Colon Cancer Stage II

Stage II colon cancer means the cancer has grown into or through the outer layers of the colon wall but has not yet spread to the lymph nodes or other parts of the body. Understanding your diagnosis and treatment options can help you make informed decisions about your care.

Table of contents

• What is Stage II Colon Cancer?
• The Three Categories of Stage II Colon Cancer
• Treatment Options
• Factors That Affect Treatment Decisions
• What to Expect After Treatment

What is Stage II Colon Cancer?

In stage II colon cancer, the cancer has spread into the outer layers of the colon or rectum but has not spread to any lymph nodes (small bean-shaped organs that help fight infection)^[1]. This stage falls between stage I, where cancer is contained within the inner layers of the colon, and stage III, where cancer has reached the lymph nodes^[4].

Stage II colon cancer is a diverse group of cancers. Approximately one-quarter of all colon cancer cases are classified as stage II^[7]. While this stage generally has a good outlook, the cancer can vary significantly in its characteristics and behavior^[4].

The Three Categories of Stage II Colon Cancer

Stage II colon cancer is divided into three categories based on how deeply the cancer has grown into or through the colon wall^[1].

Stage IIA: Cancer has spread into the muscularis propria layer of the colon (the outer muscle layer) but has not grown beyond it. It has not spread to any other organs or lymph nodes^[1].

Stage IIB: Cancer has spread through to the outermost layer of the colon wall, which is called the serosa (the thin outer covering of the colon). It has not spread to any other organs or lymph nodes^[1].

Stage IIC: Cancer has spread through the colon wall and into nearby tissue. It has not spread to any other organs or lymph nodes^[1].

Treatment Options

Surgery

Surgery is the main treatment for stage II colon cancer^[5]. Often, the only treatment needed is a partial colectomy, a surgery that removes the section of colon where the cancer is located^[1]. This procedure is also called a bowel resection and typically includes removal of nearby lymph nodes to check for cancer spread^[12].

In some cases, a colostomy or ileostomy may be needed after the bowel resection. A colostomy creates an opening from the colon to the outside of the body through the abdominal wall, while an ileostomy creates an opening from the ileum (the last part of the small intestine). These create a new path for stool to leave the body^[12]. The colostomy or ileostomy can be temporary to allow the intestine to rest and heal after surgery^[12].

If the cancer was part of a polyp and the polyp was completely removed during a colonoscopy (a procedure to examine the inside of the colon), no further surgery may be needed^[12].

Chemotherapy

The role of chemotherapy (drug treatment that kills cancer cells) in stage II colon cancer is an area of ongoing discussion among doctors^[11]. Chemotherapy aims to eliminate any cancer cells that may remain after surgery, helping to prevent the cancer from returning^[11].

Chemotherapy may be offered after surgery if there is a high risk that the cancer will come back^[12]. An estimated 75% of people with stage II colon cancer will be cancer-free 5 years later without additional chemotherapy after surgery, but 25% will not^[16]. The challenge is identifying which patients will benefit from chemotherapy, as most patients treated with it do not gain from the therapy^[7].

The chemotherapy drugs that may be given for stage II colon cancer include^[12]:

• Capecitabine (Xeloda)
• 5-fluorouracil (Adrucil, 5-FU) with leucovorin (folinic acid)
• Oxaliplatin (Eloxatin)
• FOLFOX – a combination of leucovorin, 5-fluorouracil and oxaliplatin
• CAPOX (also called XELOX) – a combination of capecitabine and oxaliplatin

Factors That Affect Treatment Decisions

Doctors consider several factors when deciding whether chemotherapy should be used after surgery. These are called high-risk features, and their presence suggests a greater chance that the cancer might return^[11].

Chemotherapy may be considered if at least one of the following high-risk features is present^[12]:

• The tumor is T4 (stage 2B or 2C)
• Fewer than 12 lymph nodes were removed or could be examined by the pathologist (a doctor who examines tissue samples)^[12][4]
• The tumor has grown into nearby lymph nodes, blood vessels, or the space surrounding nerves
• The tumor is high grade (the cancer cells look very different from normal cells)^[12]
• There is a blockage in the intestine (bowel obstruction) or a tear or hole in the intestine (bowel perforation)^[11]
• Not enough healthy tissue was removed along with the tumor, or cancer cells are found in the tissue removed with the tumor (positive margins)^[11]

Additional factors that help doctors make treatment decisions include the tumor’s microsatellite instability (MSI) status. Patients with certain types of MSI tumors, particularly those with T3 disease, have excellent outcomes and may not require chemotherapy^[7]. For patients with microsatellite-stable disease, other tests based on gene expression can provide additional information about prognosis and help inform discussions about chemotherapy benefits^[7].

The decision about whether to use chemotherapy depends on balancing the small potential benefit against the real risks of chemotherapy side effects^[11]. Your healthcare team will work with you to develop a treatment plan based on your specific situation^[4].

What to Expect After Treatment

Stage II colon cancer is considered to have a good prognosis overall^[4]. Regular follow-up care is essential to monitor for any return of cancer and to manage any long-term effects of treatment.

Your doctor may recommend a schedule that includes^[21]:

• Colonoscopy: Typically done one year after surgery, then every three to five years if results are normal
• Imaging tests such as CT scans, which may be conducted every 6-12 months for those at higher risk
• Blood tests to check a tumor marker called CEA (carcinoembryonic antigen), which may be measured every 3-6 months for a few years after treatment if it was high before surgery

Some people experience long-term changes after colon cancer treatment. These may include bowel changes such as diarrhea, constipation, or changes in bowel control^[21]. Working with your healthcare team can help you manage these effects and maintain your quality of life.

Creating a survivorship care plan with your doctor is an important step. This plan should include a schedule for follow-up exams and tests, awareness of potential long-term side effects, and recommendations for maintaining overall health through nutrition and exercise^[21].