ASCO Patient Guide: Adjuvant Chemotherapy for Stage II Colon Cancer

Quick Links

Newly Diagnosed: First Steps to Take

Find an Oncologist

Clinical Trials

Managing Side Effects

Survivorship: Next Steps to Take

Other ASCO websites

Home > ASCO Resources > Patient Guides

ASCO Patient Guide: Adjuvant Chemotherapy for Stage II Colon Cancer

Introduction

August 2004

To help doctors give their patients the best possible care, ASCO asks its medical experts to review the latest research on issues in cancer care and develop recommendations called clinical practice guidelines.

To help patients understand their cancer care, ASCO created this patient guide, based on the guidelines ASCO's experts developed to help people with stage II colon cancer.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.

Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product or company.

All guides are available in print or in PDF format. To order copies of ASCO Patient Guides, call ASCO customer service at 888-273-3508 or visit ASCO's publications shopping cart.

Last Updated: August 16, 2004

< Previous

Next >

What is stage II colon cancer?

Colon cancer is a disease in which the normal cells in the lining of the colon begin to change in a way that causes them to grow uncontrollably and form a mass of cells, called a tumor. If a tumor is large enough, it can interfere with the normal function of the colon, such as digesting food and passing waste. The colon is part of the large intestine; the rectum is the last few inches of the colon, and the treatment of tumors in this area may differ from other areas of the colon.

Stage II colon cancer means that the cancer has spread through the wall of the colon and may have spread to nearby tissues or organs, but has not spread to the nearby lymph nodes. Lymph nodes are tiny, bean-shaped structures clustered throughout the body. They filter out and remove bacteria, viruses, and other foreign substances such as cancer cells from the bloodstream, and supply lymphocytes (white blood cells) to the bloodstream.

When patients have surgery for colon cancer, surgeons typically remove lymph nodes in the surrounding area as part of the standard surgical procedure. In this process, the doctors are able to learn whether the cancer has spread to the lymph nodes. Pathologists (doctors who study tissue samples for evidence of disease) carefully review the tumor sample removed by the surgeon to determine how many lymph nodes were removed and whether there is evidence of colon cancer in any of these nodes.

If cancer has not spread to the lymph nodes, it is a stage II cancer. If one or more lymph nodes show evidence of cancer, it is a stage III cancer. The chances of remaining cancer-free following surgery are better for patients with stage II cancer, as there is less likelihood of microscopic cells left behind after surgery than in patients with stage III cancer. After successful surgery for stage II colon cancer, the survival rate after five years (excluding deaths from other causes) is approximately 75%.

Last Updated: August 16, 2004

< Previous

Next >

What are the ASCO recommendations?

Adjuvant chemotherapy is not recommended for routine use in patients with stage II colon cancer.

Clinical trials have not established with certainty that adjuvant chemotherapy helps patients with stage II colon cancer, although the results of most trials show a small benefit of adjuvant chemotherapy. Specifically, patients who receive adjuvant chemotherapy have about a 4% to 5% greater chance of survival five years after surgery, compared with patients who had surgery alone. The exact benefit is not known with certainty because not enough stage II patients have been included in clinical trials.

The reason for the ongoing uncertainty is that the chance of recovery after surgery alone is so favorable that many patients with stage II disease would need to be included in clinical trials to demonstrate a benefit. In other words, many patients have to be treated to help the small number of patients who have microscopic disease that was left behind after surgery.

The panel estimated that the chances of living five years after treatment (also known as the five-year relative survival rate) increases by 5% or less for average-risk patients with stage II colon cancer who receive adjuvant chemotherapy, compared with those who do not. In other words, patients who receive chemotherapy treatment after surgery have a very small chance of reducing the risk of their cancer coming back, compared with patients who do not receive the extra treatment. This means that patients should talk to their doctors about whether a small benefit is worth the risk of extra treatment.

In certain cases, it may be reasonable for you and your doctor to consider adjuvant chemotherapy.

Although most people with stage II colon cancer are cured after surgery, about 25% experience a recurrence (return) of cancer.

The following factors seem to be related to a recurrence of colon cancer.

A tumor that has invaded other organs or grown through the lining of the abdominal cavity
Perforation (tearing) of the colon at the site of the tumor
The availability of a small number of lymph nodes in the sample removed by the surgeon
The tumor's histology (appearance of the tumor under a microscope)

However, none of these factors guarantee that the cancer will or will not return, and doctors cannot use these factors to predict how effective adjuvant chemotherapy will be for an individual patient. Therefore, the degree of possible benefit must be balanced against the side effects typically seen with adjuvant chemotherapy.

All patients are encouraged to discuss with their doctor the value of adjuvant chemotherapy.

Making a decision about whether to receive adjuvant chemotherapy is personal. Because the value of adjuvant chemotherapy for patients with stage II colon cancer is not clear, there are no right or wrong answers.

The ASCO Guidelines describe several points of discussion for patients and their doctors to help guide the decision-making process. The following suggestions are designed to help people talk about treatment options with their doctor.

Ask your doctor to talk to you about adjuvant chemotherapy. Consider bringing another person along to help you ask questions. Or, take notes so that you can review them later.
Tell your doctor what kind of information you are comfortable hearing. For example, some people prefer numbers or percentages and some people prefer descriptions ("very small"). If you ask for estimates with numbers, make sure you understand what the numbers mean and refer to. Recognize that they are estimates.
Decide how much information you want to know about your cancer, such as how many lymph nodes were examined after your surgery or detailed information about the tumor, and help guide your doctor by indicating whether you prefer more or less detail.

Last Updated: August 16, 2004

< Previous

Next >

Options

Printer-Friendly

E-mail this page

Download PDF

Jump to Section