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Colorectal Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Colorectal Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About colorectal cancer

Colorectal cancer begins when healthy cells in the lining of the colon or rectum change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. These changes usually take years to develop. Both genetic and environmental factors can cause the changes. However, when a person has an uncommon inherited syndrome (see Risk Factors and Prevention), changes can occur within months to years.

Anatomy of the colon and rectum

The colon and rectum make up the large intestine, which plays an important role in the body's ability to process waste. The colon makes up the first 5 to 6 feet of the large intestine, and the rectum makes up the last 6 inches, ending at the anus (see Medical Illustrations).

The colon and rectum have 5 sections. The ascending colon is the portion that extends from a pouch called the cecum. The cecum is the beginning of the large intestine into which the small intestine empties; it’s on the right side of the abdomen. The transverse colon crosses the top of the abdomen. The descending colon takes waste down the left side. Finally, the sigmoid colon at the bottom takes waste a few more inches, down to the rectum. Waste leaves the body through the anus.

About colorectal polyps

Colorectal cancer most often begins as a polyp, a noncancerous growth that may develop on the inner wall of the colon or rectum as people get older. If not treated or removed, a polyp can become a potentially life-threatening cancer. Recognizing and removing precancerous polyps can prevent colorectal cancer.

There are several forms of polyps. Adenomatous polyps, or adenomas, are growths that may become cancerous and can be found with a colonoscopy (see Risk Factors and Prevention). Polyps are most easily found during colonoscopy because they usually bulge into the colon, forming a mound on the wall of the colon that can be found by the doctor.

About 10% of colon polyps are flat and hard to find with a colonoscopy unless a dye is used to highlight them. These flat polyps have a high risk of becoming cancerous, regardless of their size.

Hyperplastic polyps may also develop in the colon and rectum. They are not considered precancerous.

Types of colorectal cancer

Colorectal cancer can begin in either the colon or the rectum. Cancer that begins in the colon is called colon cancer. Cancer that begins in the rectum is called rectal cancer.

Most colon and rectal cancers are a type of tumor called adenocarcinoma, which is cancer of the cells that line the inside tissue of the colon and rectum. This section specifically covers adenocarcinoma. Other types of cancer that occur far less often but can begin in the colon or rectum include carcinoid tumor, gastrointestinal stromal tumor (GIST), small cell carcinoma, and lymphoma

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.   

Colorectal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

In the United States, colorectal cancer is the fourth most common cancer diagnosed each year for all adults combined. Separately, it is the third most common cancer in men and third most common cancer in women.

This year, an estimated 134,490 adults in the United States will be diagnosed with colorectal cancer. These numbers include 95,270 new cases of colon cancer and 39,220 new cases of rectal cancer.

It is estimated that 49,190 deaths (26,020 men and 23,170 women) will be attributed to colon or rectal cancer this year. Colorectal cancer is the second leading cause of cancer death in the United States.

Colorectal cancer is commonly diagnosed among older patients, with an average age of 72 at the time of diagnosis in the United States. Older patients who are diagnosed with colorectal cancer face unique challenges, specifically with regard to cancer treatment. For more information, please visit Cancer.Net’s section about aging and cancer.

When colorectal cancer is found early, it can often be cured. The death rate from this type of cancer has been declining since the mid-1980s, possibly because it is usually diagnosed earlier now and treatments have improved.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with colorectal cancer is 65%. The 10-year survival rate is 58%. However, survival rates for colorectal cancer can vary based on a variety of factors, particularly the stage.

The 5-year survival rate of people with localized stage colorectal cancer is 90%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 71%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 13%. However, for patients who have just 1 or a few tumors that have spread from the colon or rectum to the lung or liver, surgical removal of these tumors can eliminate the cancer, which greatly improves the 5-year survival rate for these patients.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with colorectal cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. To see other pages, use the menu. 

For medical illustrations showing the different stages of colorectal cancer, please visit the Stages section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

A person with an average risk of colorectal cancer has about a 5% chance of developing colorectal cancer overall. Generally, most colorectal cancers (about 95%) are considered sporadic, meaning the genetic changes develop by chance after a person is born, so there is no risk of passing these genetic changes on to one’s children. Inherited colorectal cancers are less common (about 5%) and occur when gene mutations, or changes, are passed within a family from 1 generation to the next (see below). Often, the cause of colorectal cancer is not known. However, the following factors may raise a person’s risk of developing colorectal cancer:

  • Age. The risk of colorectal cancer increases as people get older. Colorectal cancer can occur in young adults and teenagers, but more than 90% of colorectal cancers occur in people older than 50. The average age of people diagnosed with colorectal cancer in the United States is 72.

  • Gender. Men have a slightly higher risk of developing colorectal cancer than women.

  • Family history of colorectal cancer. Colorectal cancer may run in the family if first-degree relatives (parents, brothers, sisters, children) or many other family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) have had colorectal cancer. This is especially true when family members are diagnosed with colorectal cancer before age 60. If a person has a family history of colorectal cancer, his or her risk of developing the disease is nearly double the average risk of colorectal cancer. The risk further increases if other close relatives have also developed colorectal cancer or if a first-degree relative was diagnosed at a younger age.

It is important to talk to your family members about your family’s history of colorectal cancer. If you think you may have a family history of colorectal cancer, talk with a genetic counselor first before you have any genetic testing. Only genetic testing can determine if you have a genetic mutation, and genetic counselors are trained to explain the risks and benefits of genetic testing.

  • Inflammatory bowel disease (IBD). People with IBD, such as ulcerative colitis or Crohn’s disease, may develop chronic inflammation of the large intestine. This increases the risk of colorectal cancer. IBD is not the same as irritable bowel syndrome (IBS). IBS does not increase your risk of colorectal cancer.

  • Adenomatous polyps (adenomas). Polyps are not cancer, but some types of polyps called adenomas can develop into colorectal cancer over time. Polyps can often be completely removed using a tool during a colonoscopy, a test in which a doctor looks into the colon using a lighted tube after the patient has been sedated. Polyp removal can prevent colorectal cancer. People who have had adenomas have a greater risk of additional polyps and of colorectal cancer, and they should have follow-up screening tests regularly (see below.)

  • Personal history of certain types of cancer. People with a personal history of colorectal cancer and women who have had ovarian cancer or uterine cancer are more likely to develop colorectal cancer themselves.

  • Race. Black people have the highest rates of sporadic, or non-hereditary, colorectal cancer in the United States. Colorectal cancer is also a leading cause of cancer-related deaths among black people. Black women are more likely to die from colorectal cancer than women from any other racial group, and black men are even more likely to die from colorectal cancer than black women. The reasons for these differences are unclear. Because black people are more likely to be diagnosed with colorectal cancer at a younger age, the American College of Gastroenterology suggests that black people begin screening with colonoscopies at age 45 (see Screening). Earlier screening may find changes in the colon at a point when they are more easily treated.

  • Physical inactivity and obesity. People who lead an inactive lifestyle, meaning no regular exercise and a lot of sitting, and people who are overweight and obese may have an increased risk of colorectal cancer.

  • Nutrition. Current research consistently links eating more red meat and processed meat to a higher risk of the disease. Other dietary factors have also been looked at to see if they affect the risk of developing colorectal cancer.

  • Smoking. Recent studies have shown that smokers are more likely to die from colorectal cancer than nonsmokers.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of colorectal cancer.

The following may lower a person’s risk of colorectal cancer:

  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Some studies suggest that aspirin and other NSAIDs may reduce the development of polyps in people with a history of colorectal cancer or polyps. However, regular use of NSAIDs may cause major side effects, including bleeding of the stomach lining and blood clots leading to stroke or heart attack. Taking aspirin or other NSAIDs are not a substitute for having regular colorectal cancer screenings. People should talk with their doctor about the risks and benefits of taking aspirin on a regular basis.

  • Diet and supplements. A diet rich in fruits and vegetables and low in red meat may help reduce the risk of colorectal cancer. Some studies have also found that people who take calcium and vitamin D supplements have a lower risk of colorectal cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. To see other pages, use the menu.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for colorectal cancer

Colorectal cancer can often be prevented through regular screening, which can find polyps before they become cancerous. Talk with your doctor about when screening should begin based on your age and family history of the disease. Although some people should be screened earlier, people with an average risk should begin screening at age 50. Black people should start receiving screening at age 45 because they are more often diagnosed at a younger age. Because colorectal cancer usually does not cause symptoms until the disease is advanced, it is important for people to talk with their doctor about the pros and cons of each screening test and how often each test should be given. Under the guidelines below, people should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors:

  • A personal history of colorectal cancer or adenomatous polyps

  • A strong family history of colorectal cancer or polyps, such as cancer or polyps in a first-degree relative younger than 60 or in 2 first-degree relatives of any age. A first-degree relative is defined as a parent, sibling, or child.

  • A personal history of chronic IBD

  • A family history of any hereditary colorectal cancer syndrome, such as FAP, Lynch Syndrome, or other syndromes (see Risk Factors and Prevention)

The tests used to screen for colorectal cancer are described below.

  • Colonoscopy. A colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. A flexible, lighted tube called a colonoscope is inserted into the rectum and the entire colon to look for polyps or cancer. During this procedure, a doctor can remove polyps or other tissue for examination (see “biopsy” in the Diagnosis section). The removal of polyps can also prevent colorectal cancer.
  • Computed tomography (CT or CAT) colonography. CT colonography, sometimes called virtual colonoscopy, is a screening method being studied in some centers. It requires interpretation by a skilled radiologist to provide the best results. A radiologist is a doctor who specializes in obtaining and interpreting medical images. However, CT colonography may be an alternative for people who cannot have a standard colonoscopy due to the risk of anesthesia, which is medication to block the awareness of pain, or if a person has a blockage in the colon that prevents a full examination.
  • Sigmoidoscopy. A sigmoidoscopy uses a flexible, lighted tube that is inserted into the rectum and lower colon to check for polyps, cancer, and other abnormalities. During this procedure, a doctor can remove polyps or other tissue for later examination. The doctor cannot check the upper part of the colon, the ascending and transverse colon, with this test. This screening test allows for the removal of polyps, which can also prevent colorectal cancer, but if polyps or cancer are found using this test, a colonoscopy to view the entire colon is recommended.
  • Fecal occult blood test (FOBT) and fecal immunochemical test (FIT). A fecal occult blood test is used to find blood in the feces, or stool, which can be a sign of polyps or cancer. A positive test, meaning that blood is found in the feces, can be from causes other than a colon polyp or cancer, including bleeding in the stomach or upper GI tract and even ingestion of rare meat or other foods. There are 2 types of tests: guaiac (FOBT) and immunochemical (FIT). Polyps and cancers do not bleed continually, so FOBT must be done on several stool samples each year and should be repeated every year. Even then, the reduction in deaths from colorectal cancer is fairly small, around 30% if done yearly and 18% if done every other year.
  • Double contrast barium enema (DCBE). For patients who cannot have a colonoscopy, an enema containing barium is given, which helps make the colon and rectum stand out on x-rays. A series of x-rays is then taken of the colon and rectum. In general, most doctors would recommend other screening tests because a barium enema is less likely to detect precancerous polyps than a colonoscopy, sigmoidoscopy, or CT colonography.
  • Stool DNA tests. This test analyzes the DNA from a person’s stool sample to look for cancer. It uses changes in the DNA that occur in polyps and cancers to determine whether a colonoscopy should be done.

Colorectal cancer screening recommendations

Different organizations have made different recommendations for colorectal cancer screening. There are 2 sets of recommendations described below. Talk with your doctor about the best test(s) and time between tests based on your health history and personal colorectal cancer risk.

The American Gastroenterological Association, the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, the American Cancer Society, and the American College of Radiology have developed consensus guidelines for colorectal cancer screening, with the goal of preventing cancer. Beginning at age 50, both men and women of average risk should follow 1 of these testing schedules.

The following tests detect both polyps and cancer:

  • Flexible sigmoidoscopy, every 5 years

  • Colonoscopy, every 10 years

  • DCBE, every 5 years

  • CT colonography, every 5 years

These tests primarily detect cancer:

  • Guaiac-based FOBT, every year

  • Immunochemical FOBT, every year

  • Stool DNA test, as often as your doctor recommends

The U.S. Preventive Services Task Force (USPSTF) also has guidelines for colorectal cancer screening, which do not recommend any specific screening method. Instead, USPSTF simply recommends that people between ages 50 and 75 should receive regular screening.

According to the USPSTF, adults between ages 76 and 85 should talk with their doctor to see if screening is right for them. However, people who have a history of polyps or colorectal cancer have a higher risk of the disease, and screening may still be recommended at an older age.

For more information regarding specific considerations with regard to treatment decisions in older patients, read Cancer.Net’s article on this topic.

It is important to note that, regardless of the screening test and schedule, any test that indicates an abnormality should be followed up with a colonoscopy.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.  

Colorectal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

It is important to remember that the symptoms and signs of colorectal cancer listed in this section are the same as those of extremely common conditions that are not cancer, such as hemorrhoids and IBS. When cancer is suspected, these symptoms usually have begun recently, are severe and long lasting, and change over time. By being alert to the symptoms of colorectal cancer, it may be possible to detect the disease early when it is most likely to be treated successfully. However, many people with colorectal cancer do not have any symptoms until the disease is advanced, so people need to be screened regularly.

People with colorectal cancer may experience the following symptoms or signs. As mentioned above, it is also possible that these changes may be caused by a medical condition that is not cancer, especially for the general symptoms of abdominal discomfort, bloating, and irregular bowel movements.

  • A change in bowel habits

  • Diarrhea, constipation, or feeling that the bowel does not empty completely

  • Bright red or very dark blood in the stool

  • Stools that look narrower or thinner than normal

  • Discomfort in the abdomen, including frequent gas pains, bloating, fullness, and cramps

  • Weight loss with no known explanation

  • Constant tiredness or fatigue

  • Unexplained iron-deficiency anemia, which is a low number of red blood cells

Talk with your doctor if any of these symptoms last for several weeks or become more severe. If you are concerned about any changes you experience, please talk with your doctor and ask to schedule a colonoscopy.

Because colorectal cancer can occur in people younger than the recommended screening age and in older people between screenings, anyone at any age who experiences these symptoms should visit a doctor to find out if he or she should have a colonoscopy.

Your doctor will ask how long and how often you’ve been experiencing the symptoms(s), in addition to other questions. This is to help find the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide. 

Colorectal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • Your medical and family history

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose colorectal cancer.

  • Colonoscopy. As described in Screening, a colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. A colonoscopist is a doctor who specializes in performing this test. If colorectal cancer is found, a complete diagnosis that accurately describes the location and spread of the cancer may not be possible until the tumor is surgically removed.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis of colorectal cancer. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A biopsy may be performed during a colonoscopy, or it may be done on any tissue that is removed during surgery. Sometimes, a CT scan or ultrasound is used to help perform a needle biopsy. A needle biopsy removes tissue through the skin with a needle that is guided into the tumor.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

  • Blood tests. Because colorectal cancer often bleeds into the large intestine or rectum, people with the disease may become anemic. A test of the number of red cells in the blood, which is part of a complete blood count (CBC), can indicate that bleeding may be occurring.

Another blood test detects the levels of a protein called carcinoembryonic antigen (CEA). High levels of CEA may indicate that a cancer has spread to other parts of the body. CEA is not a perfect test for colorectal cancer because levels are high for only about 60% of people with colorectal cancer that has spread to other organs from the colon. In addition, other medical conditions can cause CEA to increase. A CEA test is most often used to monitor colorectal cancer for patients who are already receiving treatment. It is not useful as a screening test. Learn more about tumor markers for colorectal cancer.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. In a person with colorectal cancer, a CT scan can check for the spread of cancer in the lungs, liver, and other organs. It is often done before surgery (see Treatment Options).

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI is the best imaging test to find where the colorectal cancer has grown.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs to find out if cancer has spread. Endorectal ultrasound is commonly used to find out how deeply rectal cancer has grown and can be used to help plan treatment. However, this test cannot accurately detect cancer that has spread to nearby lymph nodes or beyond the pelvis. Ultrasound can also be used to view the liver, although CT scans or MRIs (see above) are preferred because they are better for finding tumors in the liver.

  • Chest x-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. An x-ray of the chest can help doctors find out if the cancer has spread to the lungs.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. PET scans are not regularly used for all patients with colorectal cancer, but there are specific situations in which your doctor may find them useful.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): Has the tumor grown into the wall of the colon or rectum? How many layers?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for colorectal cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe how deeply the primary tumor has grown into the bowel lining. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of cancer in the colon or rectum.

Tis: Refers to carcinoma in situ (also called cancer in situ). Cancer cells are found only in the epithelium or lamina propria, which are the top layers lining the inside of the colon or rectum.

T1: The tumor has grown into the submucosa, which is the layer of tissue underneath the mucosa or lining of the colon.

T2: The tumor has grown into the muscularis propria, a deeper, thick layer of muscle that contracts to force the contents of the intestines along.

T3: The tumor has grown through the muscularis propria and into the subserosa, which is a thin layer of connective tissue beneath the outer layer of some parts of the large intestine, or it has grown into tissues surrounding the colon or rectum.

T4a: The tumor has grown into the surface of the visceral peritoneum, which means it has grown through all layers of the colon.

T4b: The tumor has grown into or has attached to other organs or structures.

Node (N)

The "N" in the TNM system stands for lymph nodes. The lymph nodes are tiny, bean-shaped organs that are located throughout the body that help the body fight infections as part of the immune system. Lymph nodes near the colon and rectum are called regional lymph nodes. All others are distant lymph nodes that are found in other parts of the body.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no spread to regional lymph nodes.

N1a: There are tumor cells found in 1 regional lymph node.

N1b: There are tumor cells found in 2 to 3 regional lymph nodes.

N1c: There are nodules made up of tumor cells found in the structures near the colon that do not appear to be lymph nodes.

N2a: There are tumor cells found in 4 to 6 regional lymph nodes.

N2b: There are tumor cells found in 7 or more regional lymph nodes.

Metastasis (M)

The "M" in the TNM system describes cancer that has spread to other parts of the body, such as the liver or lungs. This is called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The disease has not spread to a distant part of the body.

M1a: The cancer has spread to 1 other part of the body beyond the colon or rectum.

M1b: The cancer has spread to more than 1 part of the body other than the colon or rectum.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: The cells are more like healthy cells (called well differentiated).

G2: The cells are somewhat like healthy cells (called moderately differentiated).

G3: The cells look less like healthy cells (called poorly differentiated).

G4: The cells barely look like healthy cells (called undifferentiated).

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: This is called cancer in situ. The cancer cells are only in the mucosa, or the inner lining, of the colon or rectum.

Stage 0 Thyroid Cancer

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Stage I: The cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum. It has not spread into nearby tissue or lymph nodes (T1 or T2, N0, M0).

Stage I Thyroid Cancer

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Stage IIA: The cancer has grown through the wall of the colon or rectum and has not spread to nearby tissue or to the nearby lymph nodes (T3, N0, M0).

Stage IIA Thyroid Cancer

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Stage IIB: The cancer has grown through the layers of the muscle to the lining of the abdomen, called the visceral peritoneum. It has not spread to the nearby lymph nodes or elsewhere (T4a, N0, M0).

Stage IIB Thyroid Cancer

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Stage IIC: The tumor has spread through the wall of the colon or rectum and has grown into nearby structures. It has not spread to the nearby lymph nodes or elsewhere (T4b, N0, M0).

Stage IIC Thyroid Cancer

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Stage IIIA: The cancer has grown through the inner lining or into the muscle layers of the intestine and spread to 1 to 3 lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes but has not spread to other parts of the body (T1 or T2, N1 or N1c, M0; or T1, N2a, M0).

Stage IIIA Thyroid Cancer

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Stage IIIA Thyroid Cancer

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Stage IIIB: The cancer has grown through the bowel wall or to surrounding organs and into 1 to 3 lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes. It has not spread to other parts of the body (T3 or T4a, N1 or N1c, M0; T2 or T3, N2a, M0; or T1 or T2, N2b, M0).

Stage IIIB Thyroid Cancer

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Stage IIIB Thyroid Cancer

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Stage IIIB Thyroid Cancer

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Stage IIIC: The cancer of the colon, regardless of how deep it has grown, has spread to 4 or more lymph nodes but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0).

Stage IIIC Thyroid Cancer

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Stage IIIC Thyroid Cancer

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Stage IIIC Thyroid Cancer

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Stage IVA: The cancer has spread to a single distant part of the body, such as the liver or lungs (any T, any N, M1a).

Stage IVA Thyroid Cancer

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Stage IVB: The cancer has spread to more than 1 part of the body (any T, any N, M1b).

Stage IVB Thyroid Cancer

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Recurrent: Recurrent cancer is cancer that has come back after treatment. The disease may be found in the colon, rectum, or in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net. 

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that usually includes or combines different types of treatments. This is called a multidisciplinary team. For colorectal cancer, this generally includes a surgeon, medical oncologist, radiation oncologist, and a gastroenterologist. A gastroenterologist is a doctor who specializes in the function and disorders of the gastrointestinal tract. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for colorectal cancer are listed below, followed by a brief outline of treatment options listed by stage. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Studies have shown that these various treatment approaches provide similar benefits regardless of the patient’s age. However, older patients may have unique treatment challenges. In order to tailor the treatment to each patient, all treatment decisions should consider such factors as:

  • The patient’s other medical conditions

  • The patient’s overall health

  • Potential side effects of the treatment plan

  • Other medications that the patient already takes

  • The patient’s nutritional status and social support

More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found in this article in another section of Cancer.Net.  

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is the most common treatment for colorectal cancer and is often called surgical resection. Part of the healthy colon or rectum and nearby lymph nodes will also be removed. While both general surgeons and specialists may perform colorectal surgery, many people talk with specialists who have additional training and experience in colorectal surgery. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A colorectal surgeon is a doctor who has received additional training to treat diseases of the colon, rectum, and anus (formerly called a proctologist).

In addition to surgical resection, surgical options for colorectal cancer include:

  • Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal cancer surgery. With this technique, several viewing scopes are passed into the abdomen while a patient is under anesthesia. Anesthesia is medicine that blocks the awareness of pain. The incisions are smaller and the recovery time is often shorter than with standard colon surgery. Laparoscopic surgery is as effective as conventional colon surgery in removing the cancer. Surgeons who perform laparoscopic surgery have been specially trained in that technique.

  • Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body; such waste is collected in a pouch worn by the patient. Sometimes, the colostomy is only temporary to allow the rectum to heal, but it may be permanent. With modern surgical techniques and the use of radiation therapy and chemotherapy before surgery when needed, most people who receive treatment for rectal cancer do not need a permanent colostomy. Learn more about colostomies.

  • Radiofrequency ablation (RFA) or cryoablation. Some patients may be able to have surgery on the liver or lungs to remove tumors that have spread to those organs. Other ways include using energy in the form of radiofrequency waves to heat the tumors, called RFA, or to freeze the tumor, called cryoablation. Not all liver or lung tumors can be treated with one of these approaches. RFA can be done through the skin or during surgery. While this can help avoid removing parts of the liver and lung tissue that might be removed in a regular surgery, there is also a chance that parts of tumor will be left behind.

Side effects of surgery

Talk with your health care team about the possible side effects of the specific surgery beforehand, and ask how they can be prevented or relieved. In general, the side effects of surgery include pain and tenderness in the area of the operation. The operation may also cause constipation or diarrhea, which usually goes away after a while. People who have a colostomy may have irritation around the stoma. If you need to have a colostomy, the doctor, nurse, or an enterostomal therapist, who is a specialist in colostomy management, can teach you how to clean the area and prevent infection.

Many people need to retrain their bowel after surgery, which may take some time and assistance. You should talk with your doctor if you do not regain good control of bowel function.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is commonly used for treating rectal cancer because this tumor tends to recur near where it originally started. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

  • External-beam radiation therapy. External-beam radiation therapy uses a machine to deliver x-rays to where the cancer is located. Radiation treatment is usually given 5 days a week for several weeks. It may be given in the doctor's office or at the hospital.

    • Stereotactic radiation therapy. Stereotactic radiation therapy is a type of external-bean radiation therapy that may be used if a tumor has spread to the liver or lungs. This type of radiation therapy delivers a large, precise radiation dose to a small area. This technique can help avoid removing parts of the liver and lung tissue that might be removed during surgery. However, not all cancers that have spread to the liver or lungs can be treated in this way.

  • Other types of radiation therapy. For some people, specialized radiation therapy techniques, such as intraoperative radiation therapy or brachytherapy, may help get rid of small areas of cancer that could not be removed with surgery.

    • Intraoperative radiation therapy. Intraoperative radiation therapy uses a high, single dose of radiation therapy given during surgery.

    • Brachytherapy. Brachytherapy is the use of radioactive "seeds" placed inside the body. In 1 type of brachytherapy with a product called SIR-Spheres, tiny amounts of a radioactive substance called yttrium-90 are injected into the liver to treat colorectal cancer that has spread to the liver when surgery is not an option. While limited information is available about how effective this approach is, some studies suggest that it may help slow the growth of cancer cells.

  • Radiation therapy for rectal cancer. For rectal cancer, radiation therapy may be used before surgery, called neoadjuvant therapy, to shrink the tumor so that it is easier to remove. It may also be used after surgery to destroy any remaining cancer cells. Both approaches have worked to treat this disease. Chemotherapy is often given at the same time as radiation therapy, called chemoradiation therapy, to increase the effectiveness of the radiation therapy. Chemoradiation therapy is often used in rectal cancer before surgery to avoid colostomy or reduce the chance that the cancer will recur. One study found that radiation therapy plus chemotherapy before surgery worked better and caused fewer side effects than the same radiation therapy and chemotherapy given after surgery. The main benefits included a lower rate of the cancer coming back in the area where it started, fewer patients who needed permanent colostomies, and fewer problems with scarring of the bowel where the radiation therapy was given.

Side effects of radiation therapy

Talk with your doctor about the possible side effects of your radiation therapy regimen. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. It may also cause bloody stools from bleeding through the rectum or blockage of the bowel. Most side effects go away soon after treatment is finished.

Sexual problems, as well as infertility (the inability to have a child) in both men and women, may occur after radiation therapy to the pelvis. Before treatment begins, talk with your doctor about the possible sexual and fertility-related side effects of your treatment and the available options for preserving fertility.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is usually given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

Chemotherapy may be given after surgery to eliminate any remaining cancer cells. For some people with rectal cancer, the doctor will give chemotherapy and radiation therapy before surgery to reduce the size of a rectal tumor and reduce the chance of the cancer returning.

Types of chemotherapy for colorectal cancer

Currently, several drugs are approved by the U.S. Food and Drug Administration (FDA) to treat colorectal cancer in the United States. Your doctor may recommend 1 or more of them at different times during treatment. Sometimes these are combined with targeted therapy drugs (see “Targeted therapy” below).

  • Capecitabine (Xeloda)

  • Fluorouracil (5-FU, Adrucil)

  • Irinotecan (Camptosar)

  • Oxaliplatin (Eloxatin)

  • Trifluridine/tipiracil (TAS-102, Lonsurf)

Some common treatment regimens using these drugs include:

  • 5-FU

  • 5-FU with leucovorin (Wellcovorin), a vitamin that improves the effectiveness of 5-FU

  • Capecitabine, an oral form of 5-FU

  • 5-FU with leucovorin and oxaliplatin (called FOLFOX)

  • 5-FU with leucovorin and irinotecan (called FOLFIRI)

  • Irinotecan alone

  • Capecitabine with either irinotecan (called XELIRI or CAPIRI) or oxaliplatin (called XELOX or CAPEOX)

  • Any of the above with 1 of the following targeted therapies (see below): cetuximab, bevacizumab, or panitumumab

  • FOLFIRI with either of these targeted therapies (see below): ziv-aflibercept or ramucirumab

Side effects of chemotherapy

Chemotherapy may cause vomiting, nausea, diarrhea, neuropathy, or mouth sores. However, medications to prevent these side effects are available. Because of the way drugs are given, these side effects are less severe than they have been in the past for most patients. In addition, patients may be unusually tired, and there is an increased risk of infection. Neuropathy, tingling or numbness in feet or hands, may also occur with some drugs. Hair loss is an uncommon side effect with the drugs used to treat colorectal cancer.

If side effects are particularly difficult, the dose of the drug may be lowered or a treatment session may be postponed. If you are receiving chemotherapy, you should talk with your health care team to understand when to call your doctor about side effects. Read more about managing side effects. The side effects from chemotherapy usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. These drugs are becoming more important in the treatment of colorectal cancer. Learn more about the basics of targeted treatments.

Studies have shown that older patients are able to benefit from targeted therapies, similar to younger patients. In addition, the expected side effects are usually manageable in both older and younger patients.  

Types of targeted therapy

For colorectal cancer, the following targeted therapies may be options. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

  • Anti-angiogenesis therapy. Anti-angiogenesis therapy is a type of targeted therapy. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

    • Bevacizumab (Avastin). When bevacizumab is given with chemotherapy, it increases the length of time patients with advanced colorectal cancer live. In 2004, the FDA approved bevacizumab along with chemotherapy as the first treatment, or first-line treatment, for advanced colorectal cancer. Recent studies have shown it is also effective as second-line therapy along with chemotherapy.

    • Regorafenib (Stivarga). This drug was approved in 2012 for patients with metastatic colorectal cancer who have already received certain types of chemotherapy and other targeted therapies.

    •  Ziv-aflibercept (Zaltrap) and ramucirumab (Cyramza). Either of these drugs can be combined with FOLFIRI chemotherapy as a second-line treatment for metastatic colorectal cancer.

  • Epidermal growth factor receptor (EGFR) inhibitors. An EGFR inhibitor is a type of targeted therapy. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of colorectal cancer.

    • Cetuximab (Erbitux). Cetuximab is an antibody made from mouse cells that still has some of the mouse structure.

    • Panitumumab (Vectibix). Panitumumab is made entirely from human proteins and is less likely to cause an allergic reaction than cetuximab.

    Recent studies show that cetuximab and panitumumab do not work as well for tumors that have specific mutations, or changes, to a gene called RAS. ASCO released a provisional clinical opinion recommending that all patients with metastatic colorectal cancer who may receive anti-EFGR therapy, such as cetuximab and panitumumab, have their tumors tested for RAS gene mutations. If a patient’s tumor has a mutated form of the RAS gene, ASCO recommends against the use of anti-EFGR antibody therapy. Furthermore, the FDA now recommends that both cetuximab and panitumumab only be given to patients with a tumor with non-mutated, sometimes called wild-type, RAS genes.

Your tumor may also be tested for other molecular markers, including BRAF, HER2 overexpression, microsatellite instability, and others. These markers do not have FDA-approved targeted therapies yet, but there may be opportunities in clinical trials that are studying these molecular changes.

Side effects of targeted therapies

Talk with your doctor about possible side effects for a specific medication and how they can be managed. The side effects of targeted treatments can include a rash to the face and upper body, which can be prevented or reduced with various treatments. Find out more about skin reactions to targeted therapies.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Treatment options by stage

In general, stages 0, I, II, and III are often curable with surgery. However, many patients with stage III colorectal cancer, and some with stage II, receive chemotherapy after surgery to increase the chance of eliminating the disease. Patients with stage II and III rectal cancer will also receive radiation therapy with chemotherapy either before or after surgery. Stage IV is not often curable, but it is treatable, and the growth of the cancer and the symptoms of the disease can be managed. Clinical trials are also a treatment option for each stage.

Stage 0 colorectal cancer

The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy. There is no additional surgery unless the polyp cannot be fully removed.

Stage I colorectal cancer

Surgical removal of the tumor and lymph nodes is usually the only treatment needed.

Stage II colorectal cancer

Surgery is often the first treatment. Patients with stage II colorectal cancer should talk with their doctor about whether more treatment is needed after surgery because some patients receive adjuvant chemotherapy. Adjuvant chemotherapy is treatment after surgery aimed at trying to destroy any remaining cancer cells. However, cure rates for surgery alone are quite good, and there are few benefits of additional treatment for people with this stage of colorectal cancer. Learn more about adjuvant therapy for stage II colorectal cancer. A clinical trial is also an option after surgery.

For patients with stage II rectal cancer, radiation therapy is usually given in combination with chemotherapy, either before or after surgery. Additional chemotherapy may be given after surgery as well.

Stage III colorectal cancer

Treatment usually involves surgical removal of the tumor followed by adjuvant chemotherapy. A clinical trial may also an option. For patients with rectal cancer, radiation therapy may be used along with chemotherapy before or after surgery, along with adjuvant chemotherapy.

Metastatic (stage IV) colorectal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Colorectal cancer can spread to distant organs, such as the liver, lungs, the tissue called the peritoneum that lines the abdomen, or a woman’s ovaries. If this happens, it is a good idea to talk with doctors who have experience treating this stage of cancer. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy, which can be used to slow the spread of the disease and often temporarily shrink a cancerous tumor. Palliative care will also be important to help relieve symptoms and side effects.

At this stage, surgery to remove the portion of the colon where the cancer started usually cannot cure the cancer, but it can help relieve blockage of the colon or other problems related to the cancer. Surgery may also be used to remove parts of other organs that contain cancer, called resection, and can cure some people if a limited amount of cancer spreads to a single organ, such as the liver or a lung.

In colorectal cancer, if the cancer has spread only to the liver and if surgery is possible—either before or after chemotherapy—there is a chance of complete cure. Even when curing the cancer is not possible, surgery may add months or even years to a person’s life. Determining who can benefit from surgery for cancer that has spread to the liver is often a complicated process that involves doctors of multiple specialties working together to plan the best treatment option.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Generally, the treatment options for recurrent cancer are the same as those for metastatic cancer (see above) and include surgery, radiation therapy, and chemotherapy. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.  

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with colorectal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating colorectal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with colorectal cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for colorectal cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.    

Colorectal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about colorectal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Improved detection methods. Researchers are developing tests to analyze stool samples to find genetic changes associated with colorectal cancer. By finding and removing polyps or identifying cancer early, doctors have a better chance of curing the disease.

  • Tests to predict the risk of cancer recurrence. Various genes play important roles in the growth and spread of tumors. Tests to identify these genes can help doctors and patients decide whether to use chemotherapy after treatment. Researchers hope that these tests can help people with a lower risk of recurrence avoid the side effects of additional treatment.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. In the past several years, researchers have discovered a class of drugs that target the ways that tumor cells avoid the immune system. These drugs are called checkpoint inhibitors.

    The latest research has shown that certain checkpoint inhibitors, called PD-1 or PD-L1 inhibitors, can be effective against a type of metastatic colorectal cancer that is microsatellite high (MSI-H). Clinical trials are still going to confirm these results. People who are screened for hereditary colorectal cancer are also often tested for microsatellite instability. But it also can be tested for to see if someone can enter a clinical trial for checkpoint inhibitors. There are also clinical trials looking at combining checkpoint inhibitors with other drugs or cancer-directed treatments to see if they can be helpful in tumors that are not MSI-H.

  • New drugs. Many new drugs are being tested for colorectal cancer, including advanced colon and rectal cancers. New types of chemotherapy and targeted therapy are being studied. Most are only available through clinical trials.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current colorectal cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding colorectal cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.  

Colorectal Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for colorectal cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with colorectal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after you finish cancer treatment. Or, use the menu to choose another section to continue reading this guide.  

Colorectal Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. ASCO provides recommendations on the tests and schedule for follow-up care.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime. 

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from colorectal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress.

Regular physical activity can help rebuild your strength and energy level. Research has also suggested that exercise may lower the risk of colorectal cancer recurrence and let people live longer, although more studies are underway to confirm this. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options based on my diagnosis?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the risks and possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask before surgery

  • Where exactly is the cancer located?

  • What do you know about my cancer at this point?

  • If I have rectal cancer, should I have radiation therapy and chemotherapy before my rectal cancer surgery?

  • What other tests will be done before surgery?

  • Can you describe the surgery I will be having?

  • What are you planning to remove during surgery (the colon, rectum, lymph nodes)?

  • Is a biopsy part of the surgery?

  • How soon after surgery will I have all test results and a firm diagnosis?

  • Do you think I may need a temporary or permanent colostomy?

  • Is this the standard type of surgery for my condition?

  • How many times have you performed this type of operation successfully?

  • Who will give me information about how I should get ready for surgery and a hospital stay? How long will I be in the hospital?

  • How will my pain be controlled after surgery?

  • What other side effects are possible with this type of surgery?

Questions to ask after surgery

  • What is my diagnosis based on the results of surgery and biopsy reports, in TNM format?

  • Can you explain my pathology report (laboratory test results) to me?

  • Did the pathologist test my tumor for a possible genetic cause? Do I need more genetic counseling or testing?

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What is my prognosis?

  • How will additional treatment after surgery affect my prognosis?

  • What additional treatment do you recommend? Why?

  • What is the goal of each treatment?

  • Is it a standard treatment or part of a clinical trial?

  • How long will it be before I can go back to work after surgery?

  • If I need a colostomy, will you refer me to a specially trained nurse to decide on the best place for my colostomy and help me learn to manage it after the surgery?

  • Does my diagnosis mean that my relatives have a higher risk of colorectal cancer? Should they talk with their doctors about screening?

Questions to ask about having radiation therapy, chemotherapy, or targeted therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records? Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Colorectal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Colorectal Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Colorectal Cancer. Use the menu to select another section to continue reading this guide.