Colon Cancer Recurrence - What You Need to Know

Recurrent colorectal cancer is colon cancer that comes back after successful treatment. Given the complex nature of colon cancer, there's a chance of relapse after undergoing therapy but enrolling for aftercare¹ helps detect recurrent disease at an earlier stage when curative reoperation is more likely.

Colorectal cancer recurrence often happens after at least a year following successful treatment.

Recurrent colon cancer falls into three categories:

• Local recurrence: The relapse is in the same place as the first time.

• Regional recurrence: The cancer cells are found in lymph nodes or tissues near the original location. 

• Metastatic recurrence: Recurrence happens far from the first site, often in organs such as the lungs or liver.

Most doctors consider recurrence to be cancer that comes back after you've had no signs of it for at least a year.

If cancer is found in less than a year, it is probably not a recurrence but progression of original cancer, which often behaves more aggressively. That may be an indication that the first treatment routine didn't eliminate all the cancerous cells in your body.

Likelihood of colon cancer recurrence

About 30% to 40% of stage II and III colorectal cancer patients experience a recurrence within five years after surgical resection. The stage of your initial cancer diagnosis is the most significant indicator of your risk of recurrence.

Stage III cancer patients have a higher risk of relapse after treatment. Relapse risk might be higher in patients who didn't receive chemotherapy during their treatment, although this is not indicated in all patients.

The likelihood of colorectal recurrence is influenced by:

• Location of the primary tumor; patients with rectal cancers have a higher risk of local recurrence. 

• Depth of invasion

• Presence and degree of nerve or blood vessel invasion

• CEA levels (a blood test done for cancer markers) 

• CA 19-9 levels (a blood test done for cancer markers) 

• Number of lymph nodes affected

• A perforated/obscured tumor 

• Poorly differentiated histology (abnormal cells found)

• Positive surgical margins (when a tumor has clearly defined boundaries)

Timeline for colon cancer recurrence

The risk of colorectal cancer recurrence is highest within the first five years following your diagnosis. About 60% to 80% of recurrence happens within the first two years² after resection and over 90% within the first five years.

Symptoms of recurrent colon cancer

Symptoms of recurrent colorectal cancer closely resemble the ones you had following your first diagnosis. These may include:

• Altered bowel movements

• Abdominal pain

• Constipation or diarrhea

• Weight loss

• Rectal bleeding 

• Bloody stools

Sometimes a recurrence might present as distant metastasis in the liver or lung. You may feel fatigued, and depending on the extent of the spread, you may have trouble breathing, have back or pelvic pains, and lose your appetite.

Prevention

There's no sure-fire way to prevent colon cancer recurrence, but you can take specific steps to monitor or lower the risk of recurrence.

Follow-up care

Follow-up care helps manage side effects, monitor your health, and, most importantly, monitor for recurrence. It includes regular medical tests and physical examinations every three to six months for five years for people with a stage II or III diagnosis.

Colonoscopy, CEA level tests, and CT scans are a core part of follow-up care. There's no standardized follow-up care routine³ as this varies among care providers and depends on your cancer diagnosis.

Maintain a healthy weight 

Obesity increases the chances of developing colorectal cancer. Although it is still unknown if weight loss after diagnosis can prevent a recurrence, maintaining a healthy weight can improve your general health and is highly recommended.

Eat a healthy diet

Although no dietary factor has been studied in randomized trials to date, initial observational reports suggest benefits of increased fiber consumption (including leafy vegetables, fruits, and whole grains) and a diet rich in nuts (such as walnuts and almonds).

On the other hand, a diet rich in carbohydrates is associated with an increased risk of cancer recurrence and mortality.

Quit smoking

Smoking may be associated with colorectal cancer and often worsens outcomes for colorectal cancer patients. 

Be active

Moderately intense exercises for 30 to 60 minutes a day helps to prevent cancer and its recurrence. This may not be possible when you're experiencing side effects from your cancer treatment, but you should develop an exercise plan as soon as you're able to.

Exercising leads to better physical function and lowered fatigue, and improves the quality of life.

Aspirin and NSAIDs

Observational studies suggest that aspirin and other non-steroidal anti-inflammatories may improve survival rates. Many oncologists recommend a daily dose of aspirin to patients with resected early-stage colorectal carcinoma unless there are contraindications.

Treatment

Your physician will consider different factors when formulating a treatment plan. They will consider the time of diagnosis, the area of the recurrence, the extent of the spread, your age, general health, and previous treatment regime.

The treatment routine may include chemotherapy drugs, radiation, surgery, or any combination of these treatments.

Typically, doctors use a different set of chemotherapy drugs the second time around to avoid drug resistance. They may consider including radiation if it wasn't part of your first treatment plan.

Survival rates

The five-year survival rate among patients with colon cancer is about 60% and is down to improved aftercare⁴ and treatment options. Patients who live beyond five years showing no signs of recurrence are likely cured of their cancer.

The survival rate may be tied to the stage of recurrence. One study⁵ found a poorer prognosis in patients with a shorter interval between resection and recurrence.

The lowdown

Up to 40% of colorectal patients have a recurrence within five years after successful resection. Most relapses happen within the first two years.

The likelihood of a recurrence is higher among patients with a stage III diagnosis or other high-risk factors related to cancer, such as perforation or positive surgical margins.

Colorectal recurrence can affect the same location as before or move to an entirely new area. The symptoms of recurring colon cancer usually mirror the previous signs.

Enrolling for aftercare is essential to detect a recurrence at an earlier stage, when curative surgery may still be possible. You may take steps that help to prevent a recurrence, such as adhering to a diet rich in fiber, nuts, and low in carbohydrates, as well as being physically active.

Surgery, radiation, chemotherapy, or a combination of the three are the most common treatment choices if you develop a recurrence.