Medical Oncologist
CION Cancer Clinics
How your colon cancer treatment plan is decided | CION Cancer Clinics
Your colon cancer treatment plan is decided mainly by the stage, where the tumour sits and how fit you are. A tumour board of surgeons, medical oncologists, radiologists and pathologists reviews your scans and reports together before a plan is offered. This page explains what they weigh, the order things usually happen in, and where your own wishes and questions come in. At CION Cancer Clinics, a multidisciplinary team plans colon cancer treatment for your stage, from surgery to chemotherapy and follow-up.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- Who decides the treatment for colon cancer, and how?
- What does the tumour board look at before recommending a plan?
- What happens between diagnosis and a written treatment plan?
- How does the plan usually differ from stage to stage?
- Four things families assume about treatment decisions
- What this page cannot tell you
- Common questions about how a colon cancer plan is decided
The short answer
Who decides the treatment for colon cancer, and how?
A team decides, not one doctor, and the stage of the cancer drives most of the decision. Stage tells the team how deep the tumour has grown, whether lymph nodes (small glands that filter fluid from the bowel) are involved, and whether the cancer has spread to the liver, lungs or elsewhere. For most people whose colon cancer has not spread, an operation to remove the affected part of the colon comes first. What happens after it depends on what is found in the removed tissue.
The plan is made twice
There is a first plan, made from the colonoscopy, the biopsy and the CT scans. Then there is a second, firmer plan, made once the removed bowel and its lymph nodes have been examined under a microscope. The stage can move up or down between the two. When your oncologist says "we will decide about chemotherapy after the report", nobody is unsure. They are waiting for the most accurate information you will ever have.
Who does what at CION
The tumour board meets at CION and reviews every case before a plan is offered. CION's surgical oncologists plan the operation, and it is carried out at an accredited partner hospital. Chemotherapy, targeted therapy, immunotherapy and follow-up are given at CION centres.
A treatment plan is a recommendation. You are allowed to question it, and to ask for time.What the team weighs
What does the tumour board look at before recommending a plan?
Four things decide most colon cancer plans. The first carries the most weight, but the other three can change the answer.
The stage
How far the tumour has grown through the bowel wall, how many lymph nodes contain cancer, and whether it has spread. Early stages usually need an operation alone. Later stages usually add chemotherapy.
It comes from
- Colonoscopy and biopsy
- CT of the chest, abdomen and pelvis
- The pathology report after surgery
Where the tumour sits and how it behaves
A tumour on the right side of the colon needs a different operation from one in the sigmoid colon, the last bend before the rectum. A tumour that is blocking the bowel, bleeding heavily or has torn the wall may need urgent surgery or a stent before anything else is planned.
The tumour's biology
Tests on the tissue look at MMR or MSI status, which shows whether the tumour's DNA repair system works. When the cancer has spread, KRAS, NRAS and BRAF are checked too, because these genes decide which targeted drugs can work.
These results change drug choices far more than they change surgery.You
Fitness matters more than age. Heart, kidney or lung disease, diabetes and how active you are day to day decide whether an operation or a particular drug is safe. Your own wishes count here as well.
Not sure whether this applies to you?
Ask an oncologistThe usual order
What happens between diagnosis and a written treatment plan?
The diagnosis is confirmed
A colonoscopy finds the tumour and a biopsy, a small piece of tissue, confirms it is cancer. If you have not had these yet, CION arranges them through accredited diagnostic partners.
Staging scans and blood tests
A CT scan checks the chest, abdomen and pelvis for spread. A CEA blood test, a marker some colon cancers release, gives a starting point for later comparison. A PET-CT is kept for selected situations.
The tumour board meets
Your scans, biopsy and history are presented together. The surgeon, medical oncologist, radiologist and pathologist agree a recommendation. If a scan is unclear, they ask for more before deciding.
You hear the plan
A consultant explains the recommendation, the alternatives and what each one involves. Bring a family member and your questions written down.
The plan is revisited after surgery
If you had an operation, the pathology report goes back to the board. This is usually when the decision about chemotherapy after surgery is made.
By stage, in outline
How does the plan usually differ from stage to stage?
The situation
The usual starting point
Stage 1
Surgery alone, then follow-up. A very early cancer
inside a polyp is sometimes removed at colonoscopy.
Stage 2
Surgery. Chemotherapy afterwards is considered if
high-risk features are found.
Stage 3
Surgery, then chemotherapy to lower the chance of
the cancer coming back.
Stage 4
Depends on where the spread is. Some liver or lung
spread can be removed. Otherwise drug treatment leads.
A blocked or torn bowel
Emergency surgery or a stent first. The full plan
follows once you are stable.
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Commonly believed
Four things families assume about treatment decisions
"The surgeon decides everything."
Surgery usually comes first when colon cancer has not spread, so the surgeon is often the first specialist you meet. What follows is decided with the medical oncologist and the rest of the board, and it often waits for the pathology report.
"More treatment is always safer."
Chemotherapy given when the chance of benefit is small brings side effects without a matching gain. That is why most people with stage 1 cancer are not offered it. Being offered less does not mean being offered worse care.
"Asking for a second opinion will offend the doctor."
Oncologists expect it. Unless the bowel is blocked, colon cancer usually allows time for one before surgery. A second opinion reviews the same scans and reports, so bring copies of everything, including the scan images.
"Once the plan is made, it cannot change."
Plans change when new information arrives: a pathology report, a new scan, a side effect, or your own change of mind. A plan that is reviewed and adjusted is a plan working as it should.
Being straight with you
What this page cannot tell you
It cannot tell you what your own plan should be. That depends on your stage, your reports and your health, and it needs a specialist who has seen all three. Two people with the same stage can be advised differently for good reasons.
Who this page does not apply to
This page is about cancer in the colon. Cancer in the rectum, the last part of the bowel, is planned differently and often starts with radiation before any operation. If your report says rectal cancer, go to the rectal cancer pages instead. Anal cancer is different again and is usually treated without surgery first.
Where the treatment details live
This page explains how the decision is reached, not the treatments themselves. The operation is covered on the colectomy pages. Regimens and side effects are on the chemotherapy for colorectal cancer page, with separate pages on targeted therapy and on immunotherapy for MSI-high colon cancer.
If you are unsure which part of the bowel your report names, call the helpline and read it out. Someone will tell you which specialist fits.Questions we are asked
Common questions about how a colon cancer plan is decided
How long does it take to get a treatment plan?
It depends on how many tests are already done. If you arrive with a colonoscopy, biopsy and CT scan, the tumour board can usually review your case soon. Missing or unclear tests add time. Colon cancer rarely needs a decision within hours unless the bowel is blocked or bleeding heavily.
Can I attend the tumour board meeting?
Patients do not usually attend. It is a working discussion between specialists. Your consultant explains the outcome afterwards, with the reasons. If something matters to you, such as avoiding a stoma or staying close to home, tell your doctor beforehand so it is raised in the room.
Why wait for the pathology report before deciding on chemotherapy?
The report on the removed bowel is the most accurate stage you will ever have. It counts the lymph nodes involved and looks for features that raise the risk of the cancer coming back. Deciding on chemotherapy without it would mean guessing, and nobody should guess about chemotherapy.
Does my age decide whether I get treated?
Fitness matters more than the number. A healthy, active person in their late seventies may be offered the same operation as someone much younger. A frail person may be offered a gentler plan. Your doctor looks at your heart, kidneys and daily activity, not your birth year.
Is chemotherapy ever given before surgery?
Sometimes. For most colon cancer that has not spread, surgery comes first and chemotherapy, if needed, follows. Chemotherapy first is considered when the tumour has grown into nearby organs, or when liver spread might become removable. The tumour board decides which order suits you.
Will tumour test results change my plan?
Sometimes. MMR or MSI results can change whether chemotherapy helps in stage 2 disease, and can open immunotherapy when the cancer has spread. RAS and BRAF results matter mainly in advanced disease. An MMR-deficient result can also point to inherited risk in your family.
Can I refuse part of the recommended plan?
Yes. It is your decision. Ask what you would gain and lose by leaving that part out, and whether there is an alternative. Your doctor should explain the trade-off honestly and keep looking after you whichever way you decide.
Where do I start if I already have reports?
Gather your colonoscopy report, biopsy report, CT scan with its images, and any blood tests. Call the CION helpline and say you would like your case reviewed. A consultant will see you and, where needed, take your case to the tumour board.
Your Specialists
Meet CION's colon cancer specialists. Bring your colonoscopy, scan or biopsy report.
Our surgical and medical oncologists plan colon cancer care together: which operation, whether chemotherapy is needed, and the follow-up that comes after.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Colon Cancer Treatment, by Stage
- National Cancer Institute — Colon Cancer Treatment
- NHS — Treatment for bowel cancer
- NICE — Colorectal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
The tumour board and who decides your treatmentWho sits round the table and what they do with your reportsDo you need chemotherapy after surgery?The decision most often made after the pathology reportGetting a second opinion on a treatment planHow to ask, and what to bringQuestions to ask before starting treatmentA list to take into the consultation
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Want your reports reviewed before you decide?
Send us your colonoscopy, biopsy and scan reports, and a CION consultant will explain what they mean for your plan. There is no pressure to start anything with us. One helpline serves every CION centre.