What is a Colonoscopy? A colonoscopy is a procedure in which a doctor uses a thin, flexible tube called a colonoscope to view the lower GI tract. It is most often used for early detection of various types of cancer.
|Chicago, IL Colonoscopy Cost Average||$450 - $1,500|
|Los Angeles, CA Colonoscopy Cost Average||$625 - $2,100|
|Washington, DC Colonoscopy Cost Average||$470 - $1,550|
|New York, NY Colonoscopy Cost Average||$490 - $1,650|
|Atlanta, GA Colonoscopy Cost Average||$410 - $1,350|
|Miami, FL Colonoscopy Cost Average||$450 - $1,500|
|Houston, TX Colonoscopy Cost Average||$420 - $1,400|
|Phoenix, AZ Colonoscopy Cost Average||$440 - $1,450|
|Philadelphia, PA Colonoscopy Cost Average||$480 - $1,600|
|Dallas, TX Colonoscopy Cost Average||$420 - $1,400|
|Colonoscopy Cost Average||$1,800 - $12,500|
|Saint Vincent Jennings Hospital||North Vernon , IN||$2,100 - $5,400|
|Bartlesville Surgery Center||Bartlesville , OK||$525 - $1,350|
|Habersham County Medical Center||Demorest , GA||$1,650 - $4,200|
|Rutland Regional Medical Center||Rutland , VT||$600 - $1,550|
|Wausau Surgery Center||Wausau , WI||$650 - $1,700|
|Sedalia Surgery Center||Sedalia , MO||$550 - $1,400|
|Bingham Memorial Hospital||Blackfoot , ID||$1,650 - $4,300|
|I-70 Medical Center||Sweet Springs , MO||$1,950 - $5,100|
|Ketchikan General Hospital||Ketchikan , AK||$2,550 - $6,500|
|Osf Saint Francis Hospital||Escanaba , MI||$2,100 - $5,300|
|Rochelle Community Hospital||Rochelle , IL||$2,175 - $5,500|
|Skyline Endoscopy Center||Loveland , CO||$675 - $1,700|
|Kentucky Lake Surgery Center||Paris , TN||$525 - $1,350|
|Bucktail Medical Center||Renovo , PA||$2,025 - $5,300|
|Rolling Plains Memorial Hospital||Sweetwater , TX||$1,050 - $2,700|
|Avera Queen of Peace Hospital||Mitchell , SD||$775 - $2,000|
|Atlantic Surgery Center of Jacksonville Beach||Jacksonville , FL||$575 - $1,500|
|Spearfish Surgery Center||Spearfish , SD||$875 - $2,250|
|Endoscopy and Surgery Center at Woodbridge Hills||Portage , MI||$625 - $1,600|
|Wallace Thomson Hospital||Union , SC||$600 - $1,500|
|Piedmont Endoscopy Center||Winston-salem , NC||$600 - $1,500|
|The Surgery Center of Quincy||Quincy , IL||$575 - $1,450|
|Laughlin Memorial Hospital||Greeneville , TN||$600 - $1,550|
|Vaughan Regional Medical Center||Selma , AL||$1,300 - $3,300|
|Kaiser Permanente Wailuku ASC||Wailuku , HI||$725 - $1,850|
|Appalachian Gastroenterology ASC||Boone , NC||$600 - $1,500|
|Litchfield Hills Surgery Center||Torrington , CT||$750 - $1,950|
|Unity Hospital||Muscatine , IA||$875 - $2,250|
|Mississippi Coast Endoscopy and Ambulatory Surgery Center||Pascagoula , MS||$525 - $1,350|
|Doctors Surgery Center||Texarkana , AR||$500 - $1,300|
A colonoscopy is a procedure in which a doctor will insert a thin, flexible tube into the rectum. This procedure allows doctors to examine the inner lining of your large intestine. During the procedure your doctor can take tissue samples or remove abnormal growths. The test itself typically takes about 20-30 minutes, and you will be sedated during the procedure. You’ll spend another thirty minutes to an hour in the recovery room.
Why should I get a colonoscopy?
Men and women over fifty should have this test done — earlier if you are at high risk or have a family history of colon and/or rectal cancer. Having a colonoscopy will help your doctor detect early symptoms of these cancers, possibly even before they develop. Put simply, this relatively simple test can save your life.
What is the difference between a screening colonoscopy and a diagnostic colonoscopy?
There is no different between these procedures except the purpose — and often the cost. A screening colonoscopy is performed at specific ages and/or intervals to detect the signs of cancer. The American Cancer Society recommends all adults have a screening colonoscopy at age 50 and a follow up every 10 years thereafter. Patients with higher risks of colon cancer may need a more aggressive schedule. For example, if you have a family history of colon cancer, then you may be directed to have your first screening before the age the cancer was found in your family member. Likewise, if your first scan shows certain risk factors, you may be directed to have follow ups every five years.
A diagnostic colonoscopy is performed if existing issues are present in you GI tract. This may include bleeding, symptoms of colon cancer, etc.
Some insurance companies will cover screening and diagnostic colonoscopies differently which can impact how much you pay for the procedure.
What is a colonoscope?
A colonosope is a flexible tube with a camera, light and other instruments attached.
Are colonoscopies dangerous?
While all medical procedures carry some risk, colonoscopies are considered low risk procedures. Approximately 0.5 percent of colonoscopies result in injury or death. More details on the risks associated with colonoscopies are included in the Procedure Considerations section.
What is colon cancer? What is rectal cancer? What is colorectal cancer?
Colon cancer occurs when uncontrolled cell growth happens in the large intestine. Often, colon cancer starts with small, benign tumors (or polyps) that form on the walls of the large intestine. Rectal cancer develops much the same way but begins from polyps in the rectum. Often, these cancers develop simultaneously; this is called colorectal cancer.
Colorectal cancer is the fourth most diagnosed cancer in the U.S. Colorectal cancer ranks third in cancer deaths among American men and women — approximately 50,000 deaths annually.
What is a colonoscopy?
A colonoscopy is a medical procedure in which a doctor called a gastroenterologist will insert a thin, flexible tube called a colonoscope into the rectum. This procedure allows doctors to examine the inner lining of your large intestine in order to find ulcers, colon polyps, tumors, inflammation, or bleeding. It’s most commonly used to screen for colon and rectal cancer.
During the procedure your doctor may take tissue samples or remove abnormal growths called a biopsy.
What types of sedation are used for colonoscopies?
There are options when it comes to choosing the type of sedation when you have a colonoscopy, and it is even possible to have the procedure done with no sedation though some doctors will not perform the procedure without the use of some sedation.
The most common form of sedation is “conscious” sedation. This is usually done with an intravenous dose of a sedative and an analgesic. Midazolam is most commonly used. You will remain calm and pain free, but not unconscious.
General anesthesia (or deep sedation) is also an option. This usually involves an anesthesiologist who will administer Propofol and some form of analgesic. You will be completely unconscious and not remember or feel anything. Many experts don’t recommend this method because it carries higher risk than lighter sedation. It also costs more.
Another method is the Computer-Assisted Personalized Sedation (CAPS) System. Specially trained gastroenterologists and nurse teams administer a lower dose of Propofol to induce minimal to moderate sedation.
What happens during a colonoscopy?
You will most likely be wearing a gown and nothing else. After you’ve been sedated — through oral medication for sedation or sometimes intravenous medication to minimize pain or discomfort — you’ll be asked to lay on your side with your knees pulled toward your chest. Your physician will then insert the colonoscope into the rectum. There is a tube in the scope that allows the doctor to pump air into your colon, which along with the attached light, allows the doctor increased visibility. During this part, you may feel abdominal cramping or feel the need to evacuate your bowels.
Along with the light, there is also a camera at the tip of the colonoscope, which sends video to a monitor. If polyps or other abnormal tissues are seen, the doctor can take biopsies using instruments running the length of the colonoscope. The procedure can take anywhere from 20 minutes to an hour.
How long does a colonoscopy take?
The test itself typically takes about 20-30 minutes, and you will be sedated during the procedure. You’ll spend another thirty minutes to an hour in the recovery room to wake up from the sedative.
Colonoscopies are the collection of services from four providers: the physician, facility, anesthesia group and pathology lab. All will have their own costs. Typically all materials costs are paid to the facility and are usually included in the facility fees which, like all costs, should be confirmed in advance of your procedure. You may not have pathology costs if no polyps or other specimens are removed.
The facility cost is typically the largest and the one that varies the most. Facility fees can vary from $600 to over $5,000 or more for the same procedure! General anesthesia, depending on length and type of procedure, can cost between $200 to 900. Physicians’ fees can also vary from approximately $350 to $2,000 or more. Pathology costs are an additional $200 to $1,000.
The choice of provider for your colonoscopy will directly impact your costs — even if you have insurance. Study after study from groups both inside and outside the healthcare industry have shown that cost does not correlate with quality. So paying more for your colonoscopy does not mean you are receiving better care.
Uninsured patients are very strongly advised to negotiate all pricing in advance and be sure it is documented. Many providers will offer 30 – 80 percent discounts off their “Charges” for uninsured or self-pay patients. That’s a medical term for their List Price. Depending the patient’s circumstances, they may qualify for additional patient assistance. (See our Patient Assist Program for a program that can save you 80 percent on your colonoscopy.)
Insured patients are not likely to be able to negotiate any additional discounts. Your insurance company has pre-negotiated “contracted rates” with each provider. The portion of those rates that you will pay vary on many different variables such as your deductible, co-pays and co-insurance. It will also vary depending on if the provider is considered “In Network” or “Out of Network.” Contact your insurance company in advance and ask for their assistance determining your costs. For more information on Colonoscopy Pricing in your area, please see our Medical Pricing Directory.
Not only do different physicians and facilities offer varying pricing structures, but prices can vary greatly from region to region. Sometimes traveling to a different city can save thousands, even when travel costs are taken into account. Please contact our Patient Assist Concierge Team for more information on how to shop for a colonoscopy.
How should I choose a doctor for my colonoscopy?
Before choosing a physician, you’ll want to do some research. Ask your primary care physician if you have one. Ask friends who may have had the procedure. And, there are many great resources on the internet.
As you look keep the following in mind:
Location of exam (in-office, outpatient facility, hospital)
Certification (to find out if a doctor is board certified, go to certificationmatters.org)
Healthgrades is one way to research doctors, though the information can be limited and/or outdated. This site has information on the doctor’s education, hospital affiliations, sanctions, malpractice claims, locations, and insurance plans. You can also read patient feedback on topics such as wait times and patient satisfaction; HOWEVER, there are relatively few reviews compared to the number of patients most doctors have treated. Be careful not to read too much into these reviews. RateMDs is another site which allows patients to post and answer questions about the doctors. Vitals.com also includes patient ratings on bedside manner, follow-up, accuracy of diagnosis and average wait time.
Who can help me find a gastroenterologist?
If you went to your primary care physician for your symptoms, he or she will most likely refer you to a gastroenterologist they trust.
If you choose to go straight to a gastroenterologist, your insurance company will provide you with a list of doctors who are in your network.
Our Patient Assist program can help you find a qualified doctor at a very fair price.
No matter how you find your doctor, do your homework.
Will I have more than one appointment for my colonoscopy?
You may have up to three or more appointments for your colonoscopy, so keep that in mind as you make your decision. The number of appointments depends on a few factors. If you went to your primary care physician first, he or she may send you to a gastroenterologist for another office exam. You will then have the procedure. If your results are positive, you will have another appointment to discuss treatment options. In other cases, you may be able to schedule your colonoscopy with a quick phone call.
How do I schedule a colonoscopy?
After you’ve seen your primary care physician about your symptoms, he or she will likely refer you to a gastroenterologist. Gastroenterologists specialize in diagnosing and treating disorders of the digestive system (GI tract), which includes the esophagus, stomach, small intestine, large intestine, liver, pancreas, gall bladder and bile ducts.
You can also schedule an appointment directly with a gastroenterologist. (Some insurance providers will require a referral from your PCP.) Many gastroenterologists will require a consultation before scheduling the colonoscopy, though this is not always the case.
Some clinics and facilities now offer direct scheduling or direct access for colonoscopies. You or your doctor can call the facility to schedule the exam without first seeing a gastroenterologist. You may have to answer a few brief questions on the phone with a nurse or other provider prior to scheduling to see if you are a candidate. Patients with no symptoms between the ages of 50 and 70 usually don’t need to have a full consultation with the doctor first.
Where can I have a colonoscopy performed?
There are multiple options when it comes to where you get your colonoscopy done. Hospitals offer colonoscopy services, usually for patients who have recently had a heart attack, have lung disease or other serious conditions.
Most colonoscopies are performed at ambulatory surgery centers (ASC), which may also be referred to as an Outpatient Center, GI Center or Endoscopy Center. These are more convenient and you won’t be exposed to as many patients who may have communicable diseases. Colonoscopies at outpatient centers can be half the cost of the same procedure at a hospital — or less. It is important to remember that all ASCs are not created equal. Find one that is Medicare-certified, and ask how many of their patients have been admitted to the hospital due to infection.
Wait times vary greatly between hospitals and outpatient settings. It can take more than three times longer to schedule a colonoscopy at a hospital compared to an ASC.
Some physicians perform colonoscopies in their offices. Though the same equipment and sedation are used, the cost is considerably less expensive — a difference of thousands of dollars.
How do I prepare for my colonoscopy?
According to many patients, this is the most unpleasant part of the colonoscopy. It is critical that your colon is empty before the exam to ensure maximum visibility of the colon and rectum. Your doctor will give you a list of instructions.
Special diet the day before your colonoscopy: You will not be able to eat solid food the day before the exam. You may even be limited to clear liquids, such as water, tea or coffee without cream or milk, broth, and carbonated drinks. You should avoid red liquids, as those could leave a residue resembling blood. As with many medical procedures, you may be asked to abstain from all food and drink after midnight before the exam.
Laxatives: The night before your colonoscopy, you will also need to take a laxative — either pill or liquid form. In some cases, you will also take a laxative the morning of your procedure.
Enema: Your doctor may also ask you to use an over-the-counter enema kit the night (or just a few hours) before your procedure.
Medications: Remind your doctor of all the medications you are on at least a week before the colonoscopy. This is especially important if you have diabetes, high blood pressure or heart problems. Any medications that may thin your blood — even aspirin — can have adverse effects. Your doctor may ask you to temporarily stop taking certain medications, or they may reduce the dosage.
Failure to follow your doctor’s instructions may result in the cancellation of your procedure and additional fees.
What happens after the colonoscopy?
The sedative will begin to wear off after an hour, but it may take 24 hours for the effects to go away completely. It is imperative that you have someone drive you home after the procedure. It is unsafe to drive for the rest of the day, and you should expect that the doctor’s office will require someone else drive you home.
You may pass gas for a few hours after the exam; this is due to the air the doctor put in to increase visibility. Walking can help relieve the pressure.
You can continue your regular diet, though if a polyp was removed or another procedure was performed, you might be advised to eat a modified diet. Be sure to check with your doctor.
There may be a small amount of blood in your first stool. This is normal, but contact your doctor if you continue to have bloody stools after the first one. You should also contact your doctor if you develop a fever.
How will I receive the colonoscopy results?
Your doctor will tell you immediately if he or she removed any polyps or other tissue samples. If so, the doctor should receive the results within three weeks, at which time he or she will explain in detail what those results mean, next steps and other information.
What do my colonoscopy results mean?
Negative results: Like most medical exams, you want a negative result. The results are considered negative if your doctor finds no abnormalities. If this is the case, and you have no increased risk factors, you will most likely not need another colonoscopy for ten years. Of course, if you start to show any of the above symptoms, you’ll want to discuss these with your physician and possibly schedule another exam.
Positive results: If the doctor does find polyps or other abnormalities, the results of your colonoscopy are positive. Though most polyps are not cancerous, they may be precancerous. Your doctor will send the samples to a pathology lab for further testing. The size and number of polyps may indicate a need for more regularly scheduled exams — less than every ten years.
If any cancerous polyps are discovered during your exam, your doctor may suggest an exam in as few as three months. Occasionally, a polyp cannot be removed during a typical exam; in this case, you will need another exam within a short period of time, usually with a specialist who can remove larger polyps or perform surgery.
What are the symptoms of colon cancer?
The first stages of colon cancer may be mild or they may not be present at all. As it grows, more symptoms may present and will be more severe.
Usually, the symptoms show up as bowel problems.
Loose or watery stools
Unexplained bloating, gas, or cramps
A feeling of incomplete evacuation of your bowels
Change in frequency of movements
Blood in your stools, which may appear as red spots or dark stools that are “tarry” in nature
What are the symptoms of rectal cancer?
The symptoms directly related to bowel habits are the same as colon cancer, though there are also more generalized symptoms to look for:
Gas pains and stomach cramps
Bloating or a feeling of being full
Change in appetite
Unexpected weight loss
What are the symptoms of colorectal cancer?
Like colon and rectal cancer, the symptoms at the beginning may be mild or nonexistent. There are two general categories of symptoms: systemic and local.
Systemic symptoms will affect your entire body and may be intermittent:
Loss of appetite
Nausea and vomiting
Local symptoms affect the lower gastrointestinal tract directly and include:
Blood in the stool
Changes in bowel habits
A feeling of incomplete bowel movement
Constipation, diarrhea, or it may alternate between both
Thinner than normal stools
If you experience any of these, schedule an appointment with your doctor — no matter your age.
What causes colon cancer?
As with most types of cancer, genetic predisposition is a major contributing factor, though a family history does not mean you will get it. Lifestyle also plays a role in whether or not you get colon cancer. Obese people and those who use tobacco products are at a higher risk than those who don’t. People who don’t get regular exercise are also at higher risk. Diet is another important consideration. Low-fiber, high-fat diets can increase risk, as well as diets high in calories and red and processed meat. Heavy alcohol consumption also increases risk.
What is the risk of developing colon cancer?
Over the average American’s life, there is a 6 percent chance of developing colon cancer for both men and women. That risk doubles if you have an immediate family member with colon cancer, and if those relatives were diagnosed before age 50, you should not wait until 50 to get a colonoscopy. Other factors of increased risk are:
Excessive alcohol consumption
See your doctor if you have any of these increased risk factors.
How can I prevent colon, rectal or colorectal cancer?
As with many cancers, there are certain lifestyle choices you can make to help prevent colon, rectal and colorectal cancers. Unfortunately, there are no guarantees.
A diet high in fruits, vegetables and whole grains can decrease your risk.
A low intake of alcohol — or none at all — is also thought to decrease your risk. The Mayo Clinic suggests one alcoholic beverage a day for women and two for men, if you choose to drink.
Non-smokers are thought to be at lower risk than smokers. If you are a smoker and need help quitting, ask your doctor for suggestions.
Exercise can also decrease your risk. Aim for 30 minutes of moderate activity on most days. Ask your doctor before beginning any new exercise regimen.
Maintaining a healthy weight is a great way to reduce your risk for many health concerns. A good rule of thumb is increasing exercise and decreasing calories. Discuss your situation with your doctor.
Are there other examinations to test for colorectal cancer?
There are other options and various reasons you might need a different test. For example, if your doctor was not able to insert the colonoscope far enough into the rectum, they may suggest a barium enema or a virtual colonoscopy.
Barium enema: A barium enema is an x-ray of the colon and rectum. A contrast solution containing barium is pushed into the anus, allowing your doctor to see the area on x-ray. There are two types of barium enemas:
Single-contrast study: During the exam, your doctor will fill the rectum with barium, which will show large abnormalities on the x-ray.
Double-contrast (sometimes called an air-contrast) study: During this exam, your doctor will fill the rectum with the barium contrast solution, drain it and then fill it with air, leaving a thin layer of barium on the colon wall. This test makes it easier to see diverticula, swelling and narrowed areas.
Virtual colonoscopy: A virtual colonoscopy is performed with a CT (computed tomography) or MRI (magnetic resonance imaging), which creates a 3-D image of the colon and rectum. Virtual colonoscopies are not widely available, and they are still being studied for accuracy compared to a standard colonoscopy.
Another option is the sigmoidoscopy. Very similar to the colonoscopy, a thin tube is inserted into the rectum. But while the colonoscopy examines the entire colon, the sigmoidoscopy only examines the left side. The pros of this method are an easier preparation and sedation is not necessary for most patients. The con of the sigmoidoscopy is that it doesn’t examine the entire colon, so there may be issues on the unexamined areas. Patients who choose this method will want to also get a fecal occult blood test (FOBT). While colonoscopies should be performed every 10 years for healthy patients, sigmoidoscopies and FOBTs should be performed every five years.
Fecal occult blood tests look for blood in the feces—often undetectable by the naked eye. You can get one of these tests at a pharmacy or from your doctor. You may need to take multiple feces samples or you may be allowed to put a test pad in the toilet, which will change colors depending what is present in your stool.
Similar to the FOBT is the fecal immunochemical test (FIT). This test, also known as the immunochemical fecal occult blood test (iFOBT), only detects blood from the lower intestine. This test is not affected by food or medicine, so it is usually more accurate than other fecal tests.
Another option is Cologuard, also known as an sDNA test. The Cologuard Collection Kit is a home exam that uses DNA technology to test for abnormal cells in your feces. Send the stool sample back to Exact Science Labs, and they will send the results to your doctor. This method is not a replacement for a colonoscopy, especially if you have any of the risk factors mentioned above.
What are the survival rates for colorectal cancer?
Though survival rate information is taken from a large sample of people, the information may not be indicative of what will happen in your case. Your doctor will be able to give you more accurate information about your specific case.
Five-year survival rate by stage for people diagnosed between 2004 and 2010.
What are the stages of colorectal cancer?
Cancer stages range from 0 (has spread the least) to IV (most advanced). Some stages have sub-stages, which are indicated by A,B, and C.
Stage (Stage grouping) Stage description
0 (Tis, N0, M0) The cancer is in its earliest stage. This stage is also known as carcinoma in situ or intramucosal carcinoma (Tis). It has not grown beyond the inner layer (mucosa) of the colon or rectum.
I (T1 or T2, N0, M0) The cancer has grown through the muscularis mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has not spread to nearby lymph nodes (N0). It has not spread to distant sites (M0).
IIA (T3, N0, M0) The cancer has grown into the outermost layers of the colon or rectum but has not gone through them (T3). It has not reached nearby organs. It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
IIB (T4a, N0, M0) The cancer has grown through the wall of the colon or rectum but has not grown into other nearby tissues or organs (T4a). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
IIC (T4b, N0, M0) The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs (T4b). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
IIIA (T1 or T2, N1, M0) The cancer has grown through the mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has spread to 1 to 3 nearby lymph nodes (N1a/N1b) or into areas of fat near the lymph nodes but not the nodes themselves (N1c). It has not spread to distant sites (M0). OR (T1, N2a, M0) The cancer has grown through the mucosa into the submucosa (T1). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0).
IIIB (T3 or T4a, N1, M0) The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral peritoneum (T4a) but has not reached nearby organs. It has spread to 1 to 3 nearby lymph nodes (N1a or N1b) or into areas of fat near the lymph nodes but not the nodes themselves (N1c). It has not spread to distant sites (M0). OR (T2 or T3, N2a, M0) The cancer has grown into the muscularis propria (T2) or into the outermost layers of the colon or rectum (T3). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0). OR (T1 or T2 N2b, M0) The cancer has grown through the mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites (M0).
IIIC (T4a, N2a, M0) The cancer has grown through the wall of the colon or rectum (including the visceral peritoneum) but has not reached nearby organs (T4a). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0). OR (T3 or T4a, N2b, M0) The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral peritoneum (T4a) but has not reached nearby organs. It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites (M0). OR **(T4b, N1 or N2, M0) The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs (T4b). It has spread to at least one nearby lymph node or into areas of fat near the lymph nodes (N1 or N2). It has not spread to distant sites (M0).
IVA (Any T, Any N, M1a) The cancer may or may not have grown through the wall of the colon or rectum (Any T). It might or might not have spread to nearby lymph nodes. (Any N). It has spread to 1 distant organ (such as the liver or lung) or distant set of lymph nodes (M1a).
IVB (Any T, Any N, M1b) The cancer might or might not have grown through the wall of the colon or rectum. It might or might not have spread to nearby lymph nodes. It has spread to more than 1 distant organ (such as the liver or lung) or distant set of lymph nodes, or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity) (M1b).
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