What is colon cancer staging?
Colon cancer staging is used to help tell you more about your specific colon cancer, including where it’s located and if it has spread to other parts of the body. If you have colorectal cancer, your care team will put your cancer into one of several stages.
Stages aren’t used as part of colon cancer screening. They are only used after you’ve been diagnosed with colorectal cancer. Colon cancer stages are important because they guide decisions about the right cancer care options for you.
Colon cancer stages
Understanding your stage can help you feel confident in your colon cancer treatment plan and next steps. Colon cancer falls into one of several stages—from 0 to 4—with 0 being the earliest precancerous stage and four being the latest. Generally, the lower the stage, the less your cancer has spread.
Within these stages, your care team also uses substages to give even more detail about the type and location of your colon cancer. These substages add a letter along with the stage number. For example, you may have stage 2B or stage 3A colon cancer.
When deciding the stage of colon cancer, your healthcare providers use a standard system that looks at three main factors: tumor, node and metastasis.
- Tumor (T): This describes the tumor size and how many layers of tissue within the colon or rectum are affected.
- Node (N): Cancer often spreads into the nearby lymph nodes. Your team will look to see if any cancer cells are in these nodes.
- Metastasis (M): Metastasis is a term that describes cancer that has spread to other organs or distant parts of your body.
Learn more about each stage:
Stage 0 colon cancer
Stage 0 colon cancer is cancer that is caught in the earliest stage. It’s sometimes called carcinoma in situ, which means that the abnormal cells have stayed within the inner lining of your colon. They have not spread to any other layers of tissue or anywhere else in the body.
When colon cancer is found in this early stage, it is highly treatable. Usually, people with stage 0 colorectal cancer only need surgery to remove the abnormal cells and don’t need other care like chemotherapy or radiation. The typical treatment, follow-up and recovery time for stage 0 cancer is one to three months.
Treatment
The primary treatment for stage 0 colon cancer is a polypectomy. This procedure removes a colon polyp that contains abnormal or cancerous cells during a colonoscopy. If the area is too large for a polypectomy, you may have surgery to remove the location of the affected colon.
After removing the cancer, your care team will carefully follow your health with additional checkups and screenings.
Survival rate
According to data from the National Cancer Institute, the survival rate for localized colon cancer, which includes stage 0, is 91% at five years.
Stage 1 colon cancer
Stage 1 colon cancer is considered localized colon cancer. This means the cancer cells are still only in the colon and haven’t spread to nearby lymph nodes or other areas of the body.
In stage 1, cancer cells have started to develop in additional layers of the colon tissue beyond just the inner lining. These layers include the second layer of tissue and the layer of muscle in the colon.
This stage of colon cancer is also very treatable. In many cases, the only treatment needed is surgery to remove the area of the colon affected by cancer. Your treatment and recovery time will depend on the procedure used to remove the tumor.
Treatment
Stage 1 colon cancer is sometimes treated by removing the cancerous polyp during a colonoscopy. You may have surgery if there are cancerous cells on the tumor’s edges or all the cancer can’t be removed.
A colon resection, also known as a partial colectomy, can remove the part of the colon affected by the tumor. Then, the remaining parts of the colon are connected back together.
Survival rate
The National Cancer Institute reports that the five-year survival rate for localized colon cancer, which includes stage 1, is more than 90%.
Stage 2 colon cancer
In stage 2 colon cancer, cancer has started to grow through the layers of the colon and possibly through the colon wall into nearby tissues. However, it has not spread to nearby lymph nodes or distant body parts.
Usually, the primary treatment for stage 2 colon cancer is surgery to remove the tumor and part of the colon. But in some cases, you may need other treatments. Your treatment and recovery time may be longer than earlier stages of colon cancer, depending on the care you need.
With this stage, your care team will also use the 2A, 2B and 2C substages to describe how far through and outside the colon wall cancer has spread.
- Stage 2A: The cancer cells have spread and reached the outer layer of the colon.
- Stage 2B: Colon cancer has spread through the outer colon wall but does not affect nearby tissues or lymph nodes.
- Stage 2C: The cancer is through the outer colon wall and has spread to some nearby tissues or organs but not the lymph nodes.
Treatment
The primary treatment for all stage 2 colon cancer substages is surgery to remove part of the colon and some nearby lymph nodes. Often, this is the only care that’s needed. If you have a high chance of colon cancer returning, your care team may talk with you about chemotherapy.
When talking with your doctor about chemotherapy, discuss if some of the cancer may have been left after surgery, if it caused a blockage or hole in the colon, if it spread into blood vessels or if it is classified as high-grade by the lab.
Survival rate
Stage 2 colon cancer is considered regional. The National Cancer Institute reports a five-year survival rate of 72% for regional colon cancer.
Stage 3 colon cancer
With stage 3 colon cancer, the cells have spread through some or all the colon’s layers and to nearby lymph nodes. But they have not spread into any other organs.
When colon cancer reaches stage 3, your care team may recommend using more than one treatment to help fight your cancer. As a result, your cancer treatment and recovery at this stage may be anywhere from six months to a year.
If you have stage 3 colon cancer, your specific cancer will be put into one of three substages—3A, 3B or 3C. Your care team will decide the substage based on how far the cancer has spread through the colon and how many lymph nodes are affected by your cancer.
- Stage 3A: Cancer has spread to the layer of muscle in the colon and one to three lymph nodes or has grown into the first two layers of the colon and spread to four to six lymph nodes.
- Stage 3B: This substage includes cancer that has spread through the colon wall into the abdominal tissue and to one to three lymph nodes; cancer in the muscle layer or outer layer and four to six lymph nodes; or cancer that is in the first two layers of the colon and at least seven lymph nodes.
- Stage 3C: The most advanced stage 3 cancer includes cancer that has spread into the abdominal lining and to four to six lymph nodes; cancer that has spread through the colon wall or into abdominal tissue and to at least seven lymph nodes; or cancer that has spread to nearby organs as well as one lymph node.
Treatment
The typical treatment for all types of stage 3 colon cancer is surgery to remove the tumor, followed by chemotherapy. During a colon resection or partial colectomy, your surgeon will remove the tumor and a section of the colon.
Sometimes, your care team includes radiation therapy in your stage 3 colon cancer treatment plan. Radiation therapy is more common when all the cancer can’t be removed during surgery. Chemotherapy and radiation help make the tumor smaller before surgery to make it easier to remove, or radiation may be used after surgery.
Survival rate
While stage 3 colon cancer has started to spread, it’s still considered regional cancer since it has not yet reached distant parts of the body. The survival rate at five years for regional colon cancer (stages 2 and 3) is 72%, according to the National Cancer Institute.
Stage 4 colon cancer
Stage 4 colon cancer is the most advanced stage of colon cancer. When colon cancer reaches this stage, it has spread beyond the colon and the nearby lymph nodes and abdominal tissue. Some places in the body where cancer is found in stage 4 colon cancer include the liver, lungs, ovaries, brain or distant lymph nodes.
You’ll likely need a combination of treatments, such as surgery, chemotherapy, targeted therapies, immunotherapy or radiation therapy. Be sure to talk with your team about all your options. If one treatment plan doesn’t help, you may try another option.
Your treatment goals may differ depending on how much the colon cancer has spread. While some treatments aim to destroy or remove cancer, others may only help control or relieve symptoms for a time.
With stage 4 cancer, your team will put your specific cancer into one of three substages:
- Stage 4A: During this substage, colon cancer has spread to just one area of the body that isn’t nearby.
- Stage 4B: More than one organ or location in the body (distant from the colon) is affected.
- Stage 4C: Cancer is found in parts of the abdominal tissue far away from the colon and other body areas.
Treatment
Because treatment for stage 4 colon cancer often includes multiple types of care for cancer in various places in the body, your care team will design a plan for your specific needs.
Some people have surgery to remove the cancer in the colon, the affected lymph nodes and other small areas of cancer in organs such as the lungs or liver. The most common stage 4 colon cancer surgery is a colectomy to remove part or all of your colon.
Depending on your surgery, your surgeon may attach the remaining part of your colon to an opening in the abdomen, called a colostomy. With a colostomy, a bag is worn outside your stomach to collect stool. A colostomy is sometimes temporary, while other times, it’s permanent.
If surgery isn’t an option for your cancer, chemotherapy is the primary treatment. Several types of chemotherapy can be used along with other options. You might also have targeted therapies or immunotherapy, which attack cancer cells that have specific proteins or genes or have radiation therapy to help control symptoms.
Survival rate
Data from the National Cancer Institute shows a five-year survival rate for distant (stage 4) cancer of 13%. If your stage 4 colon cancer can’t be cured, your team will talk with you about options to slow the progression, reduce symptoms and support your quality of life.
Personalized support at any stage of colon cancer
No matter the stage of your colon cancer, our extensive network of cancer centers and dedicated cancer teams are there for you at every step. With the support of an entire system, you have even more access to treatment options, research, education and personalized care. And that will help you feel confident that you have all the resources you need to guide your next steps.
You and your family are not alone in this journey. We are here to support you. For those diagnosed with cancer, we provide physical, emotional, social and spiritual care from diagnosis to survivorship. We also offer tools specifically made to support the needs of families and caregivers.
Connect with certified navigators
Our certified patient navigators are there with you through every stage of your cancer diagnosis, treatment and recovery. They serve as your advocates and guides to help you navigate what is sometimes a complex journey.
Whether you have a question about your care, need help coordinating an appointment or want to connect with community resources, your navigator is ready to support you. They also serve as a resource and support for your family and caregivers.
Some of the ways our navigators help include:
- Educating you to help you make informed choices
- Answering questions about your care journey
- Advocating for you and improving access to care
- Connecting you with support groups and other resources
- Coordinating screenings, appointments and referrals
- Helping you follow your care plan
- Supporting you through the ups and downs of cancer
Frequently asked questions
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Is stage 3 colon cancer curable?
In many cases, yes. There are treatments available that are effective in stage 3 colon cancer. But cancers at this stage may need more than one treatment or have a higher chance of returning. The five-year survival rate for regional colon cancer is 72%.
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Is stage 4 colon cancer curable?
A cure is not always possible for stage 4 colon cancer. But every case is different, so your doctor will discuss your options. On average, the five-year survival rate for colon cancer that has spread to distant areas of the body is 13%.
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What stage of colon cancer requires a colostomy bag?
Most people with colon cancer don’t need a permanent colostomy bag at all stages. One may be needed if colon cancer affects the function of the anus. However, 80-90% of patients have surgical options to remove cancer without a colostomy.
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What stage of colon cancer causes anemia?
Anemia can be a sign of colon cancer in its earliest stages. It’s common for tumors to cause bleeding and lead to anemia, where you don’t have enough healthy red blood cells. Some common signs of anemia are fatigue, rapid heart rate, dizziness and shortness of breath.
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How many stages of colon cancer are there?
There are multiple stages of colon cancer - stage 0 to stage 4. Lower stages of colon cancer generally mean that the cancer has spread less, while higher stages mean it has spread more. The stage of your cancer is essential to guiding the proper care for you.