Colon Cancer

Polyps with a low chance of progressing to cancer

Polyps with a high chance of progressing to cancer

Adenocarcinoma (>90%)

Curative for stages I-III
Palliative for stages III-IV

Rarely as adjuvant (after surgery) therapy for stages I-III
Palliative for all stages

Adjuvant therapy in stages III and II (too many side effects for stage I)
Treatment in stage IV

Stage IV

Only stage I primarily. Rectum is small and later stages remove too much of it, can be done in stage II and III after neoajuvant therapy if needed.

Stage IV treated with systemic therapy.

Surgery and survalence, no adjuvant therapy

Surgery and survalence, possibly adjuvant therapy for high risk patients.

Surgery, and then 6 months of one of the following regimens

mFOLFOX6
CAPEOX (may consider just 3 months)

Oxaliplatin
Leucovorin
5Fu

Oxaliplatin
Capecitabine

No surgery, FOLFOX or CAPEOX
Can also use FOLFIRI, or FOLFIRINOX

Can add bevacizumab

Irinotecan instead of oxaliplatin

FOLFOX + Irinotecan

RAS testing
BRAF testing
MSI/MMR

May respond well to EGFR inhibitors, don't use EGFR inhibitors in patients with a KRAS mutation

Don't use EGFR inhibitors

Pembrolizumab

50% dose