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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:
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:
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.
How does ctDNA testing work?
ctDNA can be detected in blood samples and can provide information for survivors who are currently receiving treatment and those who are finished with treatment. Depending on the ctDNA test, it will use either blood or both blood and tissue to provide information on short fragments of DNA that are specific to the tumor. Detection of these fragments of DNA may show that you are at a higher risk of developing recurrent cancer and/or can be used by doctors to guide effective treatment strategies.
Signatera is a clinically-validated, doctor-prescribed, residual disease test that can be designed only for you. Design of the Signatera test using information from your tumor allows for highly accurate detection of very small amount of ctDNA. The test compares DNA sequences between your cancer cells and normal cells to identify which mutations are only present in your tumor. Your personalized Signatera test will reveal if your blood contains any ctDNA fragments that match the mutations. A negative result indicates that tumor DNA was not detected in your blood. Repeat testing with SignateraTM is important because a negative result may change over time. If you have a positive result, there is a 97% chance that your cancer has returned. Your doctor will speak with you about next steps, which may include ordering additional tests such as CEA, CT, MRI, or PET scans to determine whether the cancer has returned.
Colvera is a clinically-validated, doctor-prescribed blood test designed to identify small fragments of DNA fragments that are methylated (changed) and associated with colorectal cancer, known as ctDNA, which may leak from a tumor into the bloodstream. The presence of ctDNA may show residual disease after a patient has been treated for colorectal cancer. If this test is positive, your doctor may order additional tests such as CT, MRI, or PET scans to determine whether the cancer has recurred. This test is currently done alongside CEA.
After completing treatment
After surgery
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:
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:
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.
After you have finished treatment, you may have a number of questions swirling in your mind. Here are some questions to consider asking your healthcare team to make sure you are clear on your next steps.
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:
In this podcast, oncology social worker and 2-time breast cancer survivor Hester Hill Schnipper discusses ways to cope with the fear of recurrence.
Learn how the Colorectal Cancer Alliance is advocating for the passage of the Nancy Gardner Sewell Multi-Cancer Early Detection Act (HR 2407), a bipartisan bill that ensures immediate Medicare coverage for life-saving cancer detection tests once approved by the FDA.
The treatment option is for patients with KRASG12C-mutated locally advanced or metastatic colorectal cancer (CRC) who have received prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.
The Alliance’s 45+ Reasons campaign is part of the Cycles of Impact initiative launched and supported by Independence Blue Cross in 2022 to address the urgent public health issue of colorectal cancer among the Black population.