{"entity":{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","aka":["Colon cancer","Colonic adenocarcinoma","Cancer of the colon","Right-sided and left-sided colon cancer","Rectal vs colon (different local therapy)"],"tldr":"Colon cancer is bowel cancer arising in the large bowel above the rectum. It shares its biology with colorectal cancer but is treated differently from rectal cancer: surgery comes first without radiotherapy, chemotherapy afterwards is decided by stage and increasingly by a blood test for leftover tumour DNA, and the side the tumour started on changes which drugs work once it has spread.","summary":"The WHO classification of digestive tumours describes adenocarcinoma of the colon and rectum as one chapter, with the site recorded because staging and local treatment differ (Nagtegaal 2020). The colorectal page holds the molecular subtypes; this page is the anatomical entity that the corpus's rectal cancer page mirrors. Two identically designed adjuvant trials in 855 colon and 796 rectal cancer patients showed that adding folinic acid to fluorouracil improved seven-year overall survival in colon but not rectal cancer, with different patterns of recurrence (Clinical Colorectal Cancer 2013). Within the colon, right-sided (proximal) tumours are more often mismatch-repair deficient, BRAF-mutant, mucinous and worse-prognosis in the metastatic setting, and left-sided tumours respond better to EGFR antibodies; a pooled analysis of 2,879 metastatic patients found no outcome difference between left-sided colon and rectal primaries (European Journal of Cancer 2018).\n\nHow it differs from its parent: the colorectal page carries the shared biology and the metastatic drug pathways; colon cancer differs from rectal cancer in having no role for pelvic radiotherapy, in colectomy with regional lymphadenectomy as the operation, and in the stage III adjuvant standard of three or six months of FOLFOX or CAPOX set by the IDEA collaboration and recorded on the FOLFOX and CAPOX pages.\n\nHow common: no separate GLOBOCAN figure; the proximal-colon share above is from one registry.\n\nTreatment follows the colorectal page and the NCI PDQ colon summary: colectomy for stage I to III, adjuvant FOLFOX or CAPOX for stage III and high-risk stage II, with the ctDNA-guided DYNAMIC and CIRCULATE-US trials and the exercise trial CHALLENGE linked here; mismatch-repair deficient colon cancer is treated with checkpoint inhibitors before surgery in NICHE-2 and after surgery in ATOMIC; metastatic disease follows the colorectal page by sidedness and RAS, BRAF and HER2 status.","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Colorectal_cancer","links":[{"label":"NCI PDQ: colon cancer treatment","url":"https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq"},{"label":"Nagtegaal 2020, Histopathology: the 2019 WHO classification of tumours of the digestive system","url":"https://doi.org/10.1111/his.13975"},{"label":"Clinical Colorectal Cancer 2013: two adjuvant trials reveal differences between colon and rectal cancer","url":"https://doi.org/10.1016/j.clcc.2012.07.005"},{"label":"European Journal of Cancer 2018: left-sided colon and rectal cancer in 2,879 ARCAD trial patients","url":"https://doi.org/10.1016/j.ejca.2018.08.020"},{"label":"J Cancer Res Clin Oncol 2016: mucinous and signet ring cell colorectal cancer in 28,056 Munich registry patients","url":"https://doi.org/10.1007/s00432-016-2224-2"}],"tags":["subtype-page","wave4","colorectal"],"related":["colorectal","rectal-cancer","msi-high-colorectal","braf-v600e-colorectal","colorectal-mucinous-adenocarcinoma","colorectal-serrated-adenocarcinoma","colorectal-medullary-carcinoma"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["folfox","capox","oxaliplatin","capecitabine","fluorouracil","bevacizumab","cetuximab","panitumumab","nivolumab","ipilimumab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["niche-2","atomic","dynamic","circulate-us","challenge","alascca","paradigm","crystal-fire3"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"gastrointestinal","burden":"GLOBOCAN counts colon and rectum together (1,926,425 new colorectal cancers in 2022); most colorectal cancers arise in the colon. In the Munich registry, 34 percent of ordinary adenocarcinomas were in the proximal colon (J Cancer Res Clin Oncol 2016).","subtypes":["Right-sided (proximal) colon cancer: caecum to transverse colon; more often MSI-high, BRAF-mutant and mucinous","Left-sided (distal) colon cancer: splenic flexure to sigmoid; EGFR-antibody responsive when RAS wild-type","Stage II colon cancer (ctDNA-guided adjuvant decisions)","Stage III colon cancer (three or six months of FOLFOX or CAPOX)","Mismatch-repair deficient colon cancer (neoadjuvant immunotherapy in trials)"],"biomarkers":["Mismatch repair and microsatellite instability","RAS and BRAF V600E mutation, HER2 amplification (metastatic)","Primary tumour side","Circulating tumour DNA after surgery","Carcinoembryonic antigen"],"standardOfCare":[{"setting":"Stage I to III","approach":"Colectomy with regional lymphadenectomy; adjuvant FOLFOX or CAPOX for stage III and high-risk stage II, with ctDNA guidance under study.","refs":["folfox","capox","dynamic","circulate-us","challenge"]},{"setting":"Mismatch-repair deficient, localised","approach":"Neoadjuvant nivolumab and ipilimumab (NICHE-2) and adjuvant atezolizumab with FOLFOX (ATOMIC) in trials.","refs":["niche-2","atomic","nivolumab","ipilimumab"]},{"setting":"Metastatic","approach":"As the colorectal page by sidedness and RAS, BRAF and HER2 status.","refs":["colorectal","cetuximab","panitumumab","bevacizumab","paradigm"]}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"colorectal"},"route":"/cancers/colon-cancer/","neighbours":{"cancer":[{"id":"colorectal-adenoma-like-adenocarcinoma","kind":"cancer","name":"Adenoma-like adenocarcinoma of the colon and rectum","route":"/cancers/colorectal-adenoma-like-adenocarcinoma/"},{"id":"braf-v600e-colorectal","kind":"cancer","name":"BRAF V600E-mutant colorectal cancer","route":"/cancers/braf-v600e-colorectal/"},{"id":"colorectal","kind":"cancer","name":"Colorectal 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