Have you recently completed treatment for colon or rectal cancer (which is also known as colorectal cancer, or CRC)? If so, you may be concerned about whether your cancer will come back.
Recurrent colon cancer can arise from tumor cells that survive despite treatment. In fact, up to half of CRC patients will develop recurrent cancer after treatment that was intended to cure their original disease. As a CRC survivor, you’re also at risk for developing new polyps (which are growths on the colon wall that can potentially develop into colorectal cancer).
Your risk of recurrence largely depends on the stage at which your original cancer was diagnosed. More advanced colon cancers have a greater likelihood of recurring than earlier stage cancers.
Recurrent colorectal cancer can grow in the same place (referred to as local recurrence) or develop elsewhere in a patient’s body (distant recurrence). Distant recurrent colon cancer often develops in the liver or lungs because, as blood circulates through your body, the first place it goes after leaving the colon is the liver and then to the lungs. Rectal cancer, on the other hand, can travel directly to the lungs via the blood stream.
Although rare, you can also develop CRC at another location in the colon or rectum. This is a brand-new colorectal cancer, not a recurrence.
[See: 8 Questions to Ask Your Doctor About Colon Cancer.]
Importance of Follow-Up
Regular, ongoing follow-up is important once you finish treatment for CRC. Recurrent colorectal cancer generally strikes within the first few years after a patient’s initial diagnosis.
Early detection of CRC recurrence can improve patients’ prognosis. Your follow-up routine will include physical exams as well as additional scans and colonoscopies. “We’ll do a first colonoscopy before the first anniversary of your surgery,” says Dr. Alok Khorana, director of the Gastrointestinal Malignancies Program at Cleveland Clinic. If your original cancer was diagnosed at stage 2 or stage 3, your oncologist will probably repeat the colonoscopy every year for the first three years.
Your physician will also check your blood levels of carcinoembryonic antigen, or CEA, immediately following surgery and then frequently in the first few years after treatment. Some cancer cells make CEA, so looking for it in the blood is one way to detect disease recurrence.
You may not have symptoms if your colon cancer comes back. However, you should pay attention to your bowels and bowel habits. See your physician immediately if you notice changes or other unexplained symptoms. If your cancer has spread outside the colon, you may experience pain or symptoms at the site of the new tumor.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Treatment and Prognosis
The stage at diagnosis once again drives treatment for recurrent CRC. “We restage [the recurrence] and make a new treatment plan,” says Dr. David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital.
Khorana says it’s important for patients to be treated for recurrent colorectal cancer by a multidisciplinary team. Although the prognosis with recurrent cancer is typically not as good, Khorana says oncologists are becoming more aggressive about surgically removing lung and liver lesions when possible and making maximum use of chemotherapy and other treatments.
Although having your colorectal cancer come back is scary and frustrating, don’t give up hope. This time, you might have access to brand-new treatment options that weren’t previously available. And even when colon cancer isn’t curable, you may be able to manage your cancer as a chronic disease.
[See: Which Medical Screenings Should You Have in 2017?]
Preventing Recurrence
You can take steps to lower your risk of a recurrence. If your oncologist prescribes chemotherapy after your initial surgery, be sure to complete the treatment. Another prevention strategy is following a healthy lifestyle. “If you exercise regularly after your diagnosis, you have less chance of the cancer coming back,” Khorana says, citing observational research. “I recommend 20 to 30 minutes a day, six to seven days a week. Eat fresh fruits and vegetables, and restrict red meat to less than two servings per week.”
And, of course, stick to the recommended follow-up plan so if your colon cancer does recur, you can catch and treat it as soon as possible.
Follow-Up Health Care Recommendations for Colorectal Cancer by Years After Treatment
| Follow-Up Care Recommendations | Year 1 | Year 2 | Year 3 | Year 4 and 5* |
|
Doctor’s Visit |
Every 3 to 6 months |
Every 3 to 6 months |
Every 3 to 6 months |
Every 6 months |
|
CEA test |
Every 3 months |
Every 3 months |
Every 3 months |
As determined by your doctor |
|
CT scan (chest and abdomen) |
Every year, if recommended by your doctor |
Every year, if recommended by your doctor |
Every year, if recommended by your doctor |
As determined by your doctor |
|
CT scan (pelvis) (rectal cancer only) |
Every year, if recommended by your doctor |
Every year, if recommended by your doctor |
Every year, if recommended by your doctor |
As determined by your doctor |
|
Colonoscopy |
Once |
At 3 years |
||
|
Proctosigmoidoscopy (rectal cancer only) |
Every 6 months for 5 years |
*After 5 years, the need for future tests and visits are decided by the patient and doctor.
Source: American Society of Colon and Rectal Surgeons
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When Colon Cancer Recurs originally appeared on usnews.com
