This topic is about colorectal cancer that has spread or come back. If you want to learn more about early-stage colorectal cancer, see the topic Colorectal Cancer.
Colorectal cancer happens when cells that are not normal grow in your colon or rectum. These cells grow together and form polyps. Over time, some polyps can turn into cancer. This cancer is also called colon cancer or rectal cancer, depending on where the cancer is.
Metastatic cancer is cancer that has spread to other parts of the body. When colon or rectal cancer spreads, it most often spreads to the liver. Sometimes it spreads to the lungs, bones, or other organs in the body.
Colon and rectal cancers often return months or years after treatment. This is called recurrent cancer. If the original cancer was removed before it was able to spread, the chances that it will return are lower.
Doctors don't know the exact cause. But the cancer is more likely to spread or come back if it is in a later, more advanced stage when it is first discovered.
Sometimes cancer cells are too small to be found by tests. These cells may continue to grow and show up later as metastatic cancer, even years after treatment.
The most common symptoms are:
Some people don't have any symptoms.
If your cancer has spread, you may have other symptoms, depending on where the cancer is.
The diagnosis is usually confirmed with a biopsy. During this test, your doctor will take tissue samples from any areas that don't look normal. The tissue will be looked at under a microscope to see if it contains cancer.
If you have been treated for colon or rectal cancer in the past, it's important to have regular checkups to find any new cancer as soon as possible.
Colon and rectal cancers that have spread or returned may be cured in some cases. Treatment may include surgery, radiation, chemotherapy, and targeted therapy. Rectal cancer may be treated with immunotherapy. When the cancer cannot be cured, treatment can help you feel better and live longer.
Learning that you have cancer that has spread or come back can be very hard. Some people find that it helps to talk about their feelings with their family and friends. You may also want to talk with your doctor or with other people who have had this kind of cancer. Your local American Cancer Society chapter can help you find a support group.
The exact cause of colorectal cancer is not known. Most cases start as small growths, or polyps, inside the intestine.
Metastatic and recurrent colorectal cancer is caused when the cancer spreads or comes back, even years after treatment. Sometimes cancer cells are too small to be found and removed. They keep growing and cause problems later.
The most common symptoms are:
Some people don't have any symptoms for some time.
If your cancer has spread, you may have other symptoms, depending on where the cancer is.
Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, lumps, or tumors. In colorectal cancer, these growths usually start as harmless polyps in the large intestine. If polyps are not found and removed, some of them can turn into cancer.
If the cancer is allowed to keep growing, over time it will invade and destroy nearby tissues and then spread farther.
Recurrent colorectal cancer occurs when the cancer begins to grow again months or years after treatment.
The long-term outcome, or prognosis, for colorectal cancer depends on how much the cancer has grown and spread. Experts talk about prognosis in terms of "5-year survival rates." This means the percentage of people who are still alive 5 years or longer after their cancer was found. It is important to remember that these are only averages. Everyone's case is different. And these numbers don't necessarily show what will happen to you.
The 5-year survival rate:footnote 1
These numbers are taken from reports that were done from 2007 to 2013, before newer treatments were available. So the actual chances of your survival are likely to be higher than these numbers.
Be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
Call your doctor if you have:
Tests to help your doctor see if colorectal cancer has spread or come back include:
If metastatic cancer is found, you may also have genetic tests before your doctor recommends a treatment plan. These tests look for gene changes (mutations) that can occur with colorectal cancer. They can show which chemotherapy medicines will help.
Your treatment for colorectal cancer that has spread or come back may include:
Colorectal cancer often comes back, even after treatment that seemed successful. Your cancer may return even if you do everything you can to prevent it. If this happens, focus on what you and your doctor can do to treat your symptoms to help you feel better and live longer.
Your treatment will depend on specific information about the cancer, your preferences, and your health.
Some cases can still be cured. When the cancer can't be cured, treatment can help you feel better and live longer.
Pain is one of the main concerns of people who have cancer. But cancer pain can almost always be controlled. There are several ways to control your pain, such as using strong medicines like opioids. Or you can have treatments that shrink tumors and block nerve pain.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
There is no sure way to prevent colorectal cancer from coming back or spreading to other parts of your body.
But there are lifestyle changes that can help you after treatment. Research shows that these things may help:footnote 2
Initial treatment for colorectal cancer is followed by regular doctor visits and screening to help find the cancer if it returns.
During your treatment, you can help manage your side effects and symptoms at home. If your doctor has given you instructions or medicines to treat these problems, be sure to also use them.
Try home treatments for:
Other problems that can be treated at home include:
In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.
Having cancer can be very stressful. Finding new ways to handle stress may help you feel better.
For example, you could:
Your feelings about your body may change after treatment. Dealing with your body image may involve talking openly with your partner about your worries and discussing your feelings with a doctor.
Contact your local chapter of the American Cancer Society to find a support group. Talking with other people who have had similar experiences can be very helpful.
Having cancer can change your life in many ways. For help with managing these changes, see the topic Getting Support When You Have Cancer.
Chemotherapy is the use of medicines to stop cancer's growth or relieve symptoms. Sometimes chemotherapy may be used to shrink tumors in the liver so they can be removed with surgery.
The medicines may be given through a needle in your vein, as pills you can swallow, or as a shot (injection).
The most commonly used medicines are:
Cetuximab (Erbitux) and panitumumab (Vectibix) may be used for colorectal cancer that has spread and has not improved during or after treatment with other drugs. These kinds of medicines, called monoclonal antibodies, may not work for some people. So before you have this treatment, your tumor tissue will be checked for certain gene changes (mutations).
Your doctor may prescribe medicines to control nausea and vomiting.
Surgery may be used to remove cancer from the colon or rectum. Or it may be done to remove cancer that has spread to other organs in the body. The type of surgery chosen depends upon the stage of the cancer.
If cancer that has returned to your intestine is large, more of your colon or rectum may have to be removed. If the ends of your colon or rectum can't be rejoined, you may need a colostomy. Most people don't need a permanent colostomy.
Sometimes surgery is used not to cure your cancer but to make your life more comfortable. For example, the surgeon may create a colostomy to give you relief from symptoms caused by a tumor blocking your colon.
Radiation treatment uses X-rays to destroy colorectal cancer cells. It is often combined with surgery or chemotherapy. Radiation may also be used to reduce the cancer's size when it is blocking the colon or rectum.
Radiation treatments aren't likely to cure metastatic or recurrent colorectal cancer. But they may ease pain and discomfort, slow the spread of the disease, and help you live longer.
Sometimes colorectal cancer that has spread to the liver can be removed by surgery. But usually other treatments are needed, such as:
Clinical trials are studies that look for new treatments. If you are interested, ask your doctor if there are trials you can take part in. The National Cancer Institute or your local chapter of the American Cancer Society can also help you find clinical trials.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of treatments. Some of the complementary therapies that may be helpful include:
These treatments may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and side effects. Let your doctor know if you are already using any such therapies. These treatments aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
- National Cancer Institute (2017). SEER cancer stat facts: Colon and rectum cancer. National Cancer Institute. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed November 10, 2017.
- National Comprehensive Cancer Network (2012). Colon cancer. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Other Works Consulted
- Libutti SK, et al. (2015). Cancer of the rectum. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 823–841. Philadelphia: Walters Kluwer.
- National Cancer Institute (2011). Colon Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient.
- National Cancer Institute (2011). Rectal Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional/allpages.
- National Cancer Institute (2012). Rectal Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient.
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