After colorectal cancer is treated successfully, it is possible that it can recur. Sometimes, small particles of cancer cells are left behind. While these can remain undetected for a while, they may eventually start to grow again, forming tumors in the colon or other areas of the body.
If you have been diagnosed with recurrent colorectal cancer, this information can help you understand it better and prepare questions for your colon cancer specialist.
How is a Colorectal Cancer Recurrence Detected?
After you’ve completed treatment for colorectal cancer, you can expect to see your oncologist for follow-up visits at least every six months for a period of a few years. If your cancer does come back, it is often discovered through the tests run during these appointments.
Keeping up with follow-up visits is an important way to catch any cancer recurrence early enough for effective treatment. The earlier a recurrence is detected, the sooner it can be treated and the higher the likelihood of an effective treatment.
Does the Original Stage of Colon or Rectal Cancer Affect the Likelihood of Recurrence?
When you receive your original colorectal cancer diagnosis, the oncologist defines a stage from 0 to IV (4). The lower the stage of your original diagnosis, such as stages I or II, the less likely the cancer is to return. Most early-stage colon cancers are found during a screening colonoscopy. Learn more about colorectal cancer screening.
Is Recurrent Cancer Considered Metastatic Colorectal Cancer?
Cancer can return in a few different ways.
- Local - this means the cancer starts to grow again in the area where it originally started.
- Regional - the cancer was found in lymph nodes near the original tumor.
- Metastatic - the cancer has spread to other areas of the body or in lymph nodes that are not close to the original tumor site. The liver is often the first place colon cancer will spread to. Other organs where colorectal cancer returns include the lungs, brain, and peritoneum (the lining of the abdomen).
When colorectal cancer recurs, wherever it is in the body, it will still be treated as colorectal cancer. The exception to this is if there is a second cancer that has developed. Your oncologist will explain whether it’s a second type of cancer and how that would be treated.
What Influences the Treatments that Are Used When Colorectal Cancer Returns?
Treatment options will vary depending on your unique situation and a variety of other factors, including:
- Where the recurrence is located
- The severity of the recurrence
- Your overall health and the presence of any other medical conditions
- What your previous treatment approach was, and whether it was successful
- Whether or not you have any genetic mutations or biomarkers
- Whether or not you previously received radiation therapy as part of the treatment plan
- Your preference and goals for treatment
How is Recurrent Colorectal Cancer Treated?
There are several different treatment approaches that may be used for recurrent colorectal cancer. The right set of treatments depends on if it was a local, regional, or distance recurrence.
For local recurrence
Surgery to remove the cancer may be possible. Chemotherapy may be recommended before surgery to shrink the cancer. It can also be used after surgery to be sure any other cancer cells in the body have been destroyed.
These patients usually need a treatment that includes systemic therapy such as chemotherapy. The drugs circulate throughout the lymph system to kill any cancer cells and shrink tumors that may have developed.
Surgery for distant colorectal cancer recurrence isn’t always possible. For recurrent, metastatic colorectal cancer, chemotherapy can be used. These patients have some additional treatment options that may not be available during the first treatment.
Biomarker tests are run to determine if there is a specific genetic mutation that can be targeted by a particular drug. This is called targeted therapy. Targeted therapies for colorectal cancer make it possible to specifically hone in on a gene that is allowing the cancer to grow and block it from continuing to produce cancer cells.
There are additional new therapies in the research phase for recurrent colorectal cancer that open up additional treatment options. Talk to your oncologist about whether a clinical trial may be available to you.
Palliative care and symptom management
For some patients, the effects of treatment aren't worth the risks and side effects. This happens when the cancer is either very advanced and unlikely to be curable or when the patient is unlikely to tolerate treatment due to poor health. In this situation, your doctor will recommend treatment approaches that can ensure comfort and treat symptoms such as pain management.
Radiation therapy can be used to shrink tumors that appear in other areas of the body that are causing pain. Be sure you are open with the doctor about how you’re feeling so they can find the right treatments to ease pain or other symptoms you’re experiencing from the cancer.
How to Manage Side Effects of Treatment
Side effects from treating recurrent colorectal cancer will vary depending on the treatment approach.
Some potential side effects include:
- Digestive issues like diarrhea or constipation
- Appetite changes
- Mouth sores
- Neuropathy or tingling/pain in the hands or feet.
Talk with your oncology team about what types of side effects to expect based on the unique treatment approach that is chosen for you so that you can best know how to prepare and gather tips for managing side effects.
Do You Need to See the Same Cancer Care Team You Used the First Time?
You can choose where to go for treatment of recurrent colorectal cancer. Perhaps you’ve moved since then and need a new cancer center. Or, in some cases, there are clinical trials available at one center that are not available where you received treatment originally. The choice of where to receive treatment is yours.
Rocky Mountain Cancer Centers uses a multidisciplinary approach to cancer care that includes the medical oncologist, radiation oncologist, surgeon (when necessary), and other cancer care providers. They work together to create a plan that is personalized for your treatment goals.
If you would like to schedule a consultation with one of our colorectal cancer specialists, find a location near you in Denver, Colorado Springs, Boulder or throughout the Front Range.