Surgery is the only curative modality for localized colon cancer (stage I-III). Surgical resection potentially provides the only curative option for patients with limited metastatic disease in liver and/or lung (stage IV disease), but the proper use of elective colon resections in nonobstructed patients with stage IV disease is a source of continuing debate.
Adjuvant chemotherapy is standard for patients with stage III disease. Its use in stage II disease is controversial, with ongoing studies seeking to confirm which markers might identify patients who would benefit. At present, the role of radiation therapy is limited to palliative therapy for selected metastatic sites such as bone or brain metastases.
Chemotherapy rather than surgery has been the standard management for patients with metastatic colorectal cancer. Biologic agents have assumed a major role in the treatment of metastatic cases, with selection increasingly guided by genetic analysis of the tumor. The proper use of elective colon/rectal resections in nonobstructed patients with stage IV disease is a source of continuing debate.