What Is Recurrent Colorectal Cancer?

Most folks with cancer know that there's a chance their disease could come back after they're done with treatment. If you had colorectal cancer and this happens to you, you may hear your doctor call it recurrent colorectal cancer.

Sometimes, the returning cancer shows up in the same place as the first time you had it. If that happens, it's called a local recurrence.

If the cancer comes back in lymph nodes that are near the original spot, your doctor will tell you that you've got a regional recurrence.

When it appears far from your first cancer, like the liver or lungs, your doctor will call it a distant recurrence or say it is "metastatic."

Sometimes, it's hard to tell whether you have recurrent colorectal cancer or if it's just the same disease that's now more advanced. It's often a question of timing. Recurrent colorectal cancer usually comes back after being gone for at least a year. When it's just an advanced version of the original cancer, it may show up in a few months. In that situation, the cancer often returns because the first round of treatment didn't get rid of all the cancer cells.

Symptoms

Many of the symptoms of recurrent colorectal cancer are the same or similar to the ones you had when you first had cancer. These include belly pain, constipation or diarrhea, and weight loss.

You may also feel more tired than usual, and depending if and where the cancer has spread, you may have pelvic or back pain, trouble breathing, and not want to eat anything.

It's also common, though, to have no symptoms at all. If that's the case, your recurrent colorectal cancer is less likely to have spread to other parts of your body.

How You Get a Diagnosis

Early detection of recurrent colorectal cancer raises the odds that it can be cured. Most of the time, your doctor will discover you've got it when you see him for one of your regular follow-up visits after your treatment for your original cancer is over.

During these checkups, which usually happen every 3 to 6 months, your doctor will do a physical exam and an endoscopy of your colon at regular intervals. During an endoscopy, your doctor puts a small flexible tube with a light and camera into your colon to examine it.

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He'll also ask if you have any symptoms and order a blood test for a protein called carcinoembryonic antigen (CEA). Sometimes (but not always), CEA levels are higher if you have colorectal cancer.

Your doctor may also ask you to get a colonoscopy, but these are better at finding new tumors than at discovering recurrent colorectal cancer.

Your doctor may want you to get a biopsy to confirm signs that you've got recurrent colorectal cancer. In this procedure, he'll cut off a piece of the tumor and look at it under a microscope.

He may also suggest you get imaging tests such as computed tomography (CT) of the stomach, chest, and pelvis to help see if the cancer has spread and how far.

Treatment

Your doctor will consider many different things before suggesting a treatment plan. A lot depends on how long it's been since you had the first cancer, where the cancer has come back, whether it's spread, and what kind of overall health you're in.

Your doctor may choose different chemotherapy drugs from the ones you used when you first had the disease. That's because the cancer cells may have become resistant to the earlier drugs.

Fortunately, there are a lot of treatments, including combinations of different drugs. Your doctor may decide to give you radiation, in addition to surgery and chemo, especially if you did not get radiation the first time you had colorectal cancer. Or he may alternate several chemo drugs, prescribe different strengths, or start and stop chemo to treat the cancer.

Sometimes, doctors will use drugs that directly target the cancer cells. These have different side effects than chemotherapy drugs but only work on certain types of tumors.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on May 07, 2019

Sources

SOURCES:

American Cancer Society: "When Cancer Comes Back: Cancer Recurrence," "What is cancer recurrence?" "Signs and Symptoms of Colon Cancer," "Treatment of Colon Cancer, by Stage."

UptoDate: "Patient education: Colorectal cancer treatment; metastatic cancer (Beyond the Basics)," "Treatment of locally recurrent rectal adenocarcinoma."

Duineveld, Laura A.M. Annals of Family Medicine, May/June 2016.

Wieldraaijer T. Digestive Surgery, March 14, 2017.

American College of Gastroenterology: "Colorectal Cancer Patients Need Colonoscopy After Cancer Resection: U.S. Multi-Society Task Force Releases New Recommendations."

National Comprehensive Cancer Network Guidelines for Patients: "Colon Cancer."

Hellinger, Michael D. Clinics in Colon and Rectal Surgery, November 2006.

American Society of Clinical Oncologists: "Colorectal Cancer - Diagnosis."

MD Anderson Cancer Center: "Locally Recurrent Rectal Cancer."

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