What is Stage 3 Colorectal Cancer?
Colon or large intestine cancer is classified into four stages (1 to 4).
It begins from the inner lining of the intestine and gradually penetrates deeper into the wall before spreading outside the colon.
- In Stage 1 and 2, the cancer remains confined within the intestinal wall.
- In Stage 3 colon cancer, the disease spreads into the fat and lymph nodes surrounding the colon.
Our body’s immune system (white blood cells) resides in the lymph nodes and actively fights cancer cells. When the cancer spreads to these lymph nodes, it indicates that the body’s immune system is involved.
In Stage 3, the spread is limited to nearby fat and lymph nodes adjacent to the main tumour. The cancer has not yet spread to distant lymph nodes or other organs.
By contrast, Stage 4 colorectal cancer means that the disease has reached other organs in the body.
Why is Stage 3 Colorectal Cancer Important?
In India, nearly 50% of colon and rectal cancers are diagnosed at Stage 3, making it the most common stage seen by specialists.The good news is that most patients with Stage 3 colon cancer can be cured if they receive the correct, timely, and complete treatment.
Treatment of Stage 3 Colorectal Cancer
Stage 3 colorectal cancer requires a multimodality approach — combining surgery, chemotherapy, and sometimes radiotherapy.
1. Treatment of Colon Cancer
- Surgery is the first step in most cases.
- The procedure, called a colectomy, involves removing the affected part of the colon along with nearby fat and lymph nodes.
- Nowadays, this surgery is performed laparoscopically or robotically, ensuring faster recovery and minimal pain.
- Surgery is followed by 4–6 months of chemotherapy to eliminate any remaining cancer cells.
2. Treatment of Rectal Cancer
- In rectal cancer, radiation therapy or chemoradiation is given before surgery to shrink the tumour.
- This is followed by surgery to remove the rectum.
- If the tumour is located in the upper or middle rectum, the colon can be reconnected to the lower rectum and anus.
- In low rectal tumours, sometimes both the rectum and anus need to be removed, resulting in a permanent colostomy.
- However, with robotic surgery, many patients can now avoid permanent colostomy as the anus can be preserved.
- After surgery, patients undergo chemotherapy, similar to colon cancer.
How Long Does the Entire Treatment Take?
The complete treatment for Stage 3 rectal cancer may take around 6 to 9 months, depending on the patient’s stage, recovery, and overall health condition.
Chances of Cure and Survival Rate
With appropriate multimodality treatment, around 70% of colorectal cancers can be cured.
However, the exact prognosis varies between patients. It depends on multiple factors such as:
- Tumour stage
- Patient’s general health
- Response of the tumour to treatment, which remains the most critical determinant.
Diagnosis and Staging of Colorectal Cancer
To confirm the diagnosis and stage of colorectal cancer, the following investigations are essential:
- Colonoscopy with biopsy
- CT scan (Chest, Abdomen, and Pelvis) or Whole-body FDG PET CT
- MRI Pelvis – applicable in rectal cancer only
Stage 3 diagnosis is primarily based on imaging studies showing cancer spread to nearby lymph nodes.
What Should You Do After a Colon Cancer Diagnosis?
After diagnosis, it’s vital to consult the right specialists:
- GI Cancer Surgeon (trained in colorectal surgery)
- Medical Oncologist
- Radiation Oncologist (for rectal cancer cases)
The most important aspect is shared decision-making — where the surgeon, oncologists, and patient discuss treatment options together.
Modern cancer care requires a multidisciplinary team approach. An individual opinion without team consultation is never ideal for achieving the best outcomes.
Is a Colostomy Always Necessary After Surgery?
- A temporary colostomy may be required only if the tumour causes intestinal obstruction or perforation.
- In rectal cancer, a temporary ileostomy is common after surgery and can be reversed after completing treatment. Only some low rectal cancers may require a permanent colostomy.
Quality of Life After Treatment
The goal of treatment is not only to cure but also ensure a good quality of life.
Patients can usually return to:
- Normal diet and bowel function (gradually improving over time)
- Full-time work
- Regular exercise
- Social and family life
Some temporary bowel changes are expected after surgery, but medications and guidance help restore normalcy.
Follow-Up and Tests to Detect Recurrence
After completing treatment, regular surveillance is necessary to monitor for recurrence.
Recommended Follow-Up Schedule:
- CEA Tumour Marker:
- Every 3 months in the first year
- Every 6 months for the next 2–3 years
- CT Scan:
- 6 months after treatment completion
- Then, annually for 3–4 years
- Colonoscopy:
- 1 year after surgery
- Next after 3 years (may vary per patient)
After 5 years of disease-free survival, recurrence of colorectal cancer becomes extremely rare.
Conclusion
Stage 3 colorectal cancer is treatable and often curable when diagnosed on time and managed by a multidisciplinary team.
Early recognition of symptoms, timely diagnosis, and adherence to the treatment plan are the keys to long-term survival and a good quality of life.
About the Author
Dr. Chintamani Godbole
MS, DNB, FRCS (Edinburgh)
Senior Consultant – GI & Colorectal Surgeon, MumbaiDr. Godbole is an expert in the management of colon and rectal cancers, specializing in laparoscopic and robotic colorectal surgery. He has extensive experience in complex GI oncology and is known for his patient-centric, evidence-based approach to treatment.
