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NCCN Guidelines for Patients Colon Cancer NCCN GUIDELINES FOR PATIENTS® 2021 Colon Cancer Presented with support from: Available online at NCCN.org/patients Ü Colon Cancer It's easy to get lost in the cancer world Let NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients® Colon Cancer, 2021 1 About NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology for Patients (NCCN Guidelines®) 9 Developed by doctors from 9 Present information from the 9 An alliance of leading NCCN cancer centers using NCCN Guidelines in an easy- cancer centers across the the latest research and years to-learn format United States devoted to of experience patient care, research, and 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Explain the cancer care Cancer centers 9 options likely to have the that are part of NCCN: 9 Expert recommendations for best results NCCN.org/cancercenters cancer screening, diagnosis, and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines NATIONAL COMPREHENSIVE CANCER NETWORK FOUNDATION Guiding Treatment. Changing Lives. and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Colon Cancer, Version 2.2021 – January 21, 2021. © 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 NCCN Guidelines for Patients® Colon Cancer, 2021 2 Supporters Sponsored by Fight Colorectal Cancer We fight to cure colorectal cancer and serve as relentless champions of hope for all affected by this disease through informed patient support, impactful policy change, and breakthrough research endeavors. As an organization dedicated to helping the community find trusted resources to make informed decisions about their health, we are proud to support this comprehensive resource. Fightcolorectalcancer.org Endorsed by Colorectal Cancer Alliance As the largest colorectal cancer advocacy organization, we are committed to clear and actionable information for patients and their families. The Colorectal Cancer Alliance is proud to endorse this evidence-based guide that will help individuals make the most effective treatment decisions for their cancer journey. Our resources, online communities, and certified navigators are available to help: ccalliance.org 877-422-2030. Love Your Buns Love Your Buns is committed to educating and empowering patients, caregivers, and family with the information they need to make important colorectal cancer therapy decisions, and providing survivorship support after treatment to improve their quality of life. We are honored to endorse these extensive resources. loveyourbuns.org With generous support from • Patrick Abbs • Kristina Gregory • Alan Venook, MD • Marianne and Gary Weyhmuller in honor of Harry A. Weyhmuller To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients® Colon Cancer, 2021 3 NCCN Guidelines for Patients® Colon Cancer, 2021 4 Colon Cancer Contents 6 Colon cancer basics 14 Treatment planning 24 Overview of treatments 34 Nonmetastatic colon cancer 42 Metastatic colon cancer 52 Survivorship 58 Making treatment decisions 65 Words to know 68 NCCN Contributors 69 NCCN Cancer Centers 70 Index NCCN Guidelines for Patients® Colon Cancer, 2021 5 1 Colon cancer basics 7 The colon 8 Colon polyps 9 About cancer 9 Colon cancer stages 13 Review NCCN Guidelines for Patients® Colon Cancer, 2021 6 1 Colon cancer basics The colon Colon cancer is one of the most that forms the last part of the digestive system. commonly diagnosed cancers in The digestive system breaks down food for the the United States. Improvements body to use. in its detection and treatment have led to better outcomes for patients. After being swallowed, food passes through This chapter provides some basic the esophagus and into the stomach, where information about colon cancer that will it is turned into a liquid. From the stomach, food enters the small intestine. In the small help prepare you for treatment. intestine food is broken down into very small parts to allow nutrients to be absorbed into the bloodstream. The colon Partly digested food then moves into the colon. The colon is the first and longest section of The colon is the longest part of the large the large intestine. It is almost 5 feet long and intestine, also known as the large bowel. The has four parts: the ascending, transverse, large intestine is a long tube-shaped organ descending, and sigmoid colon. The colon The colon is the first and longest part of the large intestine. The colon absorbs water from unused food, turning it into stool. Stool is held in the last section of the large intestine, called the rectum, until it exits the body through the anus. NCCN Guidelines for Patients® Colon Cancer, 2021 7 1 Colon cancer basics Colon polyps The first part of the colon is called the cecum. Colon polyps This pouch is about the size of a small orange. Sticking out from the cecum is a skinny tube A polyp is an overgrowth of cells on the inner called the appendix. It is closed at one end, lining of the colon wall. There are different and is about the size of a finger. types of polyps. Some types are more likely to turn into cancer than others. The In the colon, water is absorbed from unused most common type is called an adenoma. food, changing it from a liquid to a solid. This Adenomas are considered pre-cancerous solid, unused food is called feces or stool. because, while it may take many years, they Stool then moves into the last section of the can become invasive colon cancer. Cancer large intestine, called the rectum. Stool is held that forms in an adenoma is known as an in the rectum until it exits the body through an adenocarcinoma. Adenocarcinoma is the most opening called the anus. common type of colon cancer. Polyps that are highly unlikely to turn into cancer include hyperplastic and inflammatory polyps. Parts of the colon The colon is the longest part of the large intestine. It is almost 5 feet long and has four sections: the ascending, transverse, descending, and sigmoid colon. Parts of the colon © 2012 Terese Winslow LLC, U.S. Govt. has certain rights. NCCN Guidelines for Patients® Colon Cancer, 2021 8 1 Colon cancer basics About cancer | Colon cancer stages Removing polyps can prevent cancer before Colon cancer stages it occurs. Polyps can also be tested to make sure that cancer has not already started to The cancer stage is an assessment of the develop. While most colon polyps do not extent of cancer in the body. It is used to become cancer, almost all colon cancers plan which tests may be needed and which start in a polyp. Most polyps can be removed treatments are best for you. Having a general during a colonoscopy, using a minor surgical idea of the structure of the colon wall is helpful procedure called a polypectomy. More for understanding how colon cancer is staged. information on colon polyps is provided in Part 4, Nonmetastatic cancer. The colon wall is made of layers of tissue. Cancer starts in the innermost layer that comes in contact with food. This layer is called the mucosa. The next layer is the submucosa. About cancer It is made of connective tissue and contains mucus glands, blood and lymph vessels, The human body is made of over 30 trillion and nerves. The submucosa is followed by a cells. All cells have built-in instructions that tell layer of muscle called the muscularis propria. them how to act. These instructions are called The outer, fourth layer is called serosa (or genes. Genes are a part of deoxyribonucleic adventitia). acid (DNA). Changes called mutations in genes cause normal cells to become If left untreated, cancer cells grow through the cancerous. layers of the colon wall, towards the inside of the abdomen. The cancer can then invade Cancer cells don’t act like normal cells. Normal structures or organs outside of the colon. cells grow and then divide to make new cells Cancer cells can also break off from the colon when needed. They also die when old or tumor and travel through lymph or blood to damaged.
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