Even after successful treatment for colorectal cancer, there is still a possibility that the cancer will come back. When this happens, it is referred to as recurrent colorectal cancer.
If any cancer cells are left behind after treatment is complete, they can remain inactive for months or even years. For some people, the cancer cells become active again and start growing in the colon or rectum, called local recurrence, or other areas of the body referred to as regional and distant (or metastatic) recurrence, depending on where the cancer cells started growing.
The likelihood of recurrence within five years of initial treatment varies based on the stage at the first diagnosis. The earlier the cancer was found and treated, the less likely it is to return. While it's natural to worry about this possibility, being informed can help you know what to do and what to look for so you can talk with your cancer care team.
At Rocky Mountain Cancer Centers, we encourage our patients to keep up with screening and return for their regularly scheduled oncology follow-up appointments so we can run blood tests and scans and discuss their overall well-being. This will help us catch recurrence as early as possible if it should occur.
What are the Risk Factors for Recurrence?
Unfortunately, there is no guaranteed way to prevent a recurrence. However, if you have already undergone colorectal cancer treatment, it is important to be aware of the factors that might increase your risk of developing the disease again. Risk factors associated with recurrent colorectal cancer include:
- Stage and grade of the original cancer: Later-stage colorectal cancers are more likely to recur than those diagnosed at an earlier stage.
- Incomplete surgical margins: If cancer cells remain at the edges of the removed tissue (margin), it could impact the risk of recurrence.
- Genetics: Hereditary syndromes, such as Lynch syndrome, familial adenomatous polyposis, or other genetic factors, can influence the likelihood of colorectal cancer recurrence.
- Lifestyle and health considerations: Being overweight and having unhealthy dietary habits -- such as a diet high in processed meats, refined grains, and added sugars -- are linked to recurrence.
Common Signs and Symptoms of Recurrence
Typically, recurrence symptoms are similar to those that can be experienced before the initial diagnosis, which may include:
- Abdominal pain or discomfort
- Change in bowel habits, such as constipation and diarrhea
- Bloody stools
- Rectal bleeding
- Feeling like you still need to have a bowel movement after you just finished
- Fatigue
- Unexplained weight loss
Don’t ignore any of these. Talk with the cancer care team as soon as possible if you notice symptoms. It’s also possible for the cancer to start growing with no physical signs. That’s why follow-up screening colonoscopies are extremely important for colon and rectal cancer survivors.
How Does the Oncologist Know If and Where Colorectal Cancer Has Recurred?
A recurrence is usually detected when symptoms associated with colorectal cancer occur, or during a routine follow-up colonoscopy. This is why it is important to stay vigilant with regular screenings and follow-up appointments with your colorectal cancer care team.
After treatment, your oncologist will monitor you closely, generally through follow-up visits every 3 to 6 months for the first two to three years, and then every six months until you reach the five-year mark. During this time, monitoring may include physical exams, colonoscopies, CEA blood tests, and imaging scans to check for any signs of recurrence.
The earlier a recurrence is diagnosed, the better the chances for successful treatment and survival.
Types of Colorectal Cancer Recurrence
A recurrence may occur in the same location as the original tumor or somewhere else in the body. Your oncologist will explain which type of recurrence you have:
- Local recurrence: This means the cancer has returned to the same area where the original tumor was removed.
- Regional recurrence: This refers to cancer that has spread to nearby lymph nodes but not to other areas of the body.
- Distant recurrence: This describes cancer that has spread (metastasized) outside of the original site to areas such as the liver, lungs, brain, or distant lymph nodes.
Treatment Options for Recurrent Colorectal Cancer
Fortunately, recurrent colorectal cancer can be treated in various ways. At Rocky Mountain Cancer Centers, our multidisciplinary team of specialists will evaluate the unique factors related to your case and create a personalized treatment plan.
We will consider the location and extent of the recurrence, your previous treatments, and overall health to develop an effective treatment plan that meets your individual needs. You may also have new treatments available to you that were not part of the initial treatment plan, including targeted therapies. Your oncologist may discuss biomarker testing to see if a genetic mutation is causing the cancer cells to grow.
Learn more about biomarker testing for colorectal cancer.
Local and Regional Recurrence
When cancer returns to the original site or nearby, it is typically treated with a combination of surgery and chemotherapy. Chemo may be administered before surgery to shrink the tumor or after surgery to destroy any remaining cancer cells.
In some cases, especially when the recurrence is in the rectal area, radiation therapy may be used either during the surgery (intraoperative radiotherapy) or afterward.
Distant Recurrence
If the cancer returns in a distant part of the body, the treatment will depend on whether it can be removed surgically.
Cancer that has spread too far to be treated with surgery is often treated with a combination of medications, including chemotherapy, targeted therapies based on genetic changes, and immunotherapy. Your overall health and the medications previously administered will determine the drug combination that’s best to treat the recurrence. If the cancer doesn’t respond, a different combination may be attempted.
Radiation may also be used to help manage symptoms caused by the cancer recurrence. Use of radiation therapy during recurrence depends on whether radiation was used during the initial treatment plan and, if so, how much was given.
Several clinical trials are also available through our research team, specifically for patients with advanced or recurrent colon and rectal cancers. If one is available, your GI oncologist may suggest participating, providing you with access to the most innovative therapies.
Rocky Mountain Cancer Centers Leads the Way in Recurrent Colorectal Cancer Care
At Rocky Mountain Cancer Centers, our experienced and compassionate colorectal specialists are committed to delivering comprehensive care close to home. This includes access to clinical research trials that bring the latest advancements in colon and rectal cancer treatments.
If you were diagnosed with colorectal cancer -- whether new or recurrent -- know that the RMCC gastrointestinal (GI) cancer specialists are here to support you. Find a cancer center in Denver, Boulder, Colorado Springs, or other locations across Colorado to schedule an appointment.
