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Colon Cancer Recurrence: 10 Things Doctors Want You to Know

Publication: Healthgrades

What Happens If Colon Cancer Recurs?

If you or someone you know has been treated for colon cancer and it recurs, which means it has come back, your oncology team will develop a treatment plan to address it. Doctors have made progress treating colon cancer recurrence, and the outlook for patients has improved over the past several decades. With a serious disease like cancer, knowing the likelihood of recurrence based on colon cancer stage, as well as innovative treatment options, will prepare you to make decisions if or when cancer recurs.

1. “The likelihood of colon cancer recurrence has to do with the stage at which the first cancer was diagnosed.”

Colon cancer is categorized by one of four stages, each more advanced than the one before. “If we have an individual at stage I or II, the chances of cancer recurring are far less than stage III,” says Muffaddal Morkas, MD, a medical oncologist and hematologist at Texas Oncology, Houston Memorial City. “The pathology of the tumor does the talking as well. If someone has stage II disease but the biology is fairly aggressive, we look at that person as having a higher risk of recurrence compared to someone with a tumor that is slow growing and well behaved.”

2. “When colon cancer recurs, it may reappear somewhere other than your colon.”

“It can come back in another organ or it can come back around the site of the surgery. Oftentimes, a recurrence and a metastasis are synonymous,“ says Dean G. Tsarwhas, MD, medical director of Cancer Services, Northwestern Medicine in Lake Forest, Ill. “You can have a local recurrence, a regional recurrence, or a distant recurrence,” adds Charles Staley, MD, chief of Surgical Oncology, Winship Cancer Institute of Emory University, Atlanta, Ga. “A local recurrence is if it is where the original tumor was removed, regional is where it has spread to a lymph node in the area, and a distant recurrence can be in, for example, the liver, lung, or bone.”

3. “We may or may not perform surgery to treat colon cancer that has recurred.”

If surgeons remove your colon cancer and it comes back, it may be possible to treat it with another surgery. “If you have a local recurrence or a regional one, you can go in and remove the lymph node or the area where it recurred in the colon and that’s not usually too big a deal,“ says Dr. Staley. “In the liver and the lungs, we can do surgery for lesions that can be removed if there are not too many.” Surgery for recurrent colon cancer is usually combined with other treatments, such as chemotherapy.

4. “Colon cancer recurrence is often treated with chemotherapy.”

“Standard colon cancer chemo is a combination called FOLFOX. That’s the workhorse for colon cancer. It has about a 50% chance that tumors will shrink, which has revolutionized treatment from about 10 years ago with a response rate of 10 to 15%. The chance that we can make an impact on metastatic colon cancer [has] definitely improved,” says Dr. Staley. “If you have a couple of spots on the liver that are malignant, we would do chemotherapy up front, to be followed by a consultation with a liver surgeon [to] do an operation to take those areas out, which gives patients the best possible chance of long-term remission,” says Dr. Morkas.

5. “Radiologists can treat colon cancer recurrence with some savvy, science fiction-like techniques.”

Using a technique called ablation, “interventional radiologists can put a probe in the tumor and neutralize and kill it,” says Dr. Morkas. “Now we can ablate, using a microwave energy device to basically blow up tumors. It has expanded the people we can potentially cure with metastatic colon cancer,” adds Dr. Staley. “Radiofrequency ablation is done most frequently on the liver, sometimes on the lungs, and is available at most major hospitals.” Radiologists can also inject radioactive beads into the liver, which is a “very special technique done by highly trained interventional radiologists,” adds Dr. Morkas.

6. “Oncologists combine different treatments that work together to treat colon cancer recurrence.”

If you have a recurrence in your liver, you may have chemoembolization. “You feed chemo to the local area and you also embolize it, meaning you block off the blood supply that is feeding the tumor. It has a very effective kill rate, and gives us long periods of sustained remissions,” says Dr. Morkas. “But the bulk of the cases of recurrent or metastatic tumors are in places we cannot access, so we also use targeted therapy, based on the molecular signature of the tumor. This information is the standard of care nowadays, before we even start treatment. None of the treatments are given in isolation; this is work between the surgeon, the medical oncologist, and the interventional radiologist, acting together as a team.”

7. “Your risk of recurrent colon cancer changes with time.”

After a first colon cancer, 80% of recurrences happen in the first two to three years. “We check the blood every three to six months so we can check a tumor marker, and we’ll do an annual CT scan and periodic colonoscopies. Once you get beyond five years and there’s no sign of recurrence, that patient is likely cured of their disease,” says Dr. Tsarwhas. “If they have incurable metastatic colon cancer, life expectancy is unfortunately limited. It’s currently somewhere in the range of 20 to 36 months. If, however, somebody has a recurrence and it’s picked up early and they have treatment, they may go on to live a normal [lifespan].” 

8. “Patients who follow a healthy eating and activity plan improve their survival rates.”

“In patients who’ve been treated for colon cancer, those who exercised 150 minutes per week, had a diet rich in fruits, vegetables, and whole grains, and maintained a healthy body weight had a decreased chance of the cancer recurring. That is really exciting that patients can do things for themselves that can impact their health and longevity. Foods that have a low amount of insulin—so not having a lot of white bread, refined grain pasta, or sugar—also had a correlation with less recurrence,” says Dr. Tsarwhas.

9. “The outlook for patients with recurrent colon cancer has improved.”

“The treatment for colon cancer has come a very long way in the past 20 years I’ve been practicing as an oncologist,” says Dr. Morkas. “From a realistic standpoint, the life expectancy for someone with stage IV colon cancer is about 22 to 24 months. It seems like a very short time, but this is a bell-shaped curve, which means that half of the population will be on one side of the equation and half will be on the other side. It is not unusual for oncologists to have patients who have survived, four, five or six years and beyond with effective treatments; it’s not uncommon to have long-term survivors.”

10. “Early detection through colonoscopies can reduce your chances of ever having to deal with a colon cancer recurrence.”

You have no symptoms when you have stage I or stage II colon cancer, so screenings are essential. “The real message is, once you have colon cancer, 50% will recur and many will die. The best thing is to prevent this disease. Only about 30% of people who should get screened do get screened—it’s improving but it’s still not great,“ says Dr. Staley. When should you be screened? If you have a family history of colon cancer or other risks, it could be as early as your 20s, but the general guideline is to begin no later than 50. Talk with your doctor about when you should begin screenings for colon cancer and make sure to tell them about any risk factors.

This content was originally published on Healthgrades.

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