After your first course of colorectal cancer treatment, it is very important to keep all scheduled follow-up appointments with your doctor. People who have had colorectal cancer in the past may be at a higher risk of developing another colorectal cancer at a different location. The main goal of follow-up care is to make sure the cancer doesn’t return (cancer that does return is call “recurrent” by doctors), and to catch it early if it does. The earlier you catch recurrent colorectal cancer, the greater your chances of sending you back into remission. Stay in touch with your doctor and keep him or herinformed about any changes in your body. Let your doctor know if you experience any of the following symptoms of colorectal cancer:
Colorectal cancer can return locally, regionally, or in a distant part of the body. A local recurrence means the cancer returns in the same location as the original tumor (where the initial surgery to remove the tumor may have been). A regional recurrence means the cancer has spread beyond its original location and nearby lymph nodes, but remains within the abdominal region. A metastatic recurrence means the cancer has traveled (metastasized) through the lymph system or blood vessels to a distant part of the body like the liver or lungs. You should also be on the lookout for symptoms that may appear if your cancer returns in the following parts of the body.
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Cancer that has spread to the liver can cause jaundice (yellowing of the skin), abdominal pain, swelling of the limbs and abdomen, weight loss, fever, and/or nausea.
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Cancer that has spread to the lungs can cause shortness of breath, dry cough, extreme fatigue, and pain in the chest wall.
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Cancer that has spread to the peritoneum (lining of the abdomen) can cause abdominal discomfort, bloating, a feeling of "getting full" easily, distension, and changes in bowel patterns.
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Cancer that has spread to the lymph nodes in your abdomen often does not cause symptoms but may cause abdominal discomfort or a lump you can feel under the skin.
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Cancer that has spread to the bones is likely to cause bone pain or tenderness and can lead to fractures.
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Cancer that has spread to the brain can cause headaches, seizures, unsteadiness, memory loss, confusion, and blurred vision.
Any symptoms you experience may not be related to a colorectal cancer recurrence, but you must still tell your doctor about them. It is very important to catch recurrent colorectal cancer early, before it becomes too widespread to treat successfully.
Imaging tests such as x-rays, bone scans, ultrasounds, MRIs, and PET scans are not typically used to screen asymptomatic patients for a recurrence. In some cases these tests may be used to screen patients at high risk, just to be on the safe side. The following simple tests and procedures are commonly used to screen for a colorectal cancer recurrence:
After initial treatment, you should visit your doctor every three to six months for two to three years, every six months until year five, and then annually for life. If you had cancer that started in your rectum, your doctor may perform a digital rectal exam during these follow-up visits. Your doctor will insert a finger into your rectum and feel for any abnormalities.
Your doctor may perform this test to check for any signs of blood in the stool. Bloody stools are a symptom of colorectal cancer and may be caused by bleeding polyps or cancer inside the colon. Your doctor will collect a stool sample and send it to a lab to be analyzed with chemicals.
Tumor markers are substances found in higher than normal amounts in a person's blood when they have a specific type of cancer. The tumor marker most commonly used to test for recurrent rectal cancers is the carcinoembryonic antigen (CEA). Your doctor may draw blood every several months in the years after treatment for the original cancer has been completed in order to monitor for changes in the level of CEA in your blood.
Your doctor uses a colonoscope (narrow, flexible tube with a camera and light on the end) to examine the inner lining of your large intestine for any tumors or polyps. This test can help your doctor visualize a tumor that sometimes a CT cannot see. Your doctor will perform this procedure within the first year after treatment, and every three to five years afterwards.
Your doctor uses a lighted tube called a sigmoidoscope to examine the inside of your rectum and lower colon for polyps and abnormalities. Your doctor may, under certain circumstances, recommend this procedure every six months for five years after treatment if your tumor was in the rectum.
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A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. For a CT scan, you lie flat on a table while a machine rotates around your body and takes pictures. CT scans are routine in many patients after surgery and chemotherapy initially.
Follow-up care for colorectal cancer is important. Your cancer may never return, but it is better to be on the safe side. If your cancer does return, you'll want to catch it as early as possible to have the best chance of beating the disease again.
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