What Are Colorectal Cancer Treatments by Stage?

Doctors may need to complete various diagnostic tests before they accurately determine the stage of colorectal cancer. Some of the tests used to detect polyps, cancer, or other abnormalities include:

• Faecal Occult Blood Test: This non-invasive test detects hidden blood in the stool, which can serve as an early warning sign of colorectal cancer.
• Colonoscopy: The doctor inspects the entire length of the colon and rectum using a lighted tube with a video camera on one end inserted through the anus. They may also remove any polyps or abnormal growths present for further analysis.
• Imaging Tests: Medical imaging techniques, such as X-rays, PET scans, or CT scans, are typically used to generate high-resolution images of the colon and rectum lining, allowing doctors to examine suspicious growths or assess the extent of cancer spread.
• Biopsy: When abnormal growths are found during a colonoscopy, the doctor will extract a small piece of colon or rectal tissue and send it to the laboratory for additional testing.
• Barium Enema: In this test, the colon and rectum are filled with a contrast dye called barium to obtain a clear image of the area and effectively detect signs of colorectal cancer, such as polyps.

The treatment options for colon and rectal cancer are based primarily on the stage of the disease at diagnosis and the patient's overall fitness and preferences. The main types of colorectal cancer treatment include surgery and therapy.

Stage 0 Colon and Rectal Cancer Treatment

For early-stage colon and rectal cancer, surgery is usually enough. During a colonoscopy, your doctor can perform a polypectomy to remove small, early-stage cancer or precancerous growths from the colon wall.

For larger tumours, a partial colectomy may be recommended. This involves removing the part of the colon with the tumour and some healthy tissue around it. Radiation therapy may also be an option for certain cases.

Stage 1 Colon and Rectal Cancer Treatment

Stage 1 colorectal cancer may be treated with a polypectomy. However, if the polyp is high-grade or the tumour has grown deeper into the colon wall, a partial colectomy may be necessary to ensure complete removal.

In some cases, chemotherapy may be administered alongside surgery to improve treatment outcomes. If patients have small tumours or are unsuitable surgical candidates, radiation therapy may be considered.

Stage 2 Colon and Rectal Cancer Treatment

For stage 2 colon and rectal cancer treatment, the main treatment is usually a partial colectomy, which removes the affected part of the colon or rectum along with nearby lymph nodes.

After surgery, additional treatments like chemotherapy, immunotherapy, or radiation therapy may be recommended. These therapies help destroy any remaining cancer cells and reduce the chances of recurrence.

Stage 3 Colon and Rectal Cancer Treatment

Stage 3 treatment usually starts with a partial colectomy to remove the cancer and nearby lymph nodes. After surgery, chemotherapy and/or immunotherapy are commonly used to improve outcomes.

If the tumour is large or hard to remove, chemotherapy, immunotherapy, or radiation therapy may be given before surgery to shrink it and make surgery more effective. These therapies may also be considered for patients who are not surgical candidates or when complete surgical resection is not feasible.

Stage 4 Colon and Rectal Cancer Treatment

In stage 4 colorectal cancer, where the cancer has spread to distant organs, the goal of treatment is to control the disease, relieve symptoms, and improve quality of life. This often requires a multidisciplinary approach.

Chemotherapy is often the primary treatment, especially when surgery is not an option. It helps shrink tumours, slow cancer growth, and relieve symptoms. Sometimes, chemotherapy is used before surgery to make tumours operable or after surgery to destroy any remaining cancer cells.

Surgery may still play a role in removing the primary tumour or metastases in organs like the liver or lungs. While surgery may not always cure Stage 4 cancer, it can help reduce symptoms, improve quality of life, or enhance the effectiveness of other treatments.

Additional options include radiation therapy, immunotherapy, and targeted therapy, which can help manage tumour growth and improve quality of life.

Beyond cancer-directed treatments, palliative care plays a critical role, focusing on symptom management—such as pain relief, fatigue, and digestive issues—to enhance comfort and overall well-being during treatment.