Deceptive Colon Cancer Staging

The stage isn’t set.

By Kevin RR Williams

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HEALTH Colon cancer is considered a disease of the elderly. Ten percent of cases affect younger ones with a genetic predisposition or history of adenomatous polyps that are large or numerous within the colon or rectum. Without such a history or visible manifestation of any symptoms, screenings don't usually begin until age 50 or 55, at a time when patients may be battling multiple diseases.

Colon cancer symptoms can be numerous and non-specific. They include fatigue, unexplained weight loss, and changes in bowel habits. Bloody or black tarry stools require immediate medical attention. Preparation before a colonoscopy or following surgery may involve a low-residual diet — foods like broth or Jello that do not produce bulk.

When first diagnosed with colon cancer, one's future prospects seem to hang on the doctor's pronouncement of staging. Stage one and four have no variations. Stage two and three each have three subclassifications. In theory, Stage IIIA is significantly more advanced than Stage I. A study published in 2010 of 28,000 patients diagnosed with colon cancer revealed non-linear 5-year survival rates. This is not meant to say that 5 years is the limit. Many people live much longer (and a large number are cured). Often after age 60, there may be unrelated issues like diabetes, high blood pressure, arteriosclerosis or other ailments that impact survival rates.

Stage 5-year Observed
Survival Rate
I 74%
IIA 67%
IIB 59%
IIC 37%
IIIA 73%
IIIB 46%
IIIC 28%
IV 6%

Positive Outlook

The lowest stage has the best prospect with proper treatment soon after diagnosis. The highest stage denotes metastases (cancer within multiple organs). Yet, the Stage IIIA 5‑year survival rate is higher than all categories of Stage II colon cancer. Stage IIIB patents outlived those diagnosed with Stage IIC. Type of treatment and comorbidities can significantly affect outcomes. Half of all stages have better than 50 percent survival rates. According to the study, the top three stages with best survival rates are:

  • I (74%)
  • IIIA (73%)
  • IIA (67%)

Numbers don't tell the whole story. Some diagnosed with Stage I cancer might refuse treatment and die relatively quickly. Whereas someone with Stage IIB may undergo aggressive treatment and see cancer remission. Hence, gastroenterologists and oncologists may prefer to present outlooks based upon personal experience with scenarios matching individual patients rather than aggregated statistics. Similarly, patients should not consider Stage III hopeless, particularly when they have no secondary illness.

Late last year a family member was diagnosed with what appeared to be Stage IV colon cancer. This was because an MRI revealed suspicious shapes in the liver. However, when the surgeon removed the cancer from the colon he discovered that the shapes in the liver were cysts. So in one day, his staging changed from IV to I. The patient recovered quickly and is so thankful to still be alive and in remission. So if you get a bad report, keep positive and don't let your emotions be ruled by numbers.

Tags: carcinoma, gastroenterology, oncology, proctologist, proctology, rectal

References
  1. Low Residual Diet. bidmc.org
  2. Survival rates for colon cancer by stage. cancer.org
  3. Board-Certified Gastroenterologist Explains Why Colon Cancer Screening Participation Lags Behind that of Breast Cancer Screening. prnewswire.com
  4. Photography by Eric Green licensed from iStock Photo.