Risk Of Recurrence In Stage 3b Crc
Michael Morse, MD:This is a 57-year-old man with a left-sided colon cancer. He underwent a laparoscopic colectomy and was found to have stage IIIb disease. He had 5 out of 20 lymph nodes involved. The tumor had a KRAS mutation. It was microsatellite stable. He underwent treatment with 12 cycles of FOLFOX, although the oxaliplatin was held in the last two cycles because of the development of neuropathy. Unfortunately, 6 months later he was found to have multiple hepatic metastasis and was started on therapy with FOLFIRI, plus bevacizumab.
When I see a patient with stage IIIb disease, I ask them how much detail they want to know about their prognosis. For people who want some precision, well often go to one of the online calculators where we can input data that will tell us what their risk of recurrence would be without any therapy, what their risk of recurrence would be if they just had fluorouracil, and what if they had FOLFOX.
In general, for a patient with stage IIIb disease, the 5-year recurrence-free survival is about 50%. Now, if a patient takes chemotherapy with FOLFOX, that improves to almost 75%.
For a patient with stage IIIb disease, I emphasize that the highest risk of recurrence is in the first 2 to 4 years. However, well certainly follow them for at least 5 years.
Case Scenario 2:
The Five Stages Of Colon Cancer
Within each of the three categories, the cancer is classified even further and assigned a number and letter to indicate the extent of the disease. These assignments are based on the structure of the colon and how far the cancer has grown through the layers of the colon wall.
The stages of colon cancer are as follows:
What Is Stage 3 Cancer
Staging affects survival rates, treatment options, and the potential for remission. Remission is a period with few cancer symptoms.
Healthcare providers use a system developed by the American Joint Committee on Cancer to assess the cancer stage. This three-part system is called the TNM system. The letters and numbers differ from cancer to cancer, but they have the same structure:
- T defines the tumor itself. Healthcare providers analyze its size and how far it has spread into the surrounding tissues and organs. The T rating ranges from 0 to 4. The bigger the tumor and the more it has spread, the worse the prognosis is likely to be.
- N describes the extent of lymph node involvement and the number of lymph nodes in the area of the tumor. Lymph nodes are glands in your immune system. A tumors N value varies from 0 to 3 depending on how far it has spread.
- M stands for metastasis. That’s the spread of cancer cells to other organs. There are only two M Stages: 0 for no and 1 for yes. It is harder to treat cancer that has spread.
On the TMN scale, stage 3 cancer is considered advanced. The tumor has usually grown large, and diseased tissue can be found in other organs. It is also called locally advanced cancer or regional cancer.
Colon & Rectal Cancer Survival Rates
The National Cancer Institute has collected data to create relative five-year survival rates for different kinds of cancer the estimated percent of people at each stage who are expected to be alive five years after diagnosis.
For colorectal cancers, available statistics are based on a previous version of the TNM staging system that differs from the one used today it does not have a stage 2C, for instance.
Generally speaking, the higher the stage, the poorer the prognosis. The fact that stage 3A colon cancer has a higher survival rate than stage 2A and 2B cancers seems odd, but it may reflect more aggressive treatment, among other factors, because patients with stage 3 colon cancer always get chemotherapy, while chemo’s ability to improve survival in stage 2 disease is controversial and related to microscopic examination of the tumor.
Keep in mind that each cancer case is unique, and many factors apart from stage influence the outcome, such as a persons age, overall health, and responsiveness to treatment.
- Stage 1: colon cancer, 92 percent rectal cancer, 88 percent
- Stage 2A: colon cancer, 87 percent rectal cancer, 81 percent
- Stage 2B: colon cancer, 65 percent rectal cancer, 50 percent
- Stage 3A: colon cancer, 90 percent rectal cancer, 83 percent
- Stage 3B: colon cancer and rectal cancer, 72 percent
- Stage 3C: colon cancer, 53 percent rectal cancer, 58 percent
- Stage 4: colon cancer, 12 percent rectal, 13 percent
When Should I See My Healthcare Provider
Follow-up colon cancer care varies depending on the cancer stage. For example, people who have surgery for Stage 0 or Stage I colon cancer may have a colonoscopy one year after surgery, another colonoscopy three years after surgery and a third five years after surgery.
Unless the follow-up colonoscopies find signs of cancer, someone with Stage 0 or Stage 1 colon cancer may be able to wait several more years before having another colonoscopy.
People successfully treated for Stage II or Stage III colon cancer will need to see their healthcare provider every three to six months for the first two years after treatment and are typically followed for five years from surgery. They may have tests including colonoscopies, CEA blood tests and imaging tests.
Anyone recovering from colon cancer treatment should contact their healthcare provider if they notice changes that may indicate the cancer has come back or is spreading.
When should I go to the emergency room?
If youre receiving colon cancer treatment, ask your healthcare provider about symptoms that may be signs you should go to the emergency room. You may need to go to the emergency room if you have:
- Side effects that are more intense than you expected.
- A fever higher than 100.4 degrees Fahrenheit .
- Chills that dont go away.
- Severe abdominal pain.
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What Is The Outlook For Each Stage Of Colorectal Cancer
Colorectal cancer survival rates are used as a tool to help understand your prognosis. It provides the percentage of people with the same type and stage of cancer that are still alive after a specific amount of time usually five years after diagnosis. Many people live longer than five years, and often much longer.
Survival rates are only general estimates and cant predict how long you will live. There are a number of individual factors that can affect survival that these numbers dont take into account:
- a persons age and other health issues
- how a person responds to treatment
- specific tumor markers
- whether or not the cancer came back
Staging Colon Cancer And Rectal Cancer
Each cancer has its own staging criteria. In the case of colon and rectal cancer, the system used is one that goes by the acronym TNM, which stands for tumor, node, and metastasis.
The TNM system is organized around the answers to a series of questions.
- Tumor Has the tumor grown beyond the inside lining of the colon or rectum and into the wall? If so, how many layers deep is it?
- Node Has the tumor spread to the lymph nodes? If so, where and how many?
- Metastasis Has the cancer spread beyond the lymph nodes to other parts of the body? If so, where and how much?
Once doctors make all these assessments, they combine this information to stage the cancer.
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for colon and rectal cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the colon or rectum.
- Regional: The cancer has spread outside the colon or rectum to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the liver, lungs, or distant lymph nodes.
Treatment Of Colon Cancer By Stage
Treatment for colon cancer is based largely on the stage of the cancer, but other factors can also be important.
People with colon cancers that have not spread to distant sites usually have surgery as the main or first treatment. Chemotherapy may also be used after surgery . Most adjuvant treatment is given for about 6 months.
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Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if colon cancer spreads to the lung, the cancer cells in the lung are actually colon cancer cells. The disease is metastatic colon cancer, not lung cancer.
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What Is Colon Cancer
Colon cancer starts in your colon , the long tube that helps carry digested food to your rectum and out of your body.
Colon cancer develops from certain polyps or growths in the inner lining of your colon. Healthcare providers have screening tests that detect precancerous polyps before they can become cancerous tumors. Colon cancer thats not detected or treated may spread to other areas of your body. Thanks to screening tests, early treatment and new kinds of treatment, fewer people are dying from colon cancer.
How does this condition affect people?
Your colon wall is made of layers of mucous membrane, tissue and muscle. Colon cancer starts in your mucosa, the innermost lining of your colon. It consists of cells that make and release mucus and other fluids. If these cells mutate or change, they may create a colon polyp.
Over time, colon polyps may become cancerous. Left undetected and/or untreated, the cancer works its way through a layer of tissue, muscle and the outer layer of your colon. The colon cancer may also spread to other parts of your body via your lymph nodes or your blood vessels.
Who is affected by colon cancer?
Colon cancer typically affects people age 50 and older. Over the past 15 years, however, the number of people age 20 to 49 with colon cancer has increased by about 1.5% each year. Medical researchers arent sure why this is happening.
Survival Statistics For Colorectal Cancer
Survival statistics for colorectal cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
There are many different ways to measure and report cancer survival statistics. Your doctor can explain the statistics for colorectal cancer and what they mean to you.
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Years Of Surviving Colon Cancer: Charles Story
May 18, 2016
Cancer has a deserved reputation as a killer, and in many cases it remains a deadly diagnosis. Increasingly, however, we are seeing patients survive for a decade and even longer. As a result, more and more we are shifting our focus to managing cancer.
But what exactly does that mean?
For some patients, colorectal cancer becomes a chronic disease with ongoing treatment, similar to heart disease or diabetes. In fact, many types of chemotherapy today are available in tablets that patients can take on their own. Some patients can experience long periods of remission before a recurrence others live with the disease every day.
Want To Learn More About Your Colon Cancer Treatment Options Were Here For You
Whether you just received your diagnosis or youre looking for new treatment options, were here to help.
If youve just been diagnosed with colon cancer, find a board-certified colorectal surgeon to start building a treatment plan. We can often get you an appointment within 48-hours of diagnosis. Once you find your surgeon, just give us a call to set your appointment.
If youre interested in your nonsurgical options or looking for a new oncologist, make an appointment with one of our board-certified oncologists. From clinical cancer trials to using medical cannabis for cancer symptoms, theyll talk with you about a range of possible therapy options.
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After Colon Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Colon Or To Other Parts Of The Body
The process used to find out if cancer has spread within thecolon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
How Stage 3 Cancer Is Treated
Treatment for stage 3 cancers varies according to which organ is affected. Most are harder to treat than stage 1 or 2 cancers.
Surgery is often the first line of defense against a tumor. Some surgeries involve an open incision. Others use a tiny incision and a camera on a flexible tube. The goal is to remove the cancerous tissue.
In some cases, stage 3C cancers will need other treatments to shrink the size of the tumor. Here’s how some of those treatments work:
- Breast cancer:Stage 3 breast cancers are often treated with chemotherapy to shrink the tumors size before surgery. After surgery, radiation and hormone therapies may be used to kill any cancer cells that are left.
- Colorectal cancer: The first move for stage 3 colorectal cancer is often surgery to remove cancer from the colon and lymph nodes. Radiation may be used on the parts of the tumor they couldnt completely remove.
- Melanoma: Treatment for Stage 3 melanoma starts with surgery to remove a wide area of skin and the lymph nodes. Immune and targeted therapies can reduce the risk of the tumors coming back. Radiation or chemotherapy may follow if the lymph nodes are heavily involved.
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How Is The Stage Determined
The staging system most often used for colorectal cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How far has the cancer grown into the wall of the colon or rectum? These layers, from the inner to the outer, include:
- The inner lining , which is the layer in which nearly all colorectal cancers start. This includes a thin muscle layer .
- The fibrous tissue beneath this muscle layer
- A thick muscle layer
- The thin, outermost layers of connective tissue that cover most of the colon but not the rectum
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
- The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the liver or lungs?
The system described below is the most recent AJCC system effective January 2018. It uses the pathologic stage which is determined by examining tissue removed during an operation. This is also known as surgical staging. This is likely to be more accurate than clinical staging, which takes into account the results of a physical exam, biopsies, and imaging tests, done before surgery.
Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
* The following additional categories are not listed in the table above: