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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.
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).
How 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.
How common: no separate GLOBOCAN figure; the proximal-colon share above is from one registry.
Treatment 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.
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).
Right-sided tumours behave differently from left-sided and rectal ones; the colon drains along its mesenteric vessels, the rectum into the mesorectum and pelvic side wall.
Same organ: Micropapillary adenocarcinoma of the colon and rectum, Adenoma-like adenocarcinoma of the colon and rectum, Lynch syndrome-associated colorectal cancer, Familial adenomatous polyposis-associated colorectal cancer, Mucinous adenocarcinoma of the colon and rectum, Signet ring cell carcinoma of the colon and rectum, Medullary carcinoma of the colon, Serrated adenocarcinoma of the colon and rectum, Peritoneal mesothelioma, Colorectal cancer, Rectal cancer, Mismatch-repair deficient (MSI-high) colorectal cancer, BRAF V600E-mutant colorectal cancer, HER2-amplified colorectal cancer, KRAS G12C-mutant colorectal cancer, Early-onset colorectal cancer (under 50), Anal cancer (squamous cell carcinoma), Appendiceal cancer and pseudomyxoma peritonei, Small intestine cancer (small bowel adenocarcinoma), Small intestinal neuroendocrine tumours, Anal high-grade squamous intraepithelial lesions (precursor), Localised anal squamous cell carcinoma (stage I to III), Metastatic and recurrent anal squamous cell carcinoma, Low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei, Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell), Goblet cell adenocarcinoma of the appendix, Localised small bowel adenocarcinoma (stage I to III, resected), Advanced and metastatic small bowel adenocarcinoma
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Colectomy with regional lymphadenectomy; adjuvant FOLFOX or CAPOX for stage III and high-risk stage II, with ctDNA guidance under study.
Neoadjuvant nivolumab and ipilimumab (NICHE-2) and adjuvant atezolizumab with FOLFOX (ATOMIC) in trials.
As the colorectal page by sidedness and RAS, BRAF and HER2 status.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
The bowel cancer regimens share low blood counts, tiredness, sickness and a sore mouth. Oxaliplatin adds cold-triggered tingling, irinotecan adds early and late diarrhoea, capecitabine adds hand-foot syndrome and needs a DPD test first, and cetuximab or panitumumab add an acne-like rash and low magnesium. The rule for all of them: ring the 24-hour number rather than wait.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
The shared side effects of drugs that block blood vessel growth (bevacizumab, ramucirumab and VEGFR kinase inhibitors): high blood pressure, protein leaking into the urine, nosebleeds and more serious bleeding, slow wound healing, and rarely holes in the bowel.
See all on the product pages:BevacizumabCAPOX (capecitabine, oxaliplatin)CetuximabFOLFOX (5-FU, leucovorin, oxaliplatin)IpilimumabNivolumabPanitumumab·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Colon cancer, then print the one-page appointment sheet with room for the answers.
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.