I want to walk you through some important clinical updates in the treatment of colon cancer and what they mean for you.
Better outcomes over time
Over the last few decades, thanks to better screening like colonoscopies, we've seen a big improvement in the survival rates for colon cancer. Early detection plays a huge role, but advances in treatment have also helped lower mortality rates.
When a patient is diagnosed — often after symptoms like fatigue and anemia lead to a colonoscopy — we stage the cancer based on how deeply it has penetrated the colon wall and whether it has spread to lymph nodes or other organs. Stage 1 and 2 cancers, when caught early, have cure rates over 90% after surgery. If the cancer reaches lymph nodes (stage 3) or other organs (stage 4), survival rates drop and treatment plans change.
Surgery remains the foundation
Surgery is still the cornerstone of treatment for early-stage colon cancer. In most stage 1 and 2 cases, a high-quality surgery — meaning at least 12 lymph nodes are removed — is enough. We only recommend chemotherapy after surgery if there are certain high-risk features like perforation or obstruction.
For stage 3 patients, chemotherapy is critical. Data going back 20 years shows that chemotherapy with a drug called 5-fluorouracil (5-FU) improves survival. Traditionally, chemotherapy was given for six months. Still, newer studies show that some low-risk patients can do just as well with only three months of treatment, reducing side effects like nerve damage from drugs like oxaliplatin.
Monitoring for recurrence
After treatment, we monitor patients using several tools: CEA blood tests, yearly CT scans for up to five years and a colonoscopy at the one-year mark. A newer blood test, called circulating tumor DNA (ctDNA), can detect tiny amounts of cancer DNA in the bloodstream. This helps us catch recurrences earlier, sometimes before a CT scan can. We're proud to offer the cutting-edge clinical trial CIRCULATE at Northside, which is testing the use of ctDNA to personalize decisions about whether patients need chemotherapy after surgery.
Newer treatments for advanced colon cancer
For stage 4 colon cancer, while we haven’t seen a major breakthrough yet, we have made important strides. Standard chemotherapy has improved survival from about six months to over two years when combined with targeted therapies like VEGF inhibitors (such as bevacizumab) and EGFR inhibitors for patients without KRAS mutations.
We also now perform detailed molecular testing on tumor tissue. This helps us find specific mutations — like BRAF, HER2 or rare ones like NTRK fusions — that have targeted treatments available. One of the biggest advances is immunotherapy. Patients whose tumors have microsatellite instability (MSI-high) respond extremely well to immune checkpoint inhibitors like pembrolizumab (Keytruda), sometimes avoiding chemotherapy altogether.
Hope even for stage 4 patients
Not all stage 4 cancers are the same. If a patient has limited spread, like a small spot in the liver, surgery or targeted liver treatments can offer the possibility of long-term remission. We now treat these patients aggressively with chemotherapy first, followed by surgery if possible, and in some cases, achieve outcomes we never thought possible before.
Conclusion
Colon cancer treatment has come a long way. By using sensitive new tests and personalizing therapy based on each patient’s cancer profile, we are improving outcomes and offering new hope, even for advanced cases.
Learn more about colorectal cancer treatment at Northside Hospital.
