Management of Colon Cancer

Patient Guideline Summary

Publication Date: January 18, 2022

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society of Colon and Rectal Surgeons (ASCRS) for colon cancer. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Colon cancer occurs most commonly over 50 years of age. It is best diagnosed by screening.

There are no known causes, but certain hereditary conditions increase its incidence.

Early symptoms include a change in bowel habits and blood in the stool.

This patient summary focuses on surgical management of colon cancer.

Diagnosis

All serious diseases require a thorough evaluation. For colon cancer these are included:
Carcinoembryonic antigen (CEA)
Colonoscopy with biopsy-proved cancer
Computed tomography (CT) or magnetic resonance imaging (MRI) of the chest, abdomen, and pelvis
Tumor, Node, Metastasis Staging
Possibly positron emission tomography (PET)/CT

Treatment

It is rare for cancer treatment to proceed without multidisciplinary consultation involving experts in every related specialty.

A wide variety of surgical procedures is available depending on the extent of cancer and the surgical expertise available.
- Some localized cancers can be removed through an endoscope.
- More extensive cancers require a thorough exploration of the entire abdomen.
- Sometimes a colostomy (an opening through the abdominal wall through which the bowel empties, requiring a bag to catch the stool) is required.
  - A colostomy may be temporary, taken down at a subsequent operation.

Neoadjuvant treatment (chemotherapy or radiotherapy before surgery) may reduce tumor mass, making complete resection more likely.
- Cancers initially judged to be unresectable may become resectable following neoadjuvant treatment.
If complete removal of the cancer is not possible, surgery may still be needed to deal with bleeding, obstruction, or perforation of the bowel.

Surgery may also be helpful or necessary for distant metastases (pieces of original cancer in other locations) that are causing symptoms.

Chemotherapy after surgery (adjuvant), generally begun within 8 weeks of surgery, maybe the best option for cancer that couldn’t be removed surgically but is or will be symptomatic.

Immunotherapy has proved effective for certain types of colon cancer.

Gene analysis may help guide treatment decisions.

Abbreviations

ASCRS: American Society Of Colon And Rectal Surgeons
CEA: Carcinoembryonic Antigen
CT: Computed Tomography
MRI: Magnetic Resonance Imaging
PET: Positron Emission Tomography

Source Citation

Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, Thorsen AJ, Weiser MR, Chang GJ, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177. doi: 10.1097/DCR.0000000000002323. PMID: 34775402.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.