Monitoring for colorectal cancer recurrence

After you finish active treatment, you will continue to see your medical provider for follow-up care. This care includes managing side effects, assessing your overall health, and monitoring for a cancer recurrence. This is also known as “surveillance.” Surveillance is also used to check how well you are responding to treatment.

When you see your medical provider, they may use several different tools to assess:

• How well you are responding to treatment (if you are currently in treatment)
• If further treatment or a change may be needed
• Whether there are signs that the cancer has spread, returned, or progressed

Surveillance strategies aimed at early detection increase the chance that cancer can be treated and cured. New tools are available to detect traces of cancer in the blood.

The odds for cancer recurrence are bigger if the initial tumor was diagnosed at an advanced stage.

Cancer recurrence is when a cancer is found again after a period of time when the cancer could not be detected (remission).

With colorectal cancer, you may have not symptoms at all, or your recurrence symptoms may be the same as your original symptoms, such as:

• abdominal pain
• bloody stools
• weight loss
• diarrhea
• constipation

A colonoscopy may also reveal a recurrence, which is why it’s important to stay on schedule with your screening tests and other follow-up appointments.

The sooner a recurrence is diagnosed, the better the chances are for survival.

Now that you have completed your treatment—whether your treatment plan included surgery, chemotherapy, and/or radiation—you and your medical team should discuss your follow-up care plan. The plan will include ongoing monitoring and should also address lifestyle and emotional needs.

• Talk with your doctor (oncologist) about your risk of cancer coming back (recurrence) and how it affects your follow-up care plan and testing schedule.
• Keep your scheduled follow-up visits. These visits are important. While you cannot guarantee that cancer will not come back, routine visits will increase your chance of catching a recurrence earlier, making it easier to treat.
• Ask your care team about new tests that may be available for early detection of recurrence. There are many new non-invasive technologies (e.g. blood tests) that make it easier and faster to find cancer when it recurs.
• Find out if you can go to a survivorship and wellness clinic for your follow-up visits. While many survivors get follow-up care with their oncologist or with their primary care doctor, these clinics have specialized experts who can also help with nutrition, physical activity, and other health needs.
• Talk to your medical team about your fears and anxiety. Some patients feel lonely after the frequent visits they are used to with the care team. Our certified patient and family support navigators are available anytime to talk through your concerns.

After completing treatment

• ctDNA testing is an option for survivors who have finished curative treatment who are stage II or stage III. Along with CEA, ctDNA is currently approved for monitoring disease recurrence in survivors of stage II and III colorectal cancer. Additional tests such as CT, MRI, or PET scans may be necessary to locate the cancer recurrence. 

After surgery

• ctDNA can also be used to monitor any residual (leftover) cancer after surgery in low-risk stage II and III colon cancer and stage IIA rectal cancer. This can determine if adjuvant (after surgery) chemotherapy is needed in low-risk patients. Chemotherapy is standard of care for high-risk, more advanced colon cancer, and high-risk rectal cancer which includes radiation with or without chemotherapy.

Recurrent colorectal cancer might come back in the same place it was originally, or it might come back in another area of the body.

Recurrence is divided into three categories:

• Local recurrence. The cancer reappears in the same place or nearby the place it was found. The cancer hasn't spread to the lymph nodes or other parts of the body.
• Regional recurrence. A regional recurrence appears in the lymph nodes and tissue located near the area of your original cancer.
• Distant recurrence. Cancer has spread to areas farther away from where your cancer was first located. In colorectal cancer, this may be the liver, lungs, or brain. This is called metastatic cancer.

When colorectal cancer spreads to a new area of the body, it’s still called colorectal cancer. For example, colorectal cancer may come back in the liver, but it is still colorectal cancer, not liver cancer. The cancer in the lungs will be treated as colorectal cancer.

Treatment for recurrent colorectal cancer is based on many things, including:

• Location of the cancer
• Other health issues
• Individual preferences

The main treatments used are surgery, chemotherapy, or radiation, or a combination of any of these. Other treatments such as liver directed therapy or immunotherapy may be recommended.

Joining a clinical trial may also be an option, where you may have access to more recently developed treatments and experimental medications.

Talk to your care team about clinical trials that are appropriate for you.

colorectal cancer recurrence can bring back many of the difficult emotions you felt when you were originally diagnosed.

This time around, however, can be different because:

• You are better prepared and know much more about colorectal cancer than the first time you faced it.
• You know which coping strategies work for you such as physical activity, spending time with friends and family, and meditation.
• You have a care team that you know -- you are going back to familiar faces and people who know you.
• New treatments are rapidly becoming available.

In this podcast, oncology social worker and 2-time breast cancer survivor Hester Hill Schnipper discusses ways to cope with the fear of recurrence.