Page Contents
Staging means finding out how far colon cancer has spread in your body. Physicians group colon cancers into stages I (1) through IV (4), with stage I being the least advanced and stage IV being the most advanced.
When your Fred Hutch Cancer Center team designs your treatment plan, they will take into account the stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.
Colon Cancer Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
Colon Cancer Stages
The stage depends on:
- How deep the cancer has spread through the wall of your colon
- Whether the cancer has spread to lymph nodes around your colon
- Whether the cancer has spread to other parts of your body, such as your liver or lungs
To understand each stage, it’s helpful to know the layers of tissue in the colon wall.
- Innermost layer: mucosa
- Under the mucosa: submucosa
- Under the submucosa: muscle
- Outer layer: serosa
Here’s what each stage means in more detail:
Stage I (1)
Cancer is in the mucosa, and it has spread to the submucosa or muscle. This is considered superficial cancer.
Stage II (2)
Cancer has spread through the muscle layer. It is in the serosa (stage IIA), or it has spread further — to the lining of the organs in your abdomen (stage IIB) or to nearby organs (stage IIC).
Stage III (3)
Once cancer has spread to the nearby lymph nodes, it is considered stage III cancer. The depth of the primary cancer and the number of the lymph nodes determines the sub-stage.
- Stage IIIA: Cancer has spread to the submucosa or muscle and to one to three nearby lymph nodes or tissue near the lymph nodes, referred to as "deposits." Or cancer has spread to the submucosa and four to six nearby lymph nodes.
- Stage IIIB: Cancer has spread to the serosa or the tissue that lines the organs in the abdomen and to one to three nearby lymph nodes or tissue near the lymph nodes. Or cancer has spread to the muscle or serosa and four to six nearby lymph nodes. Or cancer has spread to the submucosa or muscle and seven or more nearby lymph nodes.
- Stage IIIC: Cancer has spread to the tissue that lines the organs in the abdomen and four to six nearby lymph nodes. Or cancer has spread to the serosa or the tissue that lines the organs in the abdomen and seven or more nearby lymph nodes. Or cancer has spread to nearby organs and one or more nearby lymph nodes or tissue near the lymph nodes.
Stage IV (4)
Cancer has spread to one part of the body separate from the colon (stage IVA) or to more than one part of the body (stage IVB). Or it has spread to the lining of the wall of the abdomen (stage IVC), and maybe to other parts of the body too.
How to Know Your Colon Cancer Stage
After you are diagnosed with colon cancer, you will have imaging scans and other tests, like biopsies, to tell if the cancer has spread and to where. In a biopsy, a tissue sample is removed with a needle and a pathologist checks to see if it contains cancer cells.
If you have had staging tests and you already know the stage of your cancer before you come to Fred Hutch, we will look at the test results before your first appointment. If you have not had these tests, we will talk with you about which tests you need, why, how to get them and when you can expect results.
Causes of Colon Cancer
The exact cause of colon cancer is not known. But studies show that certain factors are linked to increased risk. Some of these risk factors are things you can’t change, such as getting older or having a family history of colon cancer. Other factors relate to your lifestyle, so you may be able to change them. For example, smoking and eating red meat both raise colon cancer risk.
If you are at high risk for colon cancer and other gastrointestinal cancers, Fred Hutch has a special program to help. Our Gastrointestinal Cancer Prevention Program offers a personalized approach to risk assessment, screening and prevention for people at high risk.
Colon Cancer Survival Rates
In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during that five years for some other reason. For colon cancer, the relative five-year survival rate overall in the U.S. is 65%, according to the National Cancer Institute.
But the chance of surviving cancer for five years or more can be quite different from person to person. One important reason is the stage of the disease at the time of diagnosis. For colon cancer that’s only in the area where it started (localized disease), the relative five-year survival rate is about 91%. For colon cancer that has spread to distant parts of the body (metastatic disease), the rate is about 16%. Even within a subset of people, like those with localized disease, there will be differences. Patients may have different treatments and respond to treatments in different ways.
This means it’s impossible to predict the likely lifespan of any one person based on survival rates. If you would like to know more about the outlook for your disease, talk with your Fred Hutch care team. They can tell you more based on your unique situation.
The TNM staging system is another way to describe how far colon cancer has spread. (This system is used for many other types of cancer too.) The letters stand for:
- Tumor: The size of the main tumor and any spread of cancer into nearby tissue
- Nodes: The number of nearby lymph nodes where cancer has spread
- Metastasis: If cancer has spread (metastasized) to other parts of the body
In the TNM system, there will be a symbol after each letter to give details; for example, T1N0M0. In T1, the 1 indicates the size of the tumor (small). In N0, the 0 means there’s no sign of cancer in nearby lymph nodes. In M0, the 0 means cancer hasn’t spread to distant parts of the body. If you would like to know the stage of your cancer in the TNM system, ask your Fred Hutch care team.
At Fred Hutch, we will tailor your treatment plan to you. In general, people who have the same stage of colon cancer often have the same or similar treatments. Common treatments by stage may include:
- Stage I (1): Surgery to remove the tumor (resection). This could mean only taking out a polyp, or it could mean taking out a segment of your colon.
- Stage II (2): Surgery to remove the tumor and a segment of the colon. The surgeon will also take out nearby lymph nodes. People with stage II colon cancer may also have chemotherapy.
- Stage III (3): Surgery to remove the tumor and a segment of the colon. The surgeon will take out nearby lymph nodes, too. People with stage III colon cancer typically have chemotherapy after surgery.
- Stage IV (4): People with stage IV colon cancer may not have surgery because chances are low that it will cure the disease. Treatment focuses on the whole body, typically with chemotherapy, targeted therapy, immunotherapy or a combination of these. But sometimes surgery to remove tumors may help a person live longer. If colon cancer has spread to the liver, there are treatments just for this. They are similar to treatments for cancer that started in the liver.
Learn more about colon cancer treatment.
Researchers at Fred Hutch and beyond are always looking for better ways to treat advanced or metastatic colon cancer. Clinical trials are going on to test new drugs or new combinations of drugs. In recent years, patients have benefited from newer targeted therapies and immunotherapies, like immune checkpoint inhibitors.
New medicines aren’t the only line of inquiry. Other advanced approaches are helping people with late-stage disease get better results. One such approach is CRS-HIPEC. For this treatment, surgeons remove tumors they can see. Then they bathe the inside of the abdomen in warm liquid chemotherapy. Another approach is hepatic artery infusion (HAI) therapy. HAI therapy is used to treat cancer that has spread from the colon to the liver. It’s a way to get strong chemotherapy to liver tumors using a pump. Fred Hutch offers both of these treatments, which aren’t available at all cancer centers.
Learn more about treatment options.