What to expect if you’re diagnosed with colon cancer

Being diagnosed with colorectal cancer, a type of cancer that starts in the colon (large intestine) or rectum (last several inches of the large intestine), can affect many areas of your life. These types of cancers don’t usually cause obvious symptoms, like blood in the stool or abdominal pain, until they’re advanced. The good news is that if caught early enough, the five-year survival rate (percentage of people alive after being diagnosed) is as high as 90 percent. This is due in part to improvements in colon cancer treatment, as well as preventive screenings. More cancers are caught at an early stage thanks to colonoscopy, flexible sigmoidoscopy and other tests.

What is colon cancer staging?

Once you’re diagnosed with colon cancer, you’ll meet with an oncologist, a healthcare provider (HCP) who specializes in treating cancer, to determine how much the cancer has spread. This is called staging. The stages range from 0 to 4, with 0 being the least severe and 4 being the most serious.

• Stage 0: Cancer cells are only found in the inner layer of the colon
• Stage 1: Cancer cells have spread to the middle layers of the colon
• Stage 2: Cancer cells have spread into or through the colon wall
• Stage 3: Cancer cells have spread to nearby lymph nodes (small bean-shaped structures throughout the body that store white blood cells and filter substances as part of the immune system)
• Stage 4: Cancer cells have spread through the lymph nodes to other organs, such as the lungs or liver

Determining your stage

To make an accurate assessment, your HCP will take biopsies (small samples of tissue) and perform one or more imaging tests, such as X-rays, computed tomography (CT, which uses X-rays and a computer to create detailed pictures of the inside of the body), or magnetic resonance imaging (MRI, which uses radio waves to create three dimensional images of the body). Based on the results of these tests, your HCP may do surgery to remove the tumor (solid mass of cancer cells) and get a more accurate look at how far it has spread.

Understanding treatment options

While treatment choices depends on each individual case, the range of options is typically based on the stage and location of the cancer. These include the following.

• Stage 0: Surgery to remove the cancerous polyp, or small growth of cancer cells (this procedure is called a polypectomy) or surgery to remove cancer cells and nearby tissue
• Stage 1: Surgery to remove a cancerous polyp or for cancers that have spread out of the polyp; surgery to remove a section of the colon and nearby lymph nodes (this procedure is called a partial colectomy)
• Stage 2: Surgery to remove the section of the colon with cancer and nearby lymph nodes; chemotherapy (chemo, drugs that go throughout the body to kill cancer cells) after surgery, if your HCP thinks there’s a high chance that the cancer may grow back
• Stage 3: Surgery to remove the section of the colon with cancer and nearby lymph nodes, followed by chemotherapy and/or radiation (high dose X-rays)
• Stage 4: Surgery to remove the section of the colon with cancer, nearby lymph nodes and other areas where the cancer has spread (called metastases). If it’s determined that the cancer has spread too far throughout the body, in most cases surgery won’t provide a cure. If surgery is possible, chemotherapy would likely be given before and after the operation.

Some people with advanced colorectal cancer may also be able to receive immunotherapy, which is medication that helps the immune system destroy cancer cells.

What to expect after treatment

If you have surgery to treat colon cancer—even minor surgery—you’ll likely experience some pain (which can be managed with medication), fatigue, and eating problems during recovery. Depending on what type of surgery you had, complications may include bleeding from the rectum or blood clots in your legs. In rare instances, the incision (cut) made in your abdomen during surgery may re-open and have difficulty healing. If the surgeon removed part of the colon and attached the two end-pieces of the remaining colon together (which is called an anastomosis), this connection in rare cases may leak and lead to an infection. Talk to your HCP about what symptoms of possible complications of surgery to watch out for, and tell your HCP if you experience any of these symptoms.

Some people may also need a temporary or permanent colostomy, where the colon is brought through a whole cut in the abdomen and a pouch is attached to collect waste outside the body. Colostomy is typically needed if so much of the colon is removed that the remaining bowel can’t work properly. A colostomy may be temporary if bowel returns to working properly after the colon has healed.

Radiation for colon cancer can cause skin irritation, nausea, fatigue, and bowel incontinence (loss of bowel control and accidental pooping). Radiation may also cause impotence (difficulty getting penis erections) and irritation of the vagina.

Chemotherapy for colon cancer can cause hair loss, mouth sores, nausea, vomiting, fatigue and increase your chances of infection.

Your HCP will discuss with you the possible side effects to find the best treatment plan for you.

Life after colon cancer

There are now more than 1 million survivors of colorectal cancer in the U.S. For some people, no further treatment is required once the cancer is removed, especially if it's removed in the early stages. For others, the cancer may never go away completely, and chemotherapy and radiation are required to control growth and keep the cancer from spreading.

Your HCP will monitor your health, requiring follow-up exams every three to six months. Monitoring may be needed for several years after treatment, depending on the stage at which the cancer was first diagnosed.

Factors that can improve your chances of staying healthy include managing stress levels with things like meditation or deep breathing, regular physical activity as you are able, and aiming to follow a healthy diet rich in whole fruits, vegetables, grains, and lean protein, and low in salt, added sugars, and saturated fat (which is solid at room temperature, like butter).