs or areas so it only just requires surgery to remove the cancerous cells. This is called local excision performed using a colonoscope.
Stage One: This stage is where cancer has spread further into the lining of the colon but has not reached the outside walls of the colon or any other area for that matter.
What to do: If the cancer was removed at stage zero as a unit (the polyp) and nothing was left behind then nothing further needs doing. Although if the polyp is “high grade” then more surgery will be required, additionally if some get left behind after the first surgery then more will be required. Cancers that have developed otherwise require removing of a part of the colon, a partial colectomy. Colectomy can be done by conventional open surgery or by laparoscopic surgery.
Stage Two: The stage where cancer has advanced through the lining into growing over the walls of the colon but has not proceeded towards the lymph nodes.
What to do: Requires surgery, partial colectomy along with removing some of the surrounding lymph nodes. Chemotherapy post-surgery may be suggested by your doctor. Discuss before you agree to it. Colectomy can be done by conventional open surgery or by laparoscopic surgery.
Stage Three: Cancer has spread beyond the wall of the colon and reached the surrounding lymph nodes. It has not yet spread to other areas of the body or organs.
What to do: Partial colectomy including post-surgery chemotherapy but if the patient is not strong enough for surgery they are suggested chemotherapy or radiation therapy as an alternative. Surgery is the primary modality of treatment. However these patients will require additional treatment in the form of chemotherapy or radiation. Patients with rectal cancer may be advised Pre-operative chemotherapy & radiotherapy followed by surgery
Stage Four: Cancer has spread widely to several organs, to the liver, lungs, and even to the brain.
What to do: Surgery will not do much good, unless it can be used to remove the specific areas where the cancer is clustered. Mostly it is suggested to alleviate the pain but there is a chance that surgery might cure you too. Chemotherapy is absolutely required. Chemotherapy is the primary treatment. Patients with an obstructing tumor may need a colostomy or radiotherapy. Some patients with disease confined to the peritoneum may be offered curative surgery (Peritonectomy+ HIPEC)
In stages 2, 3 and 4 there is an emerging role of targeted therapies along with the traditional chemotherapy. The same are chosen on basis of biomarkers. In liver metastases, there is now a strong role for SBRT to liver lesions for high local control and potential cure in many. SBRT is a valuable alternative to liver surgery.
Cancers which have spread only to peritoneum have a chance of cure with peritonectomy with HIPEC or Hot chemotherapy wash. If the spread is limited to less than 3 nodules in liver, they can be removed by surgery following chemotherapy. In case you have a concern or query you can always consult an expert & get answers to your questions!