This topic is about
metastatic and recurrent colorectal cancer. 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.
The exact cause is not known, 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 being treated.
Some people do not have any
symptoms. When they do occur, the most common symptoms are:
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
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 begin as
small growths, or
polyps, inside the intestine.
colorectal cancer is not detected and removed, it invades and destroys nearby
tissues and may spread to other parts of the body. Even after treatment that seems successful, colorectal cancer may spread or come back.
Some people who have
metastatic or recurrent colorectal cancer do not have
any symptoms for some time. When symptoms do appear, the most common ones are:
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
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 (benign) polyps in the
large intestine (colon or rectum).
Colon polyps are common and most do not cause
problems. But if polyps are not detected and removed, some of them can turn
If the cancer is allowed to continue growing, it
eventually will invade and destroy nearby tissues and then spread farther.
Metastatic or recurrent colorectal cancer occurs when cancer cells travel, through
either the bloodstream or the
lymph system, to other parts of the body and continue
to grow in their new location. Recurrent colorectal cancer occurs when the
cancer begins to grow again months or years after treatment.
colorectal cancer will affect your life span depends on the
stage of your cancer. A cancer's stage depends on how
far it has spread.
The 5-year survival rate for people who have colorectal cancer that has
spread to nearby organs or lymph nodes is 69%.1 This means that an average of 69 out of 100 people are still alive 5 years or longer
after their cancer was discovered. For people who have colorectal cancer that has spread farther away to other parts of their bodies, the rate is 12%.1 This means that an average of 12 out of 100 people are still alive 5 years or longer after their cancer was discovered.
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.
Some people who have
metastatic or recurrent colorectal cancer do not have
any symptoms for some time. Colorectal cancer may be discovered before symptoms appear, either on X-rays or other lab tests.
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
What symptoms you may have will depend on which part of
your body is affected by the cancer. Call your doctor if you have any of these
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without giving
treatment to cure your cancer. Watchful waiting may be an option if treatment
may cause more harm than good and cannot cure your cancer. Remember,
though, that watchful waiting does not mean your doctor won't treat your
symptoms, such as pain.
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:
Colorectal cancer often comes
back, even after treatment that seemed successful. If you had colorectal cancer in the
past, pay close attention to your body and see your doctor regularly. Tell your
doctor about any changes, such as decreased appetite, bloating, or an increase
in the size of your belly.
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 for
metastatic or recurrent colorectal cancer will depend
on specific information about the cancer, your preferences, and your
Some cases of metastatic or recurrent colorectal cancer
can still be cured. When it cannot be cured, treatment can help you feel better
and live longer.
Your treatment may include:
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 is a kind of care for
people who have serious illnesses. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit.
Palliative care may help you manage symptoms
or side effects from treatment. It could also help you cope with your feelings
about living with a long-term or terminal illness, make future plans around your medical
care, or help your family better understand your illness and how to support
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
For more information, see the
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 are concerned with
enhancing the quality of your remaining life by keeping you as alert and
comfortable as possible in a familiar environment with family and friends.
Hospice programs offer services in your own home or in a hospice center,
nursing home, or hospital.
You may wish to discuss health care
and other legal issues that arise near the end of life with your family and
your doctor. You may find it helpful and comforting to state your health care
choices in writing (with an advance directive or living will) while you are
still able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you. You may wish to
choose a health care agent in case you become unable to speak for
Learning all you can about end-of-life
issues may help you feel better. For more information, see one of the following
There is no sure way to prevent
colorectal cancer from returning or showing up in
other parts of your body. After you have had it, your risk of having it again
increases. When it comes back, it is called
metastatic or recurrent colorectal cancer. It often
comes back after surgery, especially if it was not discovered when it was in an
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 catch the
cancer if it returns.
The frequency of your follow-up visits and how often you have more tests will depend on your general health and the type of colorectal cancer you had. As part of your follow-up visits, you may
Home treatment may be all that is needed
to help manage the side effects that often accompany
metastatic or recurrent colon cancer or its treatment.
Healthy habits such as eating a balanced diet and getting enough sleep and
exercise may help control your symptoms. Be sure to follow any instructions
your doctor has given you.
Learning that you have colorectal cancer and being treated for it can be
very stressful. There are steps you can take to reduce your stress. You may want to talk with family or friends. Some people find that spending time alone is what they need.
If your emotions interfere with your ability to
make decisions, it is important to talk to your doctor about them. Your cancer
treatment center may offer counseling services, support groups, and classes
such as yoga.
feelings about your body may change after treatment.
Dealing with your body image may involve talking
openly about your worries with your partner 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). For colorectal cancer that has spread to
the liver, researchers are studying ways to deliver chemotherapy directly to the liver.
Several medicines are used to
metastatic or recurrent colorectal cancer. Other medicines are
also available to treat side effects, such as nausea.
The most commonly used medicines for the treatment of
colorectal cancer are:
Cancer medicines are often used in combination. For example,
a treatment called FOLFOX4 uses oxaliplatin, leucovorin, and fluorouracil,
while the treatment called FOLFIRI uses folic acid, fluorouracil, and
irinotecan. There are several of these specific combinations.
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. These medicines
Clinical trials that test new drugs are ongoing. Talk
with your doctor about participating in a clinical trial.
Surgery to remove cancer may be used to treat
metastatic or recurrent colorectal cancer. The type of
surgery chosen depends upon the
stage of the cancer. Surgery may be used to remove cancer that is in the colon or rectum. Or surgery may be done to remove cancer that has spread to other organs in the body.
Surgical options include:
If cancer that has returned to your intestine is large,
more of your colon or rectum may have to be removed. The ends of your colon or
rectum are rejoined during surgery. If they can't be rejoined, you may need a
colostomy. Most people do not need a permanent
When cancer has spread to other parts of the body, the
kind of surgery you will need depends on where the cancer is and how big the
tumor is. 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 therapy uses X-rays to destroy
colorectal cancer cells. It is often combined with
surgery or chemotherapy. Radiation therapy may also be used to reduce the
cancer's size when it is blocking the colon or rectum or to relieve pain from
cancer that has spread to other organs.
Radiation treatments are
not 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
Treatment for cancer that has spread to the liver
Sometimes colorectal cancer that has spread to the liver can be removed
by surgery. But usually other treatments are needed, such as:
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like those mentioned above 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 potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not 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.
Clinical trials are
studies designed to find better ways to treat people and are based on the most
up-to-date information. There are a number of clinical trials involving the
treatment for metastatic or advanced colorectal cancer. If you match the
guidelines, you may be able to enroll in one. If you are interested, ask your
doctor whether there are trials in which you can participate. The National
Cancer Institute or your local chapter of the American Cancer Society can also
help you find clinical trials.
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.
CitationsAmerican Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.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 ConsultedEng 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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