I Was Just Diagnosed with Colon Cancer. What Are the Next Steps?

Key Takeaways

• A biopsy confirms a colon cancer diagnosis, and the pathology report describes the type of cancer and how abnormal the cells look.
• Lab tests on tumor tissue look for gene and protein changes to help guide treatment choices.
• Staging uses imaging, blood tests, and often surgery to assign a stage from Stage 0 through Stage IV.
• Treatment is based largely on stage, and surgery is often the main treatment when colon cancer has not spread to distant sites.
• RCCA provides care for cancer and blood disorders, including colon cancer, along with second opinions and clinical trial access, at numerous locations across New Jersey, Connecticut, and Massachusetts.

What Does a Colon Cancer Diagnosis Mean?

Colon cancer forms in the tissues of the colon, the main part of the large intestine. To confirm a diagnosis, a doctor, typically a gastroenterologist, examines the colon, and a pathologist, a doctor who studies cells and tissue under a microscope, checks samples for cancer.

Tests used to evaluate the colon and confirm a colon cancer diagnosis may include:

• Biopsy: Small pieces of tissue are removed, usually during a scope exam, and checked for signs of cancer.
• Colonoscopy: A thin, lighted tube with a camera is used to view the entire colon and rectum.
• Computed tomography (CT) colonography: A series of X-rays creates detailed pictures of the inside of the colon.
• Sigmoidoscopy: A thin, lighted tube is used to view the rectum and lower colon.

A pathology report reviews key findings from such tests. Most colon cancers are adenocarcinomas, which start in mucus-making gland cells within the colon. Less common types of colon cancer include carcinoid tumors, a type of neuroendocrine tumor, and gastrointestinal stromal tumors.

The pathology report may also describe:

• Grade: Cells are described as well, moderately, or poorly differentiated, and well-differentiated and moderately differentiated cells tend to grow slower than poorly differentiated cells.
• Lymphovascular invasion: This finding means that the cancer has grown into small blood or lymph vessels, and it may affect the treatments recommended after surgery.
• Margins: A pathologist checks the edges of removed tissue, and margin status is one of several factors used to determine whether additional treatment may be needed after a cancerous polyp is removed.

Additionally, biomarker tests look for changes in genes, proteins, and other substances in cancer cells. Results can help show if targeted therapy or immunotherapy is likely to help. Common biomarker tests include:

• Microsatellite instability (MSI) and mismatch repair (MMR) testing: MSI testing looks for instability in specific DNA sequences, while MMR testing evaluates the tumor’s mismatch-repair system. For cancers that are MSI-high or mismatch repair-deficient, immunotherapy may be an option.
• KRAS, NRAS, and BRAF testing: Advanced cancers are typically tested for changes in these genes to see if targeted therapy may help.
• HER2 and NTRK testing: Cancers without KRAS, NRAS, or BRAF changes may be tested for these changes to find other targeted options.

How Does Colon Cancer Staging Work?

Staging is the process of finding out if cancer has spread within the colon or to other parts of the body. The resulting stage, one of several colon cancer stages, describes how much cancer is in the body and helps the care team plan treatment. When colorectal cancer is found before it spreads beyond where it started, the 5-year relative survival rate is 91.3%.

Staging Tests

Clinical staging uses exams, biopsies, and imaging done before surgery. A pathologic stage comes from tissue removed during surgery and is likely to be more accurate, which means the final stage may be set after an operation. Staging relies on a set of tests and a standard system for describing results.

Staging tests may include:

• Carcinoembryonic antigen (CEA) blood test: This test measures CEA, a substance released by both cancer cells and normal cells, and it is used along with other tests.
• CT scan: Detailed images of the chest, abdomen, and pelvis can show if cancer has reached lymph nodes, the liver, the lungs, or other organs.
• Lymph node biopsy: Nearby lymph nodes, typically at least 12, are removed during surgery and checked for cancer.
• Magnetic resonance imaging (MRI): Radio waves and strong magnets create detailed pictures of soft tissue, including areas of the liver.
• Positron emission tomography (PET) scan: This imaging test may be used in select cases to help determine whether cancer has spread. During a PET scan, a slightly radioactive form of sugar collects mainly in cancer cells to help doctors visualize potential spread.

TNM System and Stages 0 Through IV

Most colon cancers are staged with the tumor, node, metastasis (TNM) system. The T describes how far the tumor has grown into the colon wall, the N describes spread to nearby lymph nodes, and the M describes spread to distant sites.

Each stage of colon cancer is defined as follows:

• Stage 0: Cancer cells are confined to the innermost lining of the colon.
• Stage I: Cancer has grown into deeper layers of the colon wall but has not spread beyond it.
• Stage II: Cancer has grown through the wall of the colon and may reach nearby tissue, but it has not spread to lymph nodes.
• Stage III: Cancer has spread to nearby lymph nodes but not to other parts of the body.
• Stage IV: Cancer has spread to distant organs or tissues, such as the liver or lungs.

What Are the Treatment Options for Each Stage of Colon Cancer?

Colon cancer treatment is based largely on stage, though biomarker results and overall health also play a role. Patients and their care team work together to decide on a plan, which may include more than one type of treatment. For some patients, colon cancer clinical trials may be an option.

Treatment generally varies between earlier and later stages of colon cancer.

Treatment for Stage 0 through Stage II Colon Cancer

Stage 0 and Stage I colon cancers are often treated with surgery alone. Surgical options may include:

• Local excision: Tools passed through a colonoscope remove small cancers along with a small amount of healthy tissue.
• Partial colectomy: A surgeon removes the section of colon with cancer and nearby lymph nodes, then reconnects the remaining sections.
• Polypectomy: The cancer is removed as part of a polyp during a colonoscopy.

For Stage II colon cancer, surgery may be the only treatment needed. For some patients with Stage II colon cancer, adjuvant chemotherapy may be considered based on MSI/MMR status and other high-risk features, such as:

• A high grade
• Growth through the colon wall
• Spread into nearby blood or lymph vessels
• Fewer than 12 lymph nodes removed
• Cancer at or near the margins
• A blockage or hole in the colon

Treatment for Stage III and Stage IV Colon Cancer

Stage III colon cancer is typically treated with a partial colectomy followed by adjuvant chemotherapy. This treatment aims to lower the chance of cancer returning and is generally given for three to six months.

For Stage IV colon cancer, surgery may help patients live longer when the cancer has spread to only a few small areas of the liver or lungs. In these cases, the surgeon may remove those areas along with the colon tumor, and chemotherapy may be given before surgery, after surgery, or both.

Other options may include targeted therapy or immunotherapy, depending on the cancer’s biomarkers and other clinical factors. These treatments are matched to specific gene or protein changes in the cancer cells, and immunotherapy may be an option for MSI-high cancers or cancers with MMR gene changes.

Which Specialists Treat Colon Cancer?

A variety of colon cancer specialists may be included in the care team, including:

• Genetic counselor: This health professional helps patients understand inherited risk and whether genetic testing may help.
• Medical oncologist: This doctor specializes in treating cancer with chemotherapy and other medicines.
• Radiation oncologist: This doctor uses radiation to treat cancer, which may be part of care for some advanced colon cancers.
• Surgical oncologist: This surgeon specializes in using surgery to treat cancer.

RCCA’s medical oncologists and hematologists treat cancer and blood disorders with therapies such as chemotherapy, targeted therapy, and immunotherapy. RCCA physicians collaborate and coordinate with other physicians on each patient’s care team. Patients preparing for a visit can learn what to expect at a first oncology appointment.

Should Patients Just Diagnosed with Colon Cancer Get a Second Opinion?

A second opinion can help confirm a colon cancer diagnosis and treatment plan. The second doctor reviews the pathology report, slides, and scans, and may agree with the first doctor, suggest changes, or provide more information. The time right after diagnosis or a biopsy is often ideal, since patients can explore options before treatment begins.

Records to gather include:

• Biopsy slides
• CT, PET, and MRI scans
• Lab and blood test results
• List of current medications
• Operative notes from any surgery
• Pathology reports

RCCA prioritizes appointments for second opinions to help patients get in quickly and offers telehealth visits when medical records are sufficient. RCCA’s guide to getting a second opinion on a cancer diagnosis explains the process in more detail.

Find Comprehensive Colon Cancer Care Near You in NJ, CT, & MA

For patients just diagnosed with colon cancer, a colon cancer specialist can explain test results, the staging process, and treatment options. Regional Cancer Care Associates (RCCA) treats cancer and blood disorders, with more than 90 medical oncologists and hematologists caring for more than 30,000 new patients and 265,000 established patients each year. RCCA also offers access to approximately 300 clinical trials at more than 20 locations near you in New Jersey, Connecticut, and Massachusetts. To learn more about RCCA, call 844-346-7222 or contact RCCA online.

Frequently Asked Questions About a New Colon Cancer Diagnosis

What should patients do first after a colon cancer diagnosis?

Common first steps include reviewing the pathology report, completing staging tests, and asking about biomarker testing and a second opinion.

How soon does colon cancer treatment need to start?

Timing depends on each patient’s case. Some people can wait a few weeks to start treatment, which may allow time for test results or a second opinion. The cancer care team can explain when treatment should begin.

How is rectal cancer treatment different from colon cancer treatment?

Both are treated mainly by stage. Treatment for Stage II and Stage III rectal cancer often includes therapy before surgery, which may involve chemotherapy, radiation therapy, or both, depending on the individual treatment plan.

What questions should patients ask at the first colon cancer appointment?

Helpful questions include where the cancer is located, what the stage means, and if more tests are needed before treatment. Patients can also ask if the cancer was checked for gene changes and if a second opinion may help.

When is a colostomy needed after colon cancer surgery?

A colostomy is needed only in some cases. After a partial colectomy, surgeons usually reconnect the remaining sections of colon. When a colostomy, an opening in the abdomen for waste to leave the body, is needed, it may be temporary and reversed later.

What is recovery like after a partial colectomy?

Patients generally advance their diet after surgery as bowel function returns and according to their surgical team’s recommendations. Pain relievers can help with discomfort early on. Patients should follow the post-care instructions provided to them.

Can colon cancer run in families?

Yes. Some colon cancers are linked to Lynch syndrome. When MSI or MMR results point to this condition, the doctor may recommend genetic counseling and testing, and relatives may want to be tested, too.

Are clinical trials an option after a new colon cancer diagnosis?

Clinical trials may be an option for some patients. Since some trials are open only to patients who have not started treatment, it can help to ask the care team about trials before treatment begins.

What colon cancer care does RCCA provide?

RCCA’s colon cancer care may include chemotherapy, targeted therapy, and immunotherapy, along with second opinions and clinical trial access; RCCA also treats blood disorders.