RGCIRC, Niti Bagh
Colon Cancer Treatment in Delhi, India | RGCIRC
Colorectal cancer is the fourth most common cancer in India among both men and women, with 64,863 new cases and 38,367 deaths reported in 2022. Over the past two decades, incidence has steadily increased, with an annual rise of 2 to 3 percent cases. Doctors across the country are also observing a higher number of cases in younger individuals. The positive side is, despite this growing burden, colon cancer remains highly treatable when detected early. However, early detection can be challenging, as the disease is often silent in its initial stages, and many patients do not experience noticeable symptoms until it has advanced. This makes awareness of risk factors and timely screening especially important.
At RGCIRC (Rajiv Gandhi Cancer Institute and Research Centre), colon cancer care is led by a specialised GI Oncosurgery and Liver Transplant team within a multidisciplinary treatment framework. The institute offers comprehensive, evidence-based care across all stages of the disease, ranging from early-stage polypectomy to advanced surgical procedures such as multivisceral resection and HIPEC for stage IV disease, all available under one roof.
What is Colon Cancer?
Types of Colon Cancer
Adenocarcinoma
Adenocarcinoma accounts for nearly 95 percent of all colon cancers. It develops from the glandular cells lining the inner surface of the colon. Most clinical guidelines, treatment protocols, and research studies on colon cancer are based on this type.
Within this category, two subtypes have particular clinical relevance. Mucinous adenocarcinoma contains a high proportion of mucin and is often diagnosed at a more advanced stage. Signet ring cell carcinoma is a rare and more aggressive variant, usually associated with a poorer prognosis.
Carcinoid Tumours (Neuroendocrine Tumours)
Carcinoid tumours arise from hormone-producing cells in the colon wall. They are generally slow-growing and are often detected incidentally during colonoscopy. Well-differentiated neuroendocrine tumours tend to have a favourable prognosis when localised. However, high-grade neuroendocrine carcinomas behave more aggressively and require intensive treatment.
Gastrointestinal Stromal Tumours (GIST)
GISTs originate from specialised cells in the colon wall known as interstitial cells of Cajal. These tumours are rare in the colon and are typically driven by mutations in the KIT or PDGFRA genes. Their treatment differs from adenocarcinoma and often involves targeted therapy, such as tyrosine kinase inhibitors, based on molecular testing
Primary Colorectal Lymphoma
Signs and Symptoms of Colon Cancer
Colon cancer often develops silently in its early stages, which is why many patients are diagnosed only after the disease has progressed. As the tumour grows and begins to affect normal bowel function, certain symptoms may appear. Their presence, especially when persistent or progressive, should prompt timely medical evaluation.
Blood in or on the Stool
Rectal bleeding or blood mixed with stool is one of the most important warning signs. The blood may appear bright red if the tumour is located in the lower colon, or dark and tarry if it originates higher up, where it undergoes changes during transit. Any unexplained rectal bleeding in adults requires further evaluation, including colonoscopy.
Changes in Bowel Habits
A persistent change in bowel pattern, such as new-onset constipation, diarrhoea, or alternating episodes of both, lasting more than two to three weeks should not be ignored. As the tumour narrows the colon, stools may also become thinner or ribbon-like in shape.
Abdominal Pain or Discomfort
Ongoing cramping, bloating, or a dull abdominal ache, particularly in the lower abdomen, may indicate tumour growth or partial obstruction. Sudden, severe abdominal pain can signal complications such as obstruction or perforation and requires urgent medical attention.
A Feeling of Incomplete Evacuation
Some patients experience a persistent sensation of not fully emptying the bowel after passing stool. This condition, known as tenesmus, may occur when a tumour in the lower colon or rectum causes irritation or partial blockage.
Unexplained Weight Loss and Fatigue
Unintentional weight loss accompanied by ongoing fatigue may reflect the body’s response to cancer. These symptoms are more commonly seen in advanced stages and should always be evaluated, especially when present with other warning signs.
Anaemia
Chronic, unnoticed blood loss from a tumour can lead to iron deficiency anaemia, even in the absence of visible bleeding. Anaemia in middle-aged or older adults without an obvious cause should be investigated through appropriate gastrointestinal evaluation.
A note on symptom timing: Many of these symptoms can also be caused by non-cancerous conditions. However, symptoms that are new, persistent, worsening, or occurring together require proper medical assessment. At RGCIRC, patients with these concerns are evaluated through a coordinated approach by specialised GI Oncosurgery and Gastroenterology teams to ensure accurate diagnosis and timely care.
Causes and Risk Factors of Colon Cancer
Colon cancer develops due to a combination of genetic, environmental, and lifestyle-related factors. While some risks cannot be changed, many are modifiable and play a significant role in disease prevention. The following are the most clinically established risk factors, organised by category.
Dietary and Lifestyle Factors
Diet is one of the most important modifiable contributors to colon cancer risk. A pattern high in red and processed meat, fried foods, sugary items, and refined carbohydrates, along with low intake of dietary fibre, vegetables, and whole grains, is associated with increased risk. These dietary habits can influence bile acid production, alter the gut microbiome, and promote chronic inflammation in the colon.
In addition, physical inactivity and obesity increase risk through mechanisms such as insulin resistance and systemic inflammation. Regular alcohol consumption and tobacco use are also well-established contributors.
Age
The risk of colon cancer rises significantly with age, with most cases occurring in individuals over 50. The likelihood increases with each passing decade. However, there is a growing trend of younger patients being diagnosed in India, particularly in urban settings, which has led to greater clinical vigilance even in younger individuals with relevant symptoms.
Family History and Genetic Syndromes
A family history of colon cancer, especially in a first-degree relative, can nearly double an individual’s lifetime risk. Certain inherited conditions carry a much higher risk. Lynch syndrome is the most common hereditary cause and accounts for a small but important proportion of cases. Familial Adenomatous Polyposis (FAP) is another condition in which numerous polyps develop in the colon, with a high likelihood of progressing to cancer if not managed appropriately.
Colorectal Polyps
Most colon cancers develop from adenomatous polyps. The risk of these polyps turning cancerous increases with their size, number, and microscopic characteristics. Individuals with a history of such polyps require regular colonoscopy and ongoing monitoring.
Inflammatory Bowel Disease
Chronic conditions such as ulcerative colitis and Crohn’s disease affecting the colon increase the risk of colon cancer. The risk is linked to how long the disease has been present and how much of the colon is involved. Regular surveillance through colonoscopy is an important part of care for these patients.
Type 2 Diabetes and Obesity
Type 2 diabetes and obesity are both independently associated with a higher risk of colon cancer. These conditions contribute through mechanisms such as elevated insulin levels, altered growth signalling pathways, and persistent low-grade inflammation. With increasing rates of metabolic disorders in India, these factors are becoming increasingly relevant.
Stages of Colon Cancer
Staging determines how far the cancer has spread at the time of diagnosis and directly guides treatment planning. Colon cancer is staged using the TNM system, which assesses tumour depth (T), lymph node involvement (N), and presence of distant metastasis (M). The clinical stages are as follows.
|
Stage |
Description |
Treatment Implications |
|
Stage 0 (In Situ) |
Cancer cells are confined to the innermost lining of the colon |
Endoscopic removal, usually through polypectomy |
|
Stage I |
Tumour has grown into the inner layers of the colon wall but has not spread beyond |
Surgery is typically curative with an excellent prognosis |
|
Stage II |
Tumour has grown through the colon wall but has not spread to lymph nodes |
Surgery is the main treatment; chemotherapy may be considered in high-risk cases |
|
Stage III |
Cancer has spread to nearby lymph nodes |
Surgery followed by adjuvant chemotherapy |
|
Stage IV |
Cancer has spread to distant organs, most commonly the liver or lungs |
Multimodal treatment including systemic therapy, surgery, and selected ablative procedures where appropriate |
At RGCIRC, staging is carried out using advanced imaging and pathological assessment, ensuring that each patient receives a treatment plan tailored to the exact extent of disease.
How is Colon Cancer Diagnosed?
Colonoscopy and Biopsy
Colonoscopy remains the gold standard investigation for colon cancer. It allows direct visualisation of the entire colon, enabling detection of suspicious lesions and polyps, along with immediate biopsy.
At RGCIRC, high-definition endoscopy supported by Narrow Band Imaging (NBI) improves the detection of subtle or flat lesions. Tissue obtained during biopsy is analysed to confirm the diagnosis, determine tumour type and grade, and assess markers such as microsatellite instability and mismatch repair status. These findings are essential for planning further treatment.
Blood Tests
- A complete blood count helps identify anaemia, which may result from chronic, unnoticed blood loss.
- Carcinoembryonic antigen (CEA) is used as a tumour marker. While not diagnostic on its own, it is valuable for establishing a baseline and for monitoring response to treatment or detecting recurrence.
Imaging Tests
- Contrast-enhanced CT scan of the chest, abdomen, and pelvis to assess tumour spread and detect distant metastasis
- MRI of the pelvis for detailed evaluation of rectal and low sigmoid tumours
- Digital PET-CT in selected cases where metastasis is unclear or recurrence is suspected
- Endoscopic ultrasound in specific situations for local staging of lower colon and rectal tumours
Pathological and Molecular Analysis
Detailed analysis of biopsy and surgical samples is carried out by the onco-pathology team. This includes both histopathological evaluation and advanced molecular testing.
Techniques such as next-generation sequencing are used to assess mutations in genes such as RAS, RAF, and HER2, along with microsatellite instability status. These results are critical in determining eligibility for targeted therapies and immunotherapy, particularly in advanced stages of the disease.
At RGCIRC, this integrated diagnostic approach ensures accurate diagnosis, precise staging, and a personalised treatment plan for every patient.
How is Colon Cancer Treated?
Treatment for colon cancer depends on the stage of the disease, the tumour’s molecular profile, and the patient’s overall health. At Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), every case is reviewed by a multidisciplinary GI and Colorectal Tumour Board. This team includes surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, and pathologists to ensure a personalised and evidence-based treatment plan.
Surgery
Surgery remains the main curative treatment for colon cancer whenever tumour removal is feasible. The GI Oncosurgery and Liver Transplant team at RGCIRC offers a comprehensive range of surgical options.
- Polypectomy: This is an endoscopic procedure used to remove polyps containing early-stage cancer confined to the mucosal layer. It is performed during colonoscopy and can be curative in selected Stage 0 and early Stage I cases.
- Colectomy: This involves removal of the affected segment of the colon along with nearby lymph nodes. Depending on tumour location, procedures may include right or left hemicolectomy, sigmoid colectomy, or subtotal colectomy. Both open and minimally invasive techniques, including laparoscopic and robotic surgery, are available. Minimally invasive approaches are associated with faster recovery and shorter hospital stay.
- Multivisceral Resection: When the tumour involves nearby organs such as the bladder, small intestine, or abdominal wall, surgery may include removal of these structures along with the tumour to achieve complete clearance.
- Comprehensive Stage IV Care: For patients with advanced disease involving the liver, lungs, or peritoneum, treatment may include a combination of systemic therapy, staged surgeries, and local treatments such as ablation or metastasectomy.
- HIPEC (Hyperthermic Intraperitoneal Chemotherapy): This specialised procedure is performed during surgery for selected patients with peritoneal spread. Heated chemotherapy is delivered directly into the abdominal cavity after tumour removal to target microscopic disease and improve outcomes.
Chemotherapy
Chemotherapy is used at different stages of treatment.
- After surgery in Stage III disease to reduce the risk of recurrence
- Before surgery in selected cases to shrink tumours
- As the primary treatment in advanced disease
Common regimens include FOLFOX, FOLFIRI, and CAPOX, often combined with targeted therapies.
Targeted Therapy
Advances in molecular testing have enabled more precise treatment. The presence or absence of specific mutations determines the use of targeted drugs.
- EGFR-targeted therapies such as cetuximab and panitumumab are effective in selected patients
- Bevacizumab targets tumour blood supply and is used across different mutation profiles
- HER2-targeted therapy is emerging for selected cases
At RGCIRC, molecular profiling is routinely performed for advanced disease to guide therapy.
Immunotherapy
Immunotherapy has become an important option for patients with specific tumour characteristics. Drugs such as pembrolizumab and nivolumab are used in cancers with mismatch repair deficiency or high microsatellite instability. These treatments can produce long-lasting responses in selected patients and are now a standard option in appropriate cases.
Radiation Therapy
Radiation therapy is not routinely used for colon cancer due to the mobility of the colon within the abdomen. However, it may be used in selected situations for symptom relief, particularly in advanced disease, such as managing pain from bone metastases.
At RGCIRC, treatment planning focuses on achieving the best possible outcomes while maintaining quality of life, using a combination of surgical expertise, advanced systemic therapies, and personalised care pathways.
Prevention and Screening
Colon cancer is one of the most preventable common cancers. This is largely due to its well-understood progression from benign polyps to invasive cancer, along with the availability of screening methods that can detect and remove these polyps early.
Colonoscopic Screening
Colonoscopy is the most effective tool for preventing colon cancer. It enables direct visualisation of the colon, allowing doctors to detect and remove adenomatous polyps before they become cancerous. It also helps identify early-stage cancers when treatment outcomes are most favourable.
Current international guidelines recommend starting screening between the ages of 45 and 50 for individuals at average risk. Those with a family history of colon cancer, previous polyps, or known genetic conditions may require earlier and more frequent screening.
Dietary and Lifestyle Modifications
Adopting healthy lifestyle habits plays a significant role in reducing risk. A balanced diet rich in vegetables, whole grains, legumes, nuts, and dairy products supports colon health.
In addition, the following measures are strongly recommended:
- Limiting red and processed meat consumption
- Reducing alcohol intake
- Avoiding tobacco use
- Maintaining a healthy body weight
- Engaging in regular physical activity
These changes help reduce inflammation, support metabolic health, and lower overall cancer risk.
Genetic Counselling for High-Risk Individuals
Why Choose RGCIRC for Colon Cancer Treatment?
Patients seeking colon cancer treatment require not only advanced medical expertise but also coordinated, patient-focused care. At RGCIRC, these elements come together to deliver comprehensive treatment across all stages of the disease.
Specialist GI Oncosurgery Expertise
RGCIRC’s Department of GI Oncosurgery and Liver Transplant has extensive experience in managing colon cancer, from early-stage disease to complex advanced cases. The team routinely performs multivisceral resections, minimally invasive surgeries, and advanced Stage IV procedures. The institute is among the few centres in India offering HIPEC for peritoneal metastases, intraoperative ablation for liver lesions, and metastasectomy for lung involvement, ensuring access to advanced surgical care when required.
Multidisciplinary Tumour Board
Every colon cancer case at RGCIRC is reviewed by a dedicated GI and Colorectal Tumour Board before treatment begins. This approach brings together specialists from surgical oncology, medical oncology, radiation oncology, gastroenterology, radiology, and pathology. Treatment decisions are based on a comprehensive evaluation, ensuring that each patient benefits from a well-rounded and evidence-based plan.
Molecular Testing and Precision Oncology
RGCIRC’s molecular laboratory enables detailed tumour profiling through next-generation sequencing. This allows identification of key biomarkers such as RAS, RAF, HER2, and microsatellite instability status, which directly guide the use of targeted therapy and immunotherapy. This precision-driven approach ensures that patients receive the most appropriate treatment from the outset.
Commitment to Accessible Care
As a not-for-profit institution, RGCIRC is committed to making quality cancer care accessible. Through its Philanthropy Department, the institute provides financial assistance and subsidised treatment options for eligible patients. Since its inception in 1996, RGCIRC has cared for more than 3.5 lakh patients from India and neighbouring regions, reflecting its long-standing commitment to equitable healthcare.
Book a Consultation at RGCIRC
If you have symptoms that concern you, a family history of colon cancer, or are due for a screening colonoscopy, our GI Oncosurgery and Gastroenterology teams are available for consultation.
To book an appointment, simply call +91-11-4702 2222 (Rohini) / +91-11-4582 2222 (Niti Bagh, South Delhi) Book online at care.rgcirc.org | Download the RGCI Care app on iOS and Android OPD Hours: Monday to Saturday, 9:00 AM to 5:00 PM | Emergency Services: 24×7 at both campuses
Frequently Asked Questions (FAQs)
Seek medical evaluation if you notice blood in stool, persistent changes in bowel habits beyond two to three weeks, unexplained weight loss, ongoing abdominal discomfort, or fatigue with anaemia. These symptoms require investigation, especially in individuals over 40 or with risk factors.
Is colon cancer treatable?Yes. Colon cancer is highly treatable, especially when detected early. Even advanced stages can be managed effectively with a combination of surgery, chemotherapy, targeted therapy, and immunotherapy.
What is the life expectancy for someone with colon cancer?Outcomes depend on the stage at diagnosis. Early-stage disease has high survival rates, while advanced stages are increasingly manageable with modern treatments. Prognosis is individualised based on clinical factors.
What is Stage I colon cancer?Stage I means the tumour is limited to the inner layers of the colon and has not spread to lymph nodes. It is usually treated with surgery alone and has an excellent prognosis.
What is the most important warning sign of colon cancer?Blood in the stool is the most important warning sign and should never be ignored but blood in stool is not always cancer, it may indicate some benign pathology. Other key signs include persistent bowel changes, unexplained weight loss, and new-onset anaemia.
How is colon cancer detected?Colonoscopy is the most accurate test, allowing direct visualisation and biopsy. Imaging tests such as CT, MRI, and PET-CT are used for staging once cancer is confirmed.
What foods should be avoided in colon cancer?Limit red and processed meats, alcohol, fried foods, and highly processed items. A balanced diet is recommended based on individual nutritional needs.
At what age is colon cancer most common?It is most common after age 50, but cases in younger adults are increasing, especially in urban populations.
Can colon cancer be prevented?Risk can be significantly reduced through regular screening and healthy lifestyle choices, including a high-fibre diet, physical activity, and avoiding tobacco and alcohol.
Does colon cancer cause pain?It may cause abdominal discomfort, but early-stage disease is often painless. Persistent or unusual abdominal symptoms should be evaluated.