Gastrointestinal medical oncologist Dr. Michael Foote is examining an MSK cancer patient in New York City with a stethoscope.
MSK's Guide To

Colon Cancer Diagnosis, Types & Stages

Overview

At MSK, treatment for colon cancer starts with a correct diagnosis. We’re here to help you take the first steps toward getting the best cancer care.

You may be reading this because you’re thinking about getting screened for colon cancer. Maybe you’re waiting for test results. Or perhaps you or someone you care about just learned they have colon cancer.  

This guide will help you understand how colon cancer is diagnosed and what your diagnosis means. Learning as much as you can may help you feel ready to talk with doctors about your care. 

Doctors Emmy Ludwig, Robin Mendelsohn, and Hans Gerdes meet to talk about a patient chart.
The diagnosis process

If you have symptoms of colon cancer, you may have a colonoscopy. If you have a polyp, you’ll have a biopsy to remove the polyp and test it for cancer cells. 

New York City gastrointestinal oncologist and cellular therapist Dr. Geoffrey Ku is smiling as he talks with his MSK patient.
Understanding your diagnosis

Your diagnosis most often will describe where the cancer started, its type, and if it has spread. We use this information to create a care plan just for you.  

The diagnosis process

How is colon cancer diagnosed?

The most common way to find colon cancer is through a routine cancer screening. Most people with early-stage colon cancer do not have symptoms. 
 
Colon cancer screening can help prevent colon cancer or find it early when it’s easier to treat. Screening guidelines are based on your risk (chances) of getting colon cancer. Talk with your doctor about your risk for getting colon cancer. 

MSK recommends people at average risk for colon cancer start getting screened at age 45. We also recommend people at higher risk for colorectal cancer talk with their healthcare provider about when to start screening. 

If you’re 75 or older, talk with your healthcare provider about whether screening is right for you. In general, we do not recommend routine screening after age 85. 

If you have signs or symptoms of colon cancer, your diagnosis process may look like this:
  • Health record: If you have symptoms, your primary care provider will review your health record. They’ll ask questions to find out if you have any colon cancer risk factors. They may send you to an expert, such as a gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist). A gastroenterologist is a doctor with special training in the gastrointestinal (GI) system.
  • Digital rectal exam and physical exam: Your doctor will use a finger to feel for any tumors or areas that are not normal in your rectum. They may check other parts of your body for health problems that are causing your symptoms. Your healthcare provider may order diagnostic tests, such as a colonoscopy or CT scan.
  • Colonoscopy: If your doctor thinks you may have colon cancer, you’ll have a colonoscopy. This test checks for polyps in your colon. Your doctor may remove polyps during the procedure. This can prevent cancer.
  • Biopsy: During a colonoscopy, your doctor may do a biopsy. This is a procedure to remove a polyp or small piece of tissue with a special instrument. The tissue sample or cells will be examined under a microscope to look for cancer cells.
  • Imaging tests: If cancer cells are found in your biopsy tissue sample, your doctor will order imaging tests. They may include a  computed tomography (CT) scan and sometimes a  magnetic resonance imaging (MRI). These tests can show if the cancer has spread to other parts of your body.
  • Genetic tests: Colon cancer can be caused by genetic changes (mutations or variants) that make normal cells become cancer. If the cancer has spread outside the colon, your doctor will test your samples. They’ll look for gene mutations common in colon cancer, in genes such as KRAS and BRAF. We’ll also test for mutations in less common genes. We’ll look for a genomic condition called high microsatellite instability (MSI-H). 

What is a colonoscopy?

A colonoscopy is a test that lets your doctor see inside your colon (large intestine). Your doctor will use a colonoscope, a flexible tube with a camera on the end. The images will appear on a video monitor. Watch our video to learn what happens during a colonoscopy.

During your procedure, your doctor can: 

  • Do a biopsy, a procedure to remove a small sample of tissue for testing.
  • Remove a polyp (growth of tissue).
  • Take photos of the inside of your colon. 

Your colon must be empty for your procedure. Your doctor cannot see polyps or other problems if there’s stool (poop) inside your colon. You may need to have the procedure again if this happens. Learn more about colonoscopies

THE MSK DIFFERENCE

We use a testing tool developed at MSK called MSK-IMPACT®. It looks at about 500 genes for genetic changes and other tumor traits. Our test finds genetic changes in the tumor that other tests can miss. As of 2024, more than 92,000 of our patients used MSK-IMPACT to find the best treatments for them.       

What is colon cancer genetic testing? 

Your doctor may suggest  genetic counseling and testing.   

Genetic testing is a medical test. It looks at your DNA to see if you were born with certain changes (mutations or variants) in specific sets of genes. These changes raise your chances of getting colorectal and other cancers.  

We’ll ask for your written permission to do the test. Before testing, we’ll review your personal and family cancer history to help decide which test is right for you. We’ll explain the test and what the results could mean.    

The test involves taking a sample of blood or saliva. You can give a blood sample at an MSK location near you.  Or, we’ll mail a saliva kit to your home. The sample is sent to a lab for testing.   

When the results come back, often in a few weeks, we’ll go over them with you. If the test shows a gene change that raises your cancer risk, we’ll help you understand what that means. We’ll talk about ways to lower your risk, such as extra screenings or even surgery to prevent cancer.   

 How genetic mutations affect your colon cancer risk and treatment

Hereditary means genes you were born with, passed on from parent to child. A hereditary syndrome can raise your risk for getting colon cancer. 

Out of every 100 people with colon cancer, about 5 to 10 of them have changes in certain genes passed from parents to children. 

A number of hereditary cancer syndromes, such as Lynch syndrome, are linked to a higher risk for colon cancer. 

MSK may offer you genetic testing. It can show if you and your family have hereditary changes (mutations) that raise your cancer risk. 

MSK is one of the few hospitals that can test for mutations in many genes at the same time. Our multi-gene panel test can find a hereditary cause of colorectal cancer or polyposis faster. This genetic testing can help us find the best treatment for your type of colon cancer.  

MSK’s test can check for gene mutations linked to Lynch syndrome, which can cause colorectal cancer.  MSK’s  Clinical Genetics Service  can do genetic testing for both people with cancer and those at risk for cancer. 

Some gene changes can guide which treatment is best for you

MSK will check your biopsy sample for gene changes that affect treatment options. 

  • Your doctor will check for a condition called high microsatellite instability (MY-kroh-SA-teh-lite in-stuh-BIH-lih-tee).
  • If cancer has spread outside the colon, your doctor will test for mutations in the genes KRAS and  BRAF. These are common in colon cancer. They influence how sensitive or resistant you are to some colon cancer treatments.
  • We’ll also test for mutations in less common genes.  

Innovations at MSK

Our experts are always exploring new ways to diagnose colon cancer and find it early when it’s easier to treat. Explore the latest colon cancer news from MSK.

Understanding your diagnosis

Learning you have colon cancer can be overwhelming. You’ll hear many medical terms you've never heard before. We’re here to help you understand what they mean and why they matter.  

The information in your diagnosis describes important details about the type of colon cancer you have. Your doctors use that information to create the best plan of care for you. 

To find out if you have colon cancer, they'll look at a sample of your cells under a microscope. Your doctor collect this sample during a biopsy.

Your cancer diagnosis will include information on the stage of the colon cancer, or how advanced it is. Staging helps us choose a treatment plan. To find the stage of the colon cancer, you'll have diagnostic tests to find out:

  • How deep the cancer has grown in the wall of your colon.
  • Whether the colon cancer has spread to other parts of your body. 
Video | 3:32 MSK patients offer helpful tips on becoming a new patient

Newly diagnosed? Hear advice from our patients.

The cancer stage describes traits such as the tumor’s size, location, and whether it has spread. The stage tells us how advanced the cancer is. The stage helps us choose a treatment that’s best for you. The stage describes which layers of the colon the cancer cells have spread to.

 Picture the colon as a tube. Here are the layers of the colon, in order from inside to outside: 

  • Mucosa is the inner layer of the tube. It lines the wall of the colon.
  • Submucosa is the next layer.
  • Muscle layer of the colon wall is next to the submucosa.
  • Serosa is the outer layer of the colon wall.
  • Visceral peritoneum (VIH-seh-rul PAYR-ih-toh-NEE-um). This layer of tissue covers the outer surface of the intestines. 
Here is some of the information your diagnosis may include:
Where the colon cancer started
Colon cancer can grow slowly over a few years. It often starts as a small abnormal (not normal) growth on the inside lining of the colon. This is called a colon polyp.   
Where the colon cancer started

Colon polyps are common, and they are not cancer. Most types will not harm you.  But some types of polyps can become cancer. For example, most colorectal cancers start in adenomatous polyps. 

Colon cancer often stays just within the colon. But if it’s not treated, it can spread to other organs, most often the liver and lungs. 

Where the colon cancer started

Colon polyps are common, and they are not cancer. Most types will not harm you.  But some types of polyps can become cancer. For example, most colorectal cancers start in adenomatous polyps. 

Colon cancer often stays just within the colon. But if it’s not treated, it can spread to other organs, most often the liver and lungs. 

If the colon cancer is spreading
Some colon tumors stay in the place where they started. But other tumors spread to other organs or parts of the body. This process is called metastasizing.   
If the colon cancer is spreading

Metastatic colon cancer means the cancer cells have spread beyond the colon to other organs. It’s also called advanced colon cancer or stage 4 colon cancer. 

Colon cancer most often spreads to the liver. Up to 7 out of every 10 people with colorectal cancer develop liver metastases. That’s because a large blood vessel called the portal vein connects the blood supply from the intestines to the liver. 

Colon cancer can also spread to the lungs, peritoneum (lining of the abdomen), ovaries, brain, and distant lymph nodes. Lymph nodes are small organs that are part of the immune system.  

If the colon cancer is spreading

Metastatic colon cancer means the cancer cells have spread beyond the colon to other organs. It’s also called advanced colon cancer or stage 4 colon cancer. 

Colon cancer most often spreads to the liver. Up to 7 out of every 10 people with colorectal cancer develop liver metastases. That’s because a large blood vessel called the portal vein connects the blood supply from the intestines to the liver. 

Colon cancer can also spread to the lungs, peritoneum (lining of the abdomen), ovaries, brain, and distant lymph nodes. Lymph nodes are small organs that are part of the immune system.  

The stage, which explains the tumor’s size, location, and how far it has spread
The stage tells us how advanced the colon cancer is and guides treatment.  
The stage, which explains the tumor’s size, location, and how far it has spread

The stage tells us how advanced the cancer is and guides treatment.  

There are 5 stages, from 0 to 4 (0 to IV). The lower the number, the less the colon cancer has spread. 

Here’s more information:
  1. Stage 0

    There are cancer cells. The tumor cells have not yet spread.   

  2. Stage 1

    There is 1 small tumor. It’s only in the place where it started.  The tumor has spread beyond the inner lining but remains within the colon wall. 

  3. Stage 2

    Localized spread: The tumor has grown larger, or the cancer has spread to nearby lymph nodes.  

  4. Stage 3

    Regional spread: The tumor has grown larger. Or, the cancer has spread further to lymph nodes that are farther away.  

  5. Stage 4

    Distant spread: Cancer has metastasized (spread) outside the place where it started.  

    Learn more about colon cancer stages 

The stage, which explains the tumor’s size, location, and how far it has spread

The stage tells us how advanced the cancer is and guides treatment.  

There are 5 stages, from 0 to 4 (0 to IV). The lower the number, the less the colon cancer has spread. 

Here’s more information:
  1. Stage 0

    There are cancer cells. The tumor cells have not yet spread.   

  2. Stage 1

    There is 1 small tumor. It’s only in the place where it started.  The tumor has spread beyond the inner lining but remains within the colon wall. 

  3. Stage 2

    Localized spread: The tumor has grown larger, or the cancer has spread to nearby lymph nodes.  

  4. Stage 3

    Regional spread: The tumor has grown larger. Or, the cancer has spread further to lymph nodes that are farther away.  

  5. Stage 4

    Distant spread: Cancer has metastasized (spread) outside the place where it started.  

    Learn more about colon cancer stages 

MSK Recommends Bring these questions to your next appointment

When you learn you have colon cancer, you’ll probably have many questions to ask your cancer doctor at your first visit. Talking about treatment options with your doctor can help you feel better prepared to make decisions about your care.  

  • What type of colon cancer do I have, and what stage is it?  
  • Did I have all the scans I need to learn the stage?   
  • What genetic testing do you offer for colon cancer?   
  • What are the best treatment options for the type and stage of colon cancer I have?   
  • When can I start treatment?   
  • Can I get treatment at MSK locations close to my home?    
  • What are the risks and side effects of colon cancer treatment?   
  • Are there new colon cancer drugs I can try?   
  • Will I need more tests before treatment starts?  
  • What experience do you have in treating my type of cancer?   
  • How will MSK help me recover after treatment?   
  • Will I get side effects from treatment? How can I manage them? 

Types of colon cancer

What are the types of colon cancer?

There are a few types of colon cancer. We’re experienced in treating them all, from the most common to the most rare. This information describes each kind of colon cancer and explains how we classify (sort) them.  

Most people who are diagnosed with colon cancer have a type called adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh). There are other rarer tumor types too.  

Most colon cancers are adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh). This is a cancer that starts in the glandular tissue that lines the colon. This kind of tissue makes mucus and other fluids. 

This cancer often starts as polyps that can bleed or cause discomfort. When the polyps grow, they can become painful. They also can change the shape of your stool (poop), making them thin or flat. 

Carcinoid (KAR-sih-noyd) tumors in the colon grow slowly. Like adenocarcinomas, they most often start in the small intestine and as polyps in the rectum. Carcinoid tumors are the most common type of neuroendocrine (NOOR-oh-EN-doh-krin) tumor. 

Gastrointestinal stromal tumors can be a type of  soft tissue sarcoma. They can be anywhere in the gastrointestinal tract but are rare in the colon. These tumors can also be other types of sarcoma that start in the blood vessels or connective tissue of the colon. 

Lymphoma  is a cancer of the immune system. It more often starts in the lymph nodes but can start in the colon. 

Colon cancer stages 0, 1, 2, 3, and 4

The cancer stage describes traits such as the tumor’s size, whether it spread, and where it spread. Staging tells us how advanced the cancer is. The stage guides the choice of treatment.  

There are 5 stages of colon cancer, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread. 

Knowing the stage of the cancer helps you and your doctor decide on the best treatment options for you.  

Staging describes which layers of the colon the cancer cells have spread to. Picture the colon as a tube. Here are the layers from inside to outside: 

  • The inner layer of the tube lines the wall of the colon. It’s called the mucosa.
  • The next layer is the submucosa.
  • Next comes the muscle layers of the colon wall.
  • The outer layer of the colon wall is called the serosa.
  • Next is the visceral peritoneum (VIH-seh-rul PAYR-ih-toh-NEE-um). This is a layer of tissue covering the outer surface of the intestines. 
The stage is based on:
  • The size and location of the original tumor (also called the primary tumor).
  • If the cancer has spread to nearby lymph nodes.
  • If the cancer has spread to other parts of the body. 
Video | 3:32 MSK patients offer helpful tips on becoming a new patient
<p>Newly diagnosed? Hear advice from our patients.</p>
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Your doctor may use letters and numbers from the TNM system to describe the stage: 
  • T  is the size of the tumor.  
  • N  is whether the cancer has spread to the lymph  nodes.  
  • M  is whether the cancer has  metastasized  (spread) to other areas.  

N0 means cancer is not in lymph nodes. N1, N2, or N3 means it’s spread to lymph nodes. M0 means cancer has not spread. M1 means it’s spread to distant organs, muscles, or bones. 

What are the stages of colon cancer?

THE MSK DIFFERENCE

MSK's Center for Young Onset Colorectal and Gastrointestinal Cancer is the first program of its kind. Our treatment experts work together to care for the needs of young adults with these cancers. We also offer mental health counseling, fertility and sexual health medicine, nutrition, and more.