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
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
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
If your cancer has spread, you may have other symptoms,
depending on where the cancer is.
Colon or rectal cancer that has spread or returned is
diagnosed using a physical exam and several tests, including blood tests, chest
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. 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.
Learning about metastatic and recurrent colorectal cancer:
Health Tools help you make wise health decisions or take action to improve your health.
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.
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
If polyps are not found and removed, some of them can turn
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:
These numbers are taken from reports that were done at least 5 years ago, before newer treatments were available. So the actual chances of your survival are likely to be higher than these numbers.
Even after treatment that seems successful, colorectal cancer may come back (recur). But this depends on the stage of the cancer before treatment.
Your risk for recurrent or metastatic cancer depends on how aggressive your cancer is and how well treatments work.
You may be seeing a doctor
regularly to check for symptoms, but symptoms might start between visits. Be
aware of what is normal for you, and tell your doctor about any changes right
away. Be sure to let your doctor know if you feel even very small
Call your doctor if you have any of these
If you have been treated for colorectal cancer,
doctors who can evaluate any new symptoms include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Tests to help your doctor see if
colorectal cancer has
spread or come back include:
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
Your treatment will depend
on specific information about the cancer, your preferences, and your
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 opiates. Or you can have treatments that shrink tumors and block nerve pain.
As your cancer gets worse, you may want to think about palliative care. Palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit. It may help you manage symptoms
or side effects from treatment. It can also help with other concerns you may have when you are living with a serious illness, such as making future plans about your medical
care. If you are interested in palliative care, talk to your
There may come a time when treatments to cure your cancer are no longer working. Or you may decide that you want to spend the time you have left in other ways and only have medical care that keeps you comfortable. If so, talk to your doctor about hospice care.
Hospice care is palliative care for people who are at the end of life, with about 6 months or less to live. Hospice caregivers help to enhance the quality of your remaining life by keeping you as alert and
comfortable as possible in a familiar environment with family and friends.
You may also want to:
To learn more about supportive care, see:
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:3
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:
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
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
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
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.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
Cancer.Net is the information website of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
The U.S. National Institutes of Health (NIH) conducts
and supports medical research to improve people's health and save lives. NIH
provides access to health and wellness information, free newsletters, current
research, health databases, fact sheets, and many other resources.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online.
Lewis C (2007). Colorectal cancer screening, search date November 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
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
Eng C (2011). Colorectal cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 5. Hamilton, ON: BC Decker.
Libutti SK, et al. (2011). Cancer of the rectum. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1127-1141. Philadephia: Lippincott Williams and Wilkins.
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.
September 5, 2012
E. Gregory Thompson, MD - Internal Medicine
& Kenneth Bark, MD - Surgery, Colon and Rectal
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