Table of ContentsView AllTable of ContentsStagesStaging and PrognosisStage of Recurrent CRC
Table of ContentsView All
View All
Table of Contents
Stages
Staging and Prognosis
Stage of Recurrent CRC
Colorectal cancer (CRC)is a term for cancers that begin in the colon or rectum. Determining the stage of colorectal cancer is important because it helps determine treatment options and, ultimately, the prognosis of the disease.
This article will review the stages of colorectal cancer, how each stage is determined, and how this information can relate to survival outcomes.
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Colorectal Cancer (of Large Intestine) Stages
Colorectal canceris classified into five stages, from stage 0 to stage 4. Stages are determined based on how far the cancer has spread from its original location. Factors that determine the stage include the size of the tumor, whether it has spread into any lymph nodes, and metastases (growth in distant areas).
These stages help oncologists (cancer specialists) determine the prognosis and best treatment options, which can include a combination of surgery, chemotherapy, targeted therapy, or radiation. Cancers discovered at an earlier stage have a better survival rate.
Stage 0 (Carcinoma in situ)
Stage 0 is the earliest stage of CRC, in which abnormal cancer cells are limited to only the inner lining of the colon or rectum. These cells haven’t grown into deeper layers or spread beyond the colon or rectum.
Stage 1
In stage 1 CRC, cancer has grown into the deeper layers of the colon or rectum wall but hasn’t grown beyond it. Cancer has not reached the lymph nodes or distant organs.
Stage 2
Stage 2 CRC is divided into three substages, 2A, 2B, and 2C:
Stage 3
Stage 4
Stage 4 is the most advanced stage of CRC and also has three subgroups:
Colorectal Cancer Staging and Prognosis
After the stage of colorectal cancer has been determined, decisions about treatment options can be made, and with that, an opinion on prognosis. However, getting to that point takes multiple steps, from diagnosis to staging. In addition to the stage, the exact type of cancer cells present is also a factor in treatment and prognosis.
Diagnosis
Diagnosing colorectal cancer begins with a healthcare provider’s physical examination and review of medical and family history to assess for any concerning signs or symptoms.
Even if any signs or symptoms aren’t present, screening for CRC is recommended for people aged 45 and older.Screening tests can include:
The appropriate screening test can be determined in conversation with your healthcare team. However, if any of the screening tests indicate the possibility of cancer cells, you will need a colonoscopy.
During a colonoscopy, a colonoscope (a long, flexible tube with a camera) examines the inside of the colon and rectum. If any concerning areas are seen, a biopsy of these cells can be collected and tested for the presence of cancer.
Biopsy and Pathology
After a biopsy is taken, it is evaluated in a lab for the presence of cancer cells and to determine their type and other characteristics. The most common type of CRC isadenocarcinoma, which is found in over 90% of CRC. Other types of CRC include:
Pathology testing includes molecular testing. Evaluating the presence or absence of certain molecular subtypes can help the oncology team make treatment decisions. Molecular mutations they may look for can include:
In addition to testing the cancer cells, blood work will likely be done to evaluate liver and kidney function, blood cell counts, and acarcinoembryonic antigen (CEA)test. A CEA can serve as a tumor marker. In many cases of CRC, the CEA is elevated at diagnosis and should decrease with treatment.
Staging
The staging process takes place after the diagnosis of CRC. During this process, further imaging studies may determine the extent to which the cancer has or hasn’t spread in the body. Imaging studies that may be ordered can include:
The specifics of each stage of CRC are reviewed above.
Does Treatment Cure Colorectal Cancer?
Stage 1 colorectal cancer is considered to be curable because the cancer is located in the walls of the colon or rectum but hasn’t spread anywhere else. Treatment for stage 1 CRC usually involves surgery to remove the tumor as well as some of the healthy tissue around it. Often, no additional treatment is required.
About one-third of newly diagnosed CRC cases are found in the early stage. The five-year relative survival rate for stage 1 CRC is 91.1%. This means that 91.1% of people with stage 1 CRC will survive their cancer for at least five years.
Stage 2 CRC can be cured as well. The main treatment for Stage 2 CRC is surgery to remove the tumor. In some cases, especially those that are high-risk, chemotherapy might be recommended. The majority of people with stage 2 CRC will survive their cancer as well.
Stage 4 colorectal cancer, in which the cancer has spread to distant organs such as the liver or lungs, is usually not considered curable. Treatment is focused on shrinking what cancer is present and trying to keep it from growing as long as possible. Treatment for stage 4 CRC can include:
About a quarter of those newly diagnosed with CRC are diagnosed with stage 4 disease. The five-year relative survival rate for stage 4 CRC is 15.7%.
Survival Rate Is Not Your PrognosisYour healthcare team can explain your individual prognosis, which is based on many factors unique to you. Overall survival rates do not apply to individuals. They also do not take into account newer treatments developed within the past five years.
Survival Rate Is Not Your Prognosis
Your healthcare team can explain your individual prognosis, which is based on many factors unique to you. Overall survival rates do not apply to individuals. They also do not take into account newer treatments developed within the past five years.
Stage of Recurrent Colorectal Cancer
Recurrence of CRC may not exhibit any symptoms, though some may be present. Symptoms may include:
If CRC has been found again, additional testing will likely be done to determine the extent of the disease. A new biopsy may need to be taken as well. The original stage that was diagnosed won’t change, but the recurrent cancer will be restaged and designated with an “r” for recurrence.
Summary
Colorectal cancer grows in the colon or rectum and is assigned in five stages, from stage 0 to stage 4. Staging helps determine the treatment needed as well as the prognosis. When CRC is detected at its earliest stages, it has a 91.1% five-year relative survival rate, which decreases to 15.7% when diagnosed at stage 4.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Cancer stat facts: colorectal cancer.American Cancer Society.Colorectal cancer stages.U.S. Preventive Services Task Force.Colorectal cancer: screening.American Cancer Society.Colorectal cancer screening tests.Kim BH, Kim JM, Kang GH, et al.Standardized pathology report for colorectal cancer, 2nd edition.J Pathol Transl Med. 2020;54(1):1-19. doi:10.4132/jptm.2019.09.28Lauretta A, Montori G, Guerrini GP.Surveillance strategies following curative resection and non-operative approach of rectal cancer: how and how long? Review of current recommendations.World Journal of Gastrointestinal Surgery. 2023;15(2):177. doi:10.4240/wjgs.v15.i2.177Chen K, Collins G, Wang H, Toh JWT.Pathological features and prognostication in colorectal cancer.Current Oncology. 2021;28(6):5356-5383. doi:10.3390/curroncol28060447Duineveld LAM, van Asselt KM, Bemelman WA, et al.Symptomatic and asymptomatic colon cancer recurrence: a multicenter cohort study.Ann Fam Med. 2016;14(3):215-220. doi:10.1370/afm.1919National Cancer Institute.Recurrent cancer: when cancer comes back.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Cancer stat facts: colorectal cancer.American Cancer Society.Colorectal cancer stages.U.S. Preventive Services Task Force.Colorectal cancer: screening.American Cancer Society.Colorectal cancer screening tests.Kim BH, Kim JM, Kang GH, et al.Standardized pathology report for colorectal cancer, 2nd edition.J Pathol Transl Med. 2020;54(1):1-19. doi:10.4132/jptm.2019.09.28Lauretta A, Montori G, Guerrini GP.Surveillance strategies following curative resection and non-operative approach of rectal cancer: how and how long? Review of current recommendations.World Journal of Gastrointestinal Surgery. 2023;15(2):177. doi:10.4240/wjgs.v15.i2.177Chen K, Collins G, Wang H, Toh JWT.Pathological features and prognostication in colorectal cancer.Current Oncology. 2021;28(6):5356-5383. doi:10.3390/curroncol28060447Duineveld LAM, van Asselt KM, Bemelman WA, et al.Symptomatic and asymptomatic colon cancer recurrence: a multicenter cohort study.Ann Fam Med. 2016;14(3):215-220. doi:10.1370/afm.1919National Cancer Institute.Recurrent cancer: when cancer comes back.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Cancer Institute.Cancer stat facts: colorectal cancer.American Cancer Society.Colorectal cancer stages.U.S. Preventive Services Task Force.Colorectal cancer: screening.American Cancer Society.Colorectal cancer screening tests.Kim BH, Kim JM, Kang GH, et al.Standardized pathology report for colorectal cancer, 2nd edition.J Pathol Transl Med. 2020;54(1):1-19. doi:10.4132/jptm.2019.09.28Lauretta A, Montori G, Guerrini GP.Surveillance strategies following curative resection and non-operative approach of rectal cancer: how and how long? Review of current recommendations.World Journal of Gastrointestinal Surgery. 2023;15(2):177. doi:10.4240/wjgs.v15.i2.177Chen K, Collins G, Wang H, Toh JWT.Pathological features and prognostication in colorectal cancer.Current Oncology. 2021;28(6):5356-5383. doi:10.3390/curroncol28060447Duineveld LAM, van Asselt KM, Bemelman WA, et al.Symptomatic and asymptomatic colon cancer recurrence: a multicenter cohort study.Ann Fam Med. 2016;14(3):215-220. doi:10.1370/afm.1919National Cancer Institute.Recurrent cancer: when cancer comes back.
National Cancer Institute.Cancer stat facts: colorectal cancer.
American Cancer Society.Colorectal cancer stages.
U.S. Preventive Services Task Force.Colorectal cancer: screening.
American Cancer Society.Colorectal cancer screening tests.
Kim BH, Kim JM, Kang GH, et al.Standardized pathology report for colorectal cancer, 2nd edition.J Pathol Transl Med. 2020;54(1):1-19. doi:10.4132/jptm.2019.09.28
Lauretta A, Montori G, Guerrini GP.Surveillance strategies following curative resection and non-operative approach of rectal cancer: how and how long? Review of current recommendations.World Journal of Gastrointestinal Surgery. 2023;15(2):177. doi:10.4240/wjgs.v15.i2.177
Chen K, Collins G, Wang H, Toh JWT.Pathological features and prognostication in colorectal cancer.Current Oncology. 2021;28(6):5356-5383. doi:10.3390/curroncol28060447
Duineveld LAM, van Asselt KM, Bemelman WA, et al.Symptomatic and asymptomatic colon cancer recurrence: a multicenter cohort study.Ann Fam Med. 2016;14(3):215-220. doi:10.1370/afm.1919
National Cancer Institute.Recurrent cancer: when cancer comes back.
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