Last updated December 18, 2021

Treatment of Colon Cancer

RECOMMENDATIONS

Evaluation and Risk Assessment

An assessment of disease-specific symptoms, past medical and family history, physical examination, and serum CEA level should typically be evaluated in patients with colon cancer. (1C)
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When possible, patients with presumed or proven colon cancer should undergo a full colonic evaluation with histologic assessment of the colonic lesion before treatment. (1C)
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Staging of Colon Cancer

Preoperative radiologic staging with a chest/abdomen/pelvis CT should typically be performed. (1B)
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Positron emission tomography/CT (PET/CT) is generally not recommended for routine colon cancer staging. (2B)
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Colon cancer staging should be performed according to the American Joint Committee on Cancer (AJCC)/TNM system and include an assessment of the completeness of surgical resection designated by the residual tumor code “R.” (1B)
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Surgical Treatment of the Primary Tumor

A thorough surgical exploration should be performed and the findings documented in the operative report. (1C)
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The extent of resection of the colon should correspond to the lymphovascular drainage of the site of the colon cancer.  (1B)
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Routine performance of extended lymphadenectomy is not recommended. (1B)
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Resection of adherent or grossly involved adjacent organs should be en bloc. (1B)
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Synchronous colon cancers may be treated by 2 separate resections or subtotal colectomy. (1B)
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Sentinel lymph node mapping for colon cancer does not replace standard lymphadenectomy. (1B)
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When expertise is available, a minimally invasive approach to elective colectomy for colon cancer is preferred. (1A)
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Hand-assisted laparoscopic and robotic surgical techniques for right colon cancer result in oncologic outcomes that are equivalent to open or straight laparoscopic techniques. (1B)
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Treatment of the malignant polyp is determined by the morphology and histology of the polyp. (1B)
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Tumor-Related Emergencies

Bleeding

When a colon cancer is the source of an acute lower GI bleed, in general, the initial management includes attempts to control the bleeding with nonsurgical approaches. In general, when surgery is required, an oncologic resection should be performed. (1C)
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Perforation

In the setting of perforation, resection following established oncologic principles with a low threshold for performing a staged procedure is recommended. (1C)
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Obstruction

For patients with obstructing left-sided colon cancer and curable disease, initial colectomy or initial endoscopic stent decompression and interval colectomy may be performed. (1B)
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For patients with obstructing right or transverse colon cancer and curable disease, initial colectomy or initial endoscopic stent decompression and interval colectomy may be performed.  (1C)
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When emergent surgery is performed for an obstructing colon cancer, intraoperative colonic lavage is not required. (1B)
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Management of Stage IV Disease

Resectable Stage IV Disease

The treatment of patients with resectable stage IV colon cancer should be individualized and based on a comprehensive multidisciplinary approach. (1B)
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Oophorectomy is recommended for grossly abnormal ovaries or contiguous extension of the colon cancer, but routine prophylactic oophorectomy is not necessary. (1C)
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 The treatment of patients with isolated peritoneal carcinomatosis should be multidisciplinary and individualized, and may include cytoreductive surgery with intraperitoneal chemotherapy. (1B)
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Unresectable Stage IV Disease

Resection of an asymptomatic primary colon cancer in patients with incurable metastatic cancer is generally not recommended. (2A)
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In patients with a large bowel obstruction caused by colon cancer who have incurable metastatic disease, or in other scenarios where palliation is the aim, decompressive stent insertion is preferable to colectomy or diversion. (1B)
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Management of Locoregional Recurrence

The treatment of patients with locoregionally recurrent colon cancer should be multidisciplinary. Potentially curative resection, including multivisceral resection, should be performed when indicated to improve overall survival. (1B)
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Recommendations Regarding Documentation

The operative report for colorectal cancer should include information regarding the diagnostic workup, intraoperative findings, and technical details of the procedure. (1C)
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Adjuvant Therapy

Adjuvant chemotherapy is typically recommended for patients with stage III colon cancer. (1A)
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Adjuvant chemotherapy may be considered for patients with high-risk stage II colon cancer. (2A)
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Recommendation Grading

Overview

Title

Treatment of Colon Cancer

Authoring Organization

Publication Month/Year

October 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D015179 - Colorectal Neoplasms, D003107 - Colorectal Surgery

Keywords

colon cancer, colorectal cancer, colorectal polyps

Source Citation

Vogel, Jon D. M.D.; Eskicioglu, Cagla M.D.; Weiser, Martin R. M.D.; Feingold, Daniel L. M.D.; Steele, Scott R. M.D. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer, Diseases of the Colon & Rectum: October 2017 - Volume 60 - Issue 10 - p 999-1017 doi: 10.1097/DCR.0000000000000926