Treatment of Colon Cancer
Publication Date: October 1, 2017
Last Updated: March 14, 2022
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
American Society of Colon and Rectal Surgeons
Publication Month/Year
October 1, 2017
Last Updated Month/Year
January 17, 2024
Supplemental Implementation Tools
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
Intended Users
Nurse, nurse practitioner, physician, physician assistant
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
Supplemental Methodology Resources
Methodology
Number of Source Documents
211
Literature Search Start Date
January 1, 1997
Literature Search End Date
April 21, 2017