Stage 1

Stage 1 bowel cancer means that the cancer has grown through the inner lining of the bowel, or into the muscle wall, but no further.

There is no cancer in the lymph nodes.

Diagram showing Stage 1 bowel cancer

TNM stands for tumour, node and metastasis: 

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

In the TNM staging, stage 1 bowel cancer is the same as:

  • T1, N0, M0
  • T2, N0, M0

Treatment for stage 1 large bowel (colon) cancer

Surgery is the main treatment. People with very early colon cancer (stage 1) do not usually need chemotherapy. 

But this might change after surgery. After your operation, a specialist doctor (pathologist) looks closely at your cancer. You might need further treatment if the pathologist’s report shows your cancer is more advanced than the surgeon previously thought.

Treatment for stage 1 cancer of the back passage (rectal cancer)

The main treatment is surgery to remove the cancer. You might have a type of surgery called:

  • trans anal endoscopic microsurgery (TEM) – the surgeon removes the cancer along with a border (margin) of healthy tissue (you have this if you have a very early stage, low risk cancer)
  • total mesorectal excision (TME) - the surgeon removes the part of the rectum that contains cancer, as well as a border (margin) of healthy tissue around it, and the fatty tissue (mesorectum) around the rectum

If you can’t or don’t want to have surgery, your multidisciplinary team (MDT) will discuss your other treatment options. Your specialist will talk to you about these other treatments, as they might not work as well as surgery. 

They might offer you:

  • internal radiotherapy (brachytherapy) instead of TEM
  • radiotherapy or chemoradiotherapy followed by TEM instead of TME

Further treatment

After your operation, a specialist doctor (pathologist) closely examines your cancer. You might need further treatment if the pathologist’s report shows your risk of the cancer coming back is higher than the surgeon previously thought.

Further treatment after TEM might include:

  • more surgery – a total mesorectal excision (TME)
  • radiotherapy possibly with chemotherapy, if you can’t have surgery

Further treatment after TME might include:

  • chemotherapy and radiotherapy together (chemoradiotherapy)

Clinical trials

Your doctor might offer you radiotherapy or chemoradiotherapy as your main treatment, as part of a clinical trial. You might have surgery as well, depending on how well the treatment works.

Other stages

Last reviewed: 
13 Jan 2022
Next review due: 
13 Jan 2025
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