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What Stage of Colon Cancer Requires a Colostomy Bag

According to WHO, colon cancer is the third most common cancer worldwide wide and its treatment not only includes chemotherapy and medication but also surgical removal of the cancerous part of the colon which is known as colostomy or colectomy. A lot of people are concerned about what stage of colon cancer requires a colostomy bag. The decision to perform a colostomy in colorectal cancer is not solely determined by the stage of cancer but rather by factors such as the location and extent of the tumor, as well as the overall health and preferences of the patient. A colostomy is more commonly associated with advanced stages of colorectal cancer where the tumor has extensively invaded the bowel wall, making it difficult to resect the affected portion and restore normal bowel continuity.

This article is written just to shed some light on the stages of cancer where colostomy may be deemed necessary. Also, we will discuss some factors that may influence the decision of colectomy.


A colostomy is a surgical procedure that involves creating an opening in the abdominal wall, known as a stoma, through which a portion of the colon is brought to the surface. This allows fecal material to bypass the diseased or obstructed part of the colon, exiting the body and collecting in an external pouch.


Colorectal or colon cancer is cancer of the last part of the digestive tract, the large intestine, and the rectum. When the cells of the colon grow abnormally and uncontrollably, then this is called colon cancer. It is the second leading cause of cancer-related deaths worldwide. the typical symptoms of colon cancer include a change in bowel movements routine(diarrhea constipation) blood in the stool, black or dark stool, abdominal pain, weight loss, lethargy, and low iron levels in the body that may lead to anemia.

Related: What are the reasons for colostomy?


The initial stage of colon cancer is called stage 0 which means very early cancer, and then ranges further stages. The lower the number, the less the cancer has spread. However, a higher number means cancer has spread more in the body.

For staging colon cancer TNM system is used which means:

T = size and extent of Tumor

N = the involvement of lymph Node

M= and how far the cancer has Metastasize( medical terminology used to describe the spread of cancer)

According to TNM, colon cancer has 4 stages.

Stage 0 = This is the very easy stage of colon cancer, it indicates that the cancer is the size of a pea and is limited only to the inner lining of the colon.

Surgery is the treatment option available here which involves removing the polyp or local excision that is removing the cancerous area through colonscope. Patients of stage 1 cancer do not require a colostomy bag.

Stage 1= Stage 1 cancer means that the cancer has grown into the deep layers of mucos but still it has not spread to the surrounding tissues and lymph nodes.

treatment: polypectomy and local excision is the surgical option available here. Still, the patient did not require a colostomy bag.

Stage 2= cancer has outgrown the wall of the colon and rectum and has started involving nearby tissues but still, it is not spread to the lymph nodes.

Treatment: Partial Colectomy is the surgery to remove the section of the colon along with chemotherapy. Now patient here requires a colostomy bag but that would be temporary.

Stage 3=cancer has now spread to the nearby tissues and lymph nodes, but it has not spread to the other parts of the body.

Treatment: Colectomy along with chemotherapy is required. the patient cannot pass stool via the rectum, rather a stoma is created in the abdominal wall that passes poop. A colostomy bag is required at this stage.

Stage 4 = This is the last stage where the cancer has spread from the colon and rectum to the other organs and tissues. the most susceptible organ is the liver, but in some cases, colon cancer may spread up to the lungs as well.

Guide: What happens to your anus after a colostomy


For the treatment of colon cancer, several factors contribute to the decision to perform colostomy. These include:

Location of tumor:

If the cancer is in the lower part of the rectum, there might be difficulties in surgery while trying to keep the anal function normal. In such cases, a colostomy might be needed.

Read More: Colostomy vs Ileostomy – Which is More Worse?

Size and invasiveness of tumor:

If the tumor is large or has spread into nearby tissues a lot, doctors might need to do more intense surgery, and this could involve a colostomy.

involvement of lymph node: If the cancer has reached the nearby lymph nodes, colostomy surgery is required.

Related: How does a colostomy bag work


Not everyone with colon cancer needs a colostomy, but it’s more likely for people with advanced stages of the disease such as stage 2 onwards. initial stages such as stage 0 and stage 1 can be treated with polypectomy or local excision. Deciding to do a colostomy is not easy—it’s a complicated choice that depends on different things for each person which includes the location and size of the tumor and how much it has spread into the lymph node. Above all, open discussion with your healthcare provider is necessary to determine whether you need a colostomy or not.

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