Stage 3 Colon Cancer

What is stage 3 colon cancer?

Colon cancer, also known as colorectal cancer, is a type of cancer that starts in the colon or rectum. According to the National Institute of Cancer, colon cancer is the third most common cancer in the world in terms of the number of new cases and deaths [¹]. Colon cancer is a complex disease that can involve mutations in multiple genes. However, certain genes are commonly affected in colon cancer, such as the APC (adenomatous polyposis coli) gene, KRAS gene, TP53 gene, BRAF gene, PIK3CA gene, and MMR (mismatch repair) genes. [²]

Stage 3 colon cancer is a more advanced stage of the disease, in which cancer cells have spread beyond the lining of the colon or rectum and into nearby lymph nodes.

What are the subtypes of stage 3 colon cancer?

There are different sub-stages within stage 3 colon cancer, based on how far the cancer has spread into the lymph nodes [³].

Stage 3A

In stage 3A cancer, the cancer has spread into the innermost layers of the colon or rectum and up to three nearby lymph nodes. The tumor has not grown through the outermost layer of the colon or rectum and has not spread to other organs.

Stage 3B

In cancer stage 3B, the cancer has spread into the outermost layers of the colon or rectum and up to three nearby lymph nodes. The tumor has not spread to other organs.

Stage 3C

In stage 3C cancer, the cancer has spread into one or more nearby lymph nodes and the outermost layers of the colon or rectum. The tumor may have grown through the outermost layer of the colon or rectum and may have spread to other organs, such as the liver or lungs.

It is important to note that the treatment and prognosis for each substage of stage 3 colon cancer may vary. Generally, the higher the substage, the more aggressive the treatment may be to effectively treat the cancer.

Stage 3 colon cancer staging and diagnosis

Colon cancer staging

Colon cancer is divided into four main stages based on the progression level of the cancer. In general, the TNM system is used to describe and classify stages in cancer and is managed by The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) [⁴].

T (tumor) describes the size and location of the tumor and can either be TX (no information), T0 (no evidence), Tis (the pre-cancer stage where cancer is growing in the tissue it was found), and any number between one to four after the T (The higher the number, the bigger the tumor or, the more it has spread).
N (nodes) indicates whether it has spread to nearby lymph nodes and can either be NX (no information about nearby lymph nodes), N0 (no cancer in nearby lymph nodes), or any number between one to four after N (the higher the number, the bigger the tumor or, the more it has spread to nearby lymph nodes).
M (metastasis) describes if and how far the cancer has spread from its origin and can either be M0 (the cancer did not spread) or M1) the cancer has spread to distant organs.

How common is stage 3 colon cancer?

According to data collected by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, there are more than 151,030 new cases of colon cancer, contributing to 7.9% of all cancers in the United States. 36% of these cases consisted of regional cancers (stage three cancer). This means that there were more than 54,000 cases of colon cancer stage 3 [⁵]. Moreover, the American Cancer Society suggests there will be around 106,970 new colon cancer cases in 2023 [⁶].

How is stage 3 colon cancer diagnosed?

When colon cancer is caught early, it is more treatable and has a better prognosis. Some of the most common diagnostic tests for colon cancer include the following:

1. Colonoscopy

A colonoscopy is when a long, flexible tube with a camera on its end is inserted into the rectum to examine the colon and rectum for abnormal growths, such as polyps or tumors [⁷]. If any abnormal growths are found, a biopsy may be taken to determine if they are cancerous.

2. Imaging Tests

Imaging tests, such as CT scans, MRIs, or PET scans, may be performed to determine the extent of the cancer's spread [⁸]. These tests can also help identify if the cancer has spread to other organs, such as the liver or lungs.

3. Blood Tests

Blood tests, such as a complete blood count (CBC) or a carcinoembryonic antigen (CEA) test, may be used to help diagnose colon cancer [⁹]. These tests can show if there are any abnormal levels of blood cells or proteins that could indicate cancer.

4. Fecal Tests

A fecal test involves checking for blood in the stool and involves either a guaiac-based fecal occult blood test (gFOBT) or the fecal immunochemical test (FIT) [¹⁰].

5. Biopsy

A biopsy is usually performed when signs of cancer are noticed and involves removing a small tissue sample for further examination in a microscope [¹¹]. A biopsy helps provide a definite diagnosis of colon cancer and the stage of progression. The procedure typically involves a pathologist analyzing the sample in a laboratory.

Stage 3 colon cancer symptoms

The symptoms of stage 3 colon cancer are similar to those of earlier stages but may be more severe or pronounced due to the extent of the cancer's spread [¹²]. Some common stage 3 cancer symptoms include:

Change in bowel habits: This can include constipation, diarrhea, or a feeling that the bowel does not empty.
Blood in the stool: This may appear as bright red blood on the toilet paper, in the toilet bowl, or as black, tarry stools.
Abdominal pain or cramping: This can occur as the tumor grows and begins to obstruct the colon or as the cancer spreads to other organs.
Fatigue: This can be caused by the cancer itself or as a side effect of treatments such as chemotherapy.
Unexplained weight loss: This can occur due to the cancer's effects on the body and the side effects of treatments such as chemotherapy.
Iron deficiency anemia: This can occur due to chronic bleeding from the tumor.

It is important to note that other conditions, such as hemorrhoids or inflammatory bowel disease, may also cause these symptoms. However, if you experience any of these symptoms, especially if they persist for over a few weeks, it is important to consult your healthcare provider for further evaluation.

In some cases, stage 3 colon cancer may not cause any symptoms until it has advanced to a later stage. This is why regular screening for colon cancer is recommended, as it can help to detect the disease in its early stages before symptoms develop.

Stage 3 colon cancer treatment

Stage 3 colon cancer primary/first-line treatment

The primary or first-line treatment for stage iii colon cancer typically involves a combination of surgery and chemotherapy. The goal of treatment is to remove the cancerous tumor and any nearby lymph nodes that may be affected and to kill any remaining cancer cells.

The first step in treating stage iii cancer is usually a surgical procedure called colectomy. The type of surgery performed will depend on the tumor staging and grading. In most cases, a portion of the colon containing the tumor will be removed, along with nearby lymph nodes. The remaining portions of the colon and rectum will then be reconnected to allow for normal bowel function [¹³].

After surgery, chemotherapy is typically given to kill any remaining cancer cells and reduce the risk of cancer recurrence. Chemotherapy may be given orally or intravenously, typically in cycles over several months. The specific chemotherapy drugs used will depend on the individual patient's condition and the stage of their cancer [¹⁴].

In some cases, radiation therapy may also help shrink the tumor before surgery or kill any remaining cancer cells after surgery.

It is important to note that the treatment plan for stage 3 colon cancer may vary depending on the individual patient's condition, the location and size of the tumor, and other factors. Your healthcare provider will work with you to determine the most appropriate treatment plan for your case.

Other types of treatment for stage 3 colon cancer

If a patient does not want to receive surgery or chemotherapy or is not responsive to the first-line treatments, they may opt for other treatments for colon stage 3 cancer [¹⁵] [¹⁶], including:

Radiation therapy

Radiation therapy may also help shrink the tumor before surgery or kill any remaining cancer cells after surgery. Radiation therapy uses high-energy X-rays to kill cancer cells [¹⁷]. It may be given externally or internally, depending on the location and size of the tumor.

Targeted therapy

Targeted therapy is a type of cancer treatment that uses drugs to target specific proteins or genes that contribute to the growth and spread of cancer cells [¹⁸]. This therapy is typically used with chemotherapy and may be given orally or intravenously.

Immunotherapy

Immunotherapy is a breakthrough cancer treatment that boosts or equips the body's own immune cells to fight cancer. This type of treatment works by stimulating the immune system to recognize and attack cancer cells [¹⁹]. Immunotherapy may be used in combination with chemotherapy or targeted therapy.

Clinical trials

Clinical trials are ongoing studies that test new treatments for cancer. Patients with grade 3 cancer may be eligible to participate in clinical trials [²⁰], which can offer access to new treatments and may help to improve the prognosis for patients with advanced cancer.

Is colon stage 3 cancer curable?

While the early stage is a curable cancer, there is no cure for stage 3 cancer. While there is no definitive cure for stage 3 colon cancer, it is treatable as it is not among the metastatic cancer stages. The goal of treatment is to remove the cancerous tumor and any affected lymph nodes and to kill any remaining cancer cells to reduce the risk of cancer recurrence. With prompt diagnosis and effective treatment, many patients with stage 3 colon cancer can achieve long-term remission and live cancer-free for many years. Moreover, there are currently several studies being conducted to find a cure for stage 3 colon cancer [²¹] [²²] [²³].

Prognosis of cancer: Stage 3 colon cancer survival rate

Colon Stage 3 cancer survival rate

According to SEER, the relative five-year colon cancer survival rate is around 65%. That means that out of a hundred patients, 65 would survive the first five years after diagnosis. Moreover, the stage 3 cancer survival rate is relatively high, around 72.8%. However, it is also true that the sooner the cancer is diagnosed, the better the chances of survival, as the localized colon cancer survival rate is around 91% [⁵].

Stage 3 colon cancer recurrence rate

The recurrence rate for stage 3 colon cancer varies depending on several factors, such as the extent of the cancer at the time of diagnosis, the stage of cancer development, the type of treatment received, and the individual's overall health. Generally, the overall recurrence rate for stage 3 colon cancer is estimated to be around 30% to 40% [²⁴]. Moreover, 95% of recurrences in colon cancer occur within four years of surgical treatment [²⁵].

Stage 3 colon cancer growth rate

Generally, colon cancer is considered slow-growing, and it can take several years for a precancerous polyp to develop into stage 3 colon cancer.

However, once the cancer has reached stage 3, it is considered to be locally advanced and has the potential to grow and spread more quickly [²⁶]. The growth rate of the cancer cells can be influenced by factors such as blood supply to the tumor, the tumor's ability to invade surrounding tissue, and the immune system's response to the cancer cells.

One study found that colon cancer showed a linear growth (continuously increasing at a constant rate) of 0.0083 mm a day. Moreover, it took 130 days on average for the tumor to double [²⁷].

Lifestyle changes for preventing and managing colon cancer

While certain risk factors, such as age and genetics, cannot be controlled, several lifestyle changes can help to prevent and manage colon cancer.

Eat a healthy diet

Eating a healthy diet which is rich in fruits, vegetables, and lean proteins is essential for maintaining overall health and reducing the risk of colon cancer [²⁸]. Studies have shown that diets high in processed foods, red meat, and saturated fats can increase the risk of colon cancer [²⁹].

Exercise regularly:

Exercising regularly has been shown to reduce the risk of colon cancer [³⁰]. Exercise can also help maintain a healthy body weight, another important factor in reducing the risk of colon cancer.

Maintain a healthy weight:

Being overweight or obese can increase the risk of colon cancer [³¹]. Maintaining a healthy weight through a combination of diet and exercise can help to reduce this risk.

Quit smoking:

Smoking is a known risk factor for several types of cancer, including colon cancer. Quitting smoking can significantly reduce the risk of developing colon cancer [³²].

Limit alcohol intake:

Excessive alcohol consumption has been linked to an increased risk of colon cancer [³³]. It is recommended to limit alcohol intake to no more than one drink per day for women and two drinks per day for men.

Get screened regularly:

Regular screening for colon cancer is important for early detection and treatment. The American Cancer Society recommends that adults at average risk for colon cancer begin regular screening at age 45 [³⁴]. Individuals at increased risk, such as those with a family history of colon cancer, may need to begin screening earlier or more frequently.

Conclusion

Takeaway

While diagnosing stage 3 colon cancer can be daunting, it is important to remember that effective treatments are available. Early detection is key, so it is important to get regular screenings if you are at higher risk for colon cancer. Lifestyle changes like quitting smoking, eating a healthy diet, and maintaining a healthy weight can also help reduce your risk of developing colon cancer. If you experience any symptoms of colon cancer, speak to your healthcare provider as soon as possible.