Stages of Colon and Rectal Cancer

Colon and rectal cancers, often collectively referred to as colorectal cancer, has four distinct stages, numbered I through IV. Stage 0, a fifth stage, is considered a pre-clinical stage.

Each stage has different treatment options and five-year survival rates. The stages and substages below are from the American Joint Committee on Cancer (AJCC) staging system, which may also be called the TNM system (tumor, nodule, metastases).

Colon cancer diagnosis
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Stage 0 (Carcinoma In Situ)

This is the earliest stage of colorectal cancer. The cancer only involves the lining, or mucosa, of the colon or rectum and is confined to one or more polyps (tissue bulging from the surface of an organ). When the polyps are surgically removed, which can sometimes be done during a colonoscopy (a procedure known as a polypectomy), the chance of them progressing to later stages of cancer can be eliminated.

Stage I

Stage I colon cancer involves more than just the inner lining of the colon. The polyp has progressed to a tumor and extends into the wall of the colon or rectum.

Treatment can include surgery to remove the section of the colon that is cancerous. This type of surgery is called a resection. The healthy, noncancerous sections of the colon are reconnected again. The five-year survival rate is 95%.

Removing Polyps

Removing polyps during routine colonoscopy is the best way to prevent colon cancer. Getting a colonoscopy or other diagnostic test for colorectal cancer is recommended for all adults who face an average risk for the disease beginning at age 45.

Stage II

Stage II colorectal cancer is when the cancer has spread beyond the colon to the tissue that surrounds the colon, but has not spread to lymph nodes. Cancer spreading in this manner from one part of the body to another is called metastasis.

A resection surgery may also be used to treat this stage of cancer. The five-year survival rate for Stage II colon cancer is 60%.

Stage II colon cancer is further subdivided into IIA, IIB, and IIC:

  • Stage IIA: The cancer has grown through the muscle layer of the colon wall but has not gone outside the colon.
  • Stage IIB: The cancer has grown through the outermost layer of the colon wall but has not gone outside the colon.
  • Stage IIC: The cancer has grown through the outermost layer of the colon wall and into nearby tissues.

Stage III

Cancer that has spread outside the colon and on to the lymph nodes in the area surrounding the colon is known as Stage III. In this stage, the cancer has not spread to other organs in the body, and treatment is more aggressive.

Surgical resection of the colon, chemotherapy, and other medical therapies may be necessary. The five-year survival rate is 35% to 60%.

Stage III colon cancer is further subdivided into IIIA, IIIB, and IIIC:

  • Stage IIIA: This substage can describe one of two situations: 1) the cancer is in the inner and middle layers of the colon wall; it may have spread to the muscle layer, and it affects between one and three lymph nodes or fat tissues near a lymph node, or 2) the cancer is in the inner and middle layers of the colon wall and affects between four to six lymph nodes.
  • Stage IIIB: This substage can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between one and three lymph nodes, or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects between four to six lymph nodes, or 3) the cancer is in the inner and middle layers of the colon wall, it could be in the muscle layer, and it affects seven or more lymph nodes.
  • Stage IIIC: This substage can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between four to six lymph nodes, or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects seven or more lymph nodes, or 3) It has spread to at least one nearby lymph node or into areas of fat near the lymph nodes (N1 or N2). It has not spread to distant sites (M0).

Stage IV

In this stage, the cancer had spread to other organs in the body such as the lungs, ovaries, or liver. In addition to a surgical resection and chemotherapy, radiation treatment and surgery to remove other affected parts of the body may be necessary.

At this stage, there is only approximately a 14% percent chance of reaching the five-year survival mark.

Stage IV colon cancer is further subdivided into IVA, IVB and IVC:

  • Stage IVA: The cancer may or may not have grown through the wall of the colon or rectum. It might or might not have spread to nearby lymph nodes. It has spread to one distant organ (such as the liver or lung) or distant set of lymph nodes, but not to distant parts of the peritoneum (the lining of the abdominal cavity).
  • Stage IVB: The cancer might or might not have grown through the wall of the colon or rectum. It might or might not have spread to nearby lymph nodes. It has spread to more than one distant organ (such as the liver or lung) or distant set of lymph nodes, but not to distant parts of the peritoneum (the lining of the abdominal cavity).
  • Stage IVC: The cancer might or might not have grown through the wall of the colon or rectum. It might or might not have spread to nearby lymph nodes. It has spread to distant parts of the peritoneum (the lining of the abdominal cavity), and may or may not have spread to distant organs or lymph nodes.

Recurrent Cancer

Cancer that comes back again after treatment, either in the colon or in some other part of the body, is called recurrent. Even after successful treatment of colon cancer, regular check-ups are necessary to catch any recurrent cancer early. Contrary to popular belief, most colon cancer patients do not need a permanent colostomy.

Early Detection Key to Survival

In the early stages, colon cancer is one of the most curable cancers. In the later stages, it is the second most deadly. Colon cancer is the second leading cause of death from cancer in America (lung cancer is the first).

Survival Rates

The SEER database, which is maintained by the National Cancer Institute, tracks five-year relative survival rates for colon and rectal cancer in the United States, based on how far the cancer has spread. The SEER database groups cancers into localized, regional, and distant stages:

  • Localized: There is no sign that the cancer has spread outside of the colon or rectum.
  • Regional: The cancer has spread outside the colon or rectum to nearby structures or lymph nodes.  
  • Distant: The cancer has spread to distant parts of the body such as the liver, lungs, or distant lymph nodes.

Five-Year Relative Survival in Colon Cancer

The following numbers are based on people diagnosed with cancers of the colon between 2010 and 2016, divided by SEER database groups:

  • Localized: 91%
  • Regional: 72%
  • Distant: 14%

Prevention

Please talk to your healthcare provider about your risk factors for colon cancer, and get screened when appropriate. People with IBD are at increased risk, but getting regular care for the IBD from a gastroenterologist and keeping colonoscopy appointments will go a long way towards removing any polyps and keeping an eye on what is going on in the colon. Everyone over the age of 45 should be screened for colorectal cancer.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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