Genetic Testing
Chemotherapy
Surgery (colectomy)
KRAS Testing
Antiangiogenic Therapy
Polyp Removal
Anti-EGFR Therapy
Radiation
Clinical Trials
 
Stage 0
Stage I
Stage II
Stage III
Stage IV
First-Line
Second-Line
Third-Line
Stage II - ChemotherapyX
Chemotherapy may be used before surgery, primarily to facilitate the procedure, or after surgery to help prevent recurrence of the cancer. Your treatment regiment will be determined by the site of the tumor, your age and risk of recurrence. You can also enroll in clinical trials of “new chemotherapy schedules or new drugs.”
Stage III - ChemotherapyX
Cancer cells have spread to the lymph nodes so the risk of recurrence is high. Chemo is commonly recommended as adjuvant therapy following your primary treatment for stage III colon cancer, whereas radiotherapy may be used alone or with chemo for rectal cancer. FOLFOX is the preferred chemo regimen for stage III patients. Other regimen options include FLOX, CapeOX, capecitabine or 5-FU/LV, but other factors, such as age and site of tumor, will help to determine the best regimen for you.
Stage IV - Chemotherapy - First-LineX
There are 4 different chemotherapies commonly used to treat metastatic colorectal cancer. Treatment outcomes for stage IV patients are maximized when patients are exposed, at some point throughout their treatment, to these three chemotherapies: 5-FU, irinotecan and oxaliplatin. Your previous treatment will affect which therapy you will receive moving forward. There are many possible chemotherapy combinations and regimes. Work with your medical team to select the best regime for your condition.
Stage IV - Chemotherapy - Second-LineX
There are 4 different chemotherapies commonly used to treat metastatic colorectal cancer. Treatment outcomes for stage IV patients are maximized when patients are exposed, at some point throughout their treatment, to these three chemotherapies: 5-FU, irinotecan and oxaliplatin. Your previous treatment will affect which therapy you will receive moving forward. There are many possible chemotherapy combinations and regimes. Work with your medical team to select the best regime for your condition.
Stage IV - Chemotherapy - Third-LineX
There are 4 different chemotherapies commonly used to treat metastatic colorectal cancer. Treatment outcomes for stage IV patients are maximized when patients are exposed, at some point throughout their treatment, to these three chemotherapies: 5-FU, irinotecan and oxaliplatin. Your previous treatment will affect which therapy you will receive moving forward. There are many possible chemotherapy combinations and regimes. Work with your medical team to select the best regime for your condition.
Stage 0 - SurgeryX
Surgery is rare for stage 0 patients but may be needed after a polypectomy, depending on where polyps are located and how many are present. If cancer is found during polyp removal, your doctor will examine the colon and rectum again before planning next steps. Your surgeon should collaborate with your medical oncologist.
Stage I - SurgeryX
Surgery is used to remove the part of the colon with cancer (a procedure called a colectomy). The location and extent of the cancer will determine how much of the colon is removed. Local lymph nodes are tested for cancer. Your surgeon should collaborate with your medical oncologist.

Stage II - SurgeryX
Surgery is used to remove the tissue to which cancer has spread and the nearby lymph nodes. Your risk factors and the location and extent of the cancer will determine how much of the colon is removed and what type of therapy may follow to prevent recurrence of the cancer. Your surgeon should collaborate with your medical oncologist.

→ Low Risk
Follow-up care options for stage II CRC patients with low risk for recurrence can include clinical trials, observation or chemotherapy.

→ High Risk
Chemotherapy is the main follow-up option for stage II CRC patients with high risk for recurrence, though radiotherapy may be beneficial after surgery for rectal cancer, specifically, when the tumor has grown into nearby structures or organs.
Stage III - SurgeryX
Surgery is used to remove tissue and lymph nodes to which cancer has spread. Chemo may follow to prevent recurrence of colon cancer, and radiotherapy may be an option for rectal cancer. Your surgeon should collaborate with your medical oncologist.
Stage IV - First-Line SurgeryX
Surgery before or after primary treatment may be done to remove the primary tumor and metastatic tumors in the lungs or liver. It may also be used as palliative care to make the patient more comfortable by reducing the size of tumors. Your surgeon should collaborate with your medical oncologist.

Stage IV - Second-Line - SurgeryX
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Stage 0 - Polyp RemovalX
If polyps are found during a colorectal screening (called a colonoscopy), they are removed and tested for cancer. The removal of polyps is called a polypectomy.
Stage I - Polyp RemovalX
If polyps are found during a colorectal screening (called a colonoscopy), they are removed and tested for cancer. The removal of polyps is called a polypectomy. If cancer has begun to spread within the colon, surgery may be used as well.
Stage IV - First-Line - Antiangiogenic TherapyX
Bevacizumab is FDA-approved as first-line treatment for mCRC in combination with chemotherapy. It is given as an infusion every two weeks. Patients begin taking bevacizumab with chemo and may continue the treatment after stopping chemo as long as the disease is controlled and side effects are manageable.
Stage IV - Second-Line - Antiangiogenic TherapyX
Bevacizumab is FDA-approved as a second-line treatment in combination with chemotherapy. It is given as an infusion every two weeks. Patients begin taking bevacizumab with chemotherapy and may continue the treatment after stopping chemo as long as the disease is controlled and side effects are manageable.

Ziv-aflibercept is FDA-approved as a second-line therapy for use with a chemotherapy combination (FOLFIRI) to treat mCRC. It is used in mCRC patients whose disease did not respond to, or has come back, after first-line treatment. Patients receive ziv-aflibercept every two weeks through an IV infusion in combination with the chemotherapy regimen. Treatment continues indefinitely as long as the disease does not progress, and side effects are manageable.
Stage IV - Third-Line - Antiangiogenic TherapyX
Regorafenib is FDA approved for treating patients with mCRC that continues to progress or recur after multiple treatments. Regorafenib is an oral medication in the form of a tablet that is typically taken once a day for twenty-one days. A seven-day rest period is taken before beginning another twenty-one-day cycle.
Stage IV - First-Line - Anti-EGFR TherapyX
Two EGFR inhibitors are approved for CRC patients without the KRAS mutation: cetuximab and panitumumab. Both may be used with different chemo regimes.
Stage IV - Second-Line - Anti-EGFR TherapyX
Two EGFR inhibitors are approved for CRC patients without the KRAS mutation: cetuximab and panitumumab. Both may be used with different chemo regimes.
Stage IV - Third-Line - Anti-EGFR TherapyX
Two EGFR inhibitors are approved for CRC patients without the KRAS mutation: cetuximab and panitumumab. Both may be used with different chemo regimes.
Stage II - RadiationX
Radiotherapy is used primarily to treat rectal cancer pre and post-surgery. In cases of recurrent cancer or when tumors have grown into nearby organs or structures, radiotherapy alone or in combination with chemo may be considered as secondary therapy following surgery.
Stage III - RadiationX
Radiotherapy combined with chemo is primarily used to treat rectal cancer, pre and post surgery. For colon cancer, chemo is the recommended treatment for stage III, but radiotherapy may be used in cases of recurrent cancer or when tumors have grown into nearby organs or structures.
Stage IV - First-Line - RadiationX
Radiation therapy may be used as part of palliative care to improve patient quality of life; debulking (make tumor smaller in size); or to target liver metastases (target hot spot in liver to make smaller).
Stage IV - Second-Line - RadiationX
REMOVE ME Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer posuere sollicitudin elit, quis vestibulum libero rhoncus vel. Quisque ipsum ligula, congue ut volutpat eu, auctor non justo. Aenean viverra nunc consectetur, cursus lectus et, laoreet felis. Vestibulum quis urna sem. Praesent eget condimentum libero, in interdum leo. Nullam in turpis at mi accumsan varius ac at quam. Quisque quis venenatis nibh. Maecenas nec purus orci. Cras facilisis scelerisque est. Morbi vitae porta turpis. Mauris accumsan purus eget rhoncus tincidunt.
Stage 0X
This is the earliest stage: cancer is restricted to the innermost lining of the colon and has not yet spread.
Stage IX
Cancer has begun to spread, but remains in the inner lining of the colon.
Stage IIX
Cancer has spread to other organs near the colon or rectum, but has not reached lymph nodes.
Stage IIIX
Cancer has spread to lymph nodes but has not reached distant parts of the body.
Stage IVX
Cancer has spread (metastasized) to distant parts of the body, often to the lungs or liver.
First-LineX
“First-line” therapy is the first time a patient is treated for metastatic disease.
Second-LineX
“Second-line” therapy is used as another treatment if the cancer progresses or reoccurs during or after first-line therapy.
Third-LineX
“Third-line” therapy is used if second-line therapy fails to produce the desired benefit.
KRAS TestingX
RAS is a gene that can influence the efficacy of anti-EGFR therapies and should be investigated for any mutations. KRAS (pronounced kay-razz) is a type of RAS gene in cancer cells that has been found to have a mutation in 40% of colorectal cancers. Anti-EGFR inhibitors are ineffective in tumors that carry KRAS mutations, so it is important to identify your KRAS status before considering anti-EGFR treatment.
Genetic TestingX
Certain genes can increase your risk for CRC and affect response to treatment. Nearly 30% of all CRC cases are inherited, and family history of the disease increases your risk. Detailed analysis of family history and relevant genetic testing will identify your level of risk for CRC. If needed, genetic counseling can help determine best screening approaches and treatment for you.
Clinical TrialsX
Clinical trials are ongoing and are an option you can discuss with your medical team. Learn more about clinical trials at www.clinicaltrials.gov.
SourcesX
NCCN Guidelines for Patients: Colon Cancer, Version 1.2012 [Brochure]. Fort Washington, PA: National Comprehensive Network, Inc., n.d.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Rectal Cancer, Version 1.2014 [Brochure]. Fort Washington, PA: National Comprehensive Network, Inc., 2013.

Jasperson KW, Tuohy TM, Neklason DW, et al. Hereditary and Familial Colon Cancer. Gastroenterology. 2010 June;138(6):2044–2058.
Where Am I?X
The location and extent of your cancer will determine the most effective treatment for your condition.
X
No Cancer

If no cancer is found, then we encourage you to learn about risk factors and the lifestyle choices you can make to prevent CRC in the future.

Cancer

If cancer is found:

1) Find a medical oncologist and a team of doctors who will collaborate to coordinate your care.

2) Get a second or third opinion!
Don’t worry about insulting your doctor—the most important priority is to know your options as a CRC patient.

3) Learn about your stage and understand your treatment options.
Know the extent of your disease: your doctor will assess which polyps are cancerous, how many, and where they were located. Your doctor will also identify if the cancer has spread to other parts of the body. This information will help to determine your treatment plan and can be obtained via biopsy or imaging tools (CT, MRI). You can ask for a copy of the pathology report and imaging tests.
DirectionsX

This chart lists the possible therapies and treatments you may need to consider with your doctors, depending on the stage of your colorectal cancer progression. Stage describes the extent and location of the cancer, and is used to plan the most effective treatment for each patient.

To use this chart, find the column that represents your stage, scan down the column to see the treatments that may be options for you, and click the section to learn more so you can discuss your options with your doctor(s).
HelpX

To use this chart, find the column that represents your stage, scan down the column to see the treatments that may be options for you, and hover over the section to learn more so you can discuss your options with your doctor(s).
Patient Road MapX

To use this chart, find the column that represents your stage, scan down the column to see the treatments that may be options for you, and click the section to learn more so you can discuss your options with your doctor(s).

Please press the red X above to begin.