In stage 3 colon cancer, the cancer cells have spread to nearby lymph nodes but not anywhere else in the body. Doctors use the National Cancer Institute’s staging system to determine whether a person’s tumor is stage 0 (no spread), stage 1 (spread to one lymph node), or stage 2 (spread to two or more lymph nodes).
The doctor may perform a biopsy to confirm the diagnosis and classify the cancer. Biopsy results can help doctors decide the best treatment options for a patient.
Surgery is a common treatment for stage 3 colon cancer. This operation removes the portion of the colon containing the cancer and any surrounding tissue or lymph nodes that contain cancer cells. It is usually followed by chemotherapy.
A regimen of oxaliplatin and a fluoropyrimidine has been used as standard adjuvant therapy in patients with stage III colon cancer since 2004. In a number of phase 3 trials, the addition of oxaliplatin improved disease-free survival. This finding was subsequently extended to overall survival. However, oxaliplatin is associated with cumulative neurotoxicity. This could be reduced by a shorter duration of adjuvant therapy.
Chemotherapy is a treatment that uses drugs to kill cancer cells and prevent them from growing. It can be given alone, in combination with another drug, or as part of a supportive care regimen.
FOLFOX and CAPOX are the most common chemo regimens for people with stage 3 colon cancer. They can be used with 5-FU and leucovorin or capecitabine alone.
This chemotherapy is also sometimes used to treat gastrointestinal stromal tumors, which can form in the walls of the colon. They can be very slow-growing and hard to detect, and they are difficult to remove.
It is very important to manage the side effects of chemo carefully, as they can affect the treatment you receive and quality of life. Symptoms can include fatigue, loss of appetite, weight gain, nausea, vomiting, and diarrhea.
The treatment for stage 3 colon cancer usually includes surgery and a course of chemotherapy. The length of the chemo depends on your age, health, and medical history.
Some studies show that a shorter course of chemo is just as effective for people with stage 3 colon cancer who have a low risk for recurrence. Other studies suggest that a shorter course of chemo can lessen the side effects.
Adjuvant chemo is recommended after surgery for many people with stage 3 colon cancer to reduce the risk of recurrence or improve the chance of cure. It is usually given after surgery and in conjunction with other treatments, such as radiation therapy or hepatic artery infusion.
Using a 3-month course of oxaliplatin with fluorouracil and leucovorin (FOLFOX or CAPOX) has been shown to offer the same benefits as 6 months of adjuvant therapy, but at a lower risk of toxicities from the chemotherapy. This short course of oxaliplatin and fluorouracil is likely to be the most appropriate for some people.
In a single-center, retrospective analysis of 11,239 patients operated for stage III colon cancer, the crude 5-year overall survival (OS) was significantly better for those who received FOLFOX and capecitabine than for those who had surgery alone. This was primarily because FOLFOX and capecitabine were significantly more effective than surgery in preventing recurrence or death.
