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When a patient is diagnosed with early-stage colon cancer, we start talking right away about how to keep it from coming back after treatment.
Though thinking that far ahead might seem strange, it’s with good reason why—recurrence is among the most common topics patients ask about after diagnosis.
By far, staying on track with follow-up appointments is the most important thing you can do to reduce the risk of colon cancer recurrence. The earlier colon cancer is diagnosed—whether it’s a first diagnosis or the cancer returned after treatment—the better the chances of curing it.
Attending follow-up exams can give you peace of mind that you’re still cancer-free—and these visits give your doctor the chance to catch recurrent cancer at an earlier, more treatable stage.
Every patient is unique, and your age, lifestyle, and genetic predisposition to cancer must be factored into your post-treatment care plan. Your MedStar Health oncologists will tailor a follow-up plan based on your unique needs.
Starting with early education about recurrence, we will be by your side long after treatment to reduce the risk of colon cancer coming back.
Earlier-stage colon cancer has a lower risk of recurrence.
Recurrent colon cancer often comes back more aggressively than the first time, and often is detected at a later stage. In general, the earlier the stage of colon cancer at diagnosis, the lower the risk it will come back:
- Stage 1: Cancer is just in the lining of the colon, with approximately 5% risk of recurrence after surgery.
- Stage 2: Cancer has spread through the colon lining but no further. After surgery, the risk of recurrence is 10-12%.
- Stage 3: The cancer has spread to the lymph nodes. After surgery and chemotherapy, the recurrence risk is 30%.
- Stage 4: The cancer has spread beyond the lymph nodes to other organs such as the liver and lungs, and is less likely to be cured with surgery or chemotherapy. However, advanced treatments can help contain the spread and improve quality of life.
MedStar Health uses the latest robotic surgery techniques to perform precise, minimally invasive procedures. We can remove just enough healthy tissue along with the colon cancer to reduce the risk of recurrence without causing unnecessary tissue damage. However, recurrence risk is never zero. Even if you have minimally invasive surgery, follow-up care is still important to monitor the risk of recurrence.
Though 70-90% of patients who have surgery for colon cancer may never have a recurrence, surveillance is key to catching cancer at an early stage if it comes back. Particularly with genetic cancers, cellular changes can occur rapidly between follow-up visits, meaning it’s all the more important to make and keep follow-up appointments.
After cancer surgery, your nurse navigator will help you set up a schedule of follow-up visits based on the stage of your cancer and your personal health needs.
Surveillance visits- what to expect.
Most patients with stage 1, 2, or 3 colon cancer can be cured with surgery. Patients with stage 3 colon cancer may also choose to have chemotherapy, which destroys remaining cancer cells and further reduces the risk of recurrence.
We follow guidelines from the National Comprehensive Cancer Network, which is part of the National Cancer Institute, for colon cancer follow-up. More visits than this doesn’t necessarily equate to better outcomes—a study published in BMC Cancer found that adding more testing does not increase survival rates. This cadence is considered optimal frequency by a board of national experts.
Most patients will return for the first surveillance visit 3 months after surgery, then every 3-6 months thereafter for two years. At these visits, your doctor might order a range of tests and exams, based on your personal health:
- Carcinoembryonic antigen (CEA) level (every 3-6 months for two years)—elevated CEA levels can indicate cancer.
- Colonoscopy (a year after diagnosis) to search for and remove suspicious polyps before they become cancerous, as well as to ensure no early recurrence.
- CT scan (every 6 months) to double-check for new or recurrent cancer masses.
- Physical exam (every 3-6 months for two years) to address any underlying concerns or side effects from treatment.
To find a specific biomarker emitted by colon cancer cells, ctDNA blood testing also is available. This is an innovative blood test we implemented within the last few years.
After you reach two years post-surgery, we can move to surveillance visits every 6-12 months unless you experience colon cancer symptoms such as changes in bowel habits, rectal bleeding, unexplained weight loss, fatigue, or dark black bowel movements which can be a sign of gastrointestinal bleeding. CT scans will go to every year.
A few more tips to reduce your recurrence risk.
Along with keeping up with surveillance visits, making specific lifestyle changes can further reduce your risk of recurrence and improve your overall health.
Avoid smoking: Using tobacco products has been linked time and again with multiple types of cancer, including colorectal cancer. If you need help quitting, talk with your doctor about our free smoking cessation programs.
Ask your doctor about aspirin: Some studies have suggested that taking daily aspirin might reduce the relative risk of colon cancer by 63% in patients with Lynch syndrome, a genetic predisposition to specific types of cancer. Other researchers suggest that average-risk patients might also benefit to the tune of 19% risk reduction.
However, more research is needed to verify large-scale recommendations for daily aspirin—long-term use carries the risk of serious side effects such as intestinal bleeding, and aspirin use is not appropriate for everyone.
Choose lean meats: Processed meats, including lunch meats and bacon, are proven to increase the risk of colon cancer. What you might save in the grocery line is not worth the risks to your gastrointestinal health. Listen to the Medical Intel podcast to learn more.
Red meat also has been associated with several types of cancers, including colon cancer. And giving up beef might also do your wallet some good. The price of hamburger and steak isn’t going down—particularly amidst the supply chain issues of the COVID-19 pandemic.
Exercise: Research has shown that getting regular exercise reduces the risk of dying from colon cancer and reduces the risk of the disease coming back after treatment. Talk with your doctor about the best options for you—walking daily, for example, can benefit your health during recovery and improve your mental clarity and cardiovascular health long term.
Keep getting regular colonoscopies: Starting at age 45, average-risk patients should get one every 10 years. After cancer, you should have a colonoscopy a year later, and then spaced out as recommended by your doctor, even if you are a young adult patient. However, if you notice symptoms, don’t wait for your next appointment—call your doctor to visit sooner.
Though the risk of recurrence is low, it is never zero. The earlier we catch colon cancer, the better your outcomes can be. And the best way to do so is to keep your follow-up appointments and stay in touch with your care team.
If keeping your appointments becomes a challenge due to transportation, childcare, or any other concern, talk with your doctor. We want you to have the best outcomes, and we can help you connect with resources to get the care you need.
