Topic Overview
Is this topic for you?
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.
What is 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.
What causes metastatic or recurrent colorectal cancer?
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.
What are the symptoms?
The most common symptoms are:
- A change in your bowel habits, such as more frequent stools,
thinner stools, or a feeling that your bowels are not emptying completely.
- Blood in your stool or very dark stools.
- Loss of appetite.
- Belly pain, especially gas pains, cramps, or
a feeling of fullness.
- Losing weight without trying.
- Constant tiredness (fatigue).
Some people don't have any
symptoms.
If your cancer has spread, you may have other symptoms,
depending on where the cancer is.
How is metastatic or recurrent colorectal cancer diagnosed?
Colon or rectal cancer that has spread or returned is
diagnosed using a physical exam and several tests, including blood tests, chest
X-rays,
bone scans,
ultrasounds, and
CT,
PET, or
MRI scans.
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.
How is it treated?
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.
Frequently Asked Questions
Learning about metastatic and recurrent colorectal cancer: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Supportive care: | |
Cause
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.
Symptoms
The most common symptoms are:
- A change in bowel habits, such as narrow stools
or frequent diarrhea or constipation.
- Blood in the stool, or stools
that look like black tar.
- Loss of appetite.
- Pain in the
belly, especially gas pains, cramps, or
a feeling of fullness.
- Unexplained weight loss.
- Constant
tiredness (fatigue).
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.
What Happens
How cancer grows and spreads
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.
- Colon cancer often spreads first to nearby lymph nodes. From there it may spread
to other parts of the body, usually to the liver. It may also spread to the
lungs, bones, or other organs in the body.
- Rectal cancer may spread directly to the lungs, bypassing the liver.
Recurrent colorectal cancer occurs when the
cancer begins to grow again months or years after treatment.
Survival rates
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:
- Is 69% for people whose cancer has
spread to nearby organs or lymph nodes.footnote 1 This means that about 69 out of 100 people are still alive 5 years or longer
after their cancer was discovered.
- Is 12% for people whose cancer has spread farther away to other parts of their bodies. footnote 1 This means that about 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.
What Increases Your Risk
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.
When To Call a Doctor
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
changes.
Call your doctor if you have any of these
symptoms:
- A change in bowel habits, such as constipation or diarrhea
- Pain or bloating in your
belly
- Weight loss, loss of appetite, or severe tiredness
- Persistent shortness of breath or cough (especially coughing up blood)
- Bone pain
- Confusion or memory problems that get worse
Who to see
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.
Exams and Tests
Tests to help your doctor see if
colorectal cancer has
spread or come back include:
- An abdominal ultrasound to find the cause of pain or
swelling in your belly.
- A colonoscopy to see if cancer has returned to your
intestine.
- Blood tests to find out if cancer has returned (CEA) or to find the cause of symptoms such as
weakness, fatigue, fever, bruising, or weight loss (complete blood count).
- A chest X-ray to find the cause of symptoms such as
persistent coughing, coughing up blood, chest pain, or trouble
breathing.
- A CT scan, an
MRI, or a
PET scan to see if colorectal cancer has spread into
the chest or organs in the belly or pelvis.
- A brain CT scan or
MRI to look into symptoms such as confusion, paralysis, numbness, vision
problems, vertigo, or headaches.
- A biopsy, such as a
liver biopsy or a
lung biopsy, to find out where the cancer cells have
spread.
- A
bone scan to find out if cancer cells have spread
to the bones.
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.
Treatment Overview
Your treatment for colorectal cancer that has spread or come back may include:
- Surgery. If cancer
has come back in your intestine or another part of your body, surgery may be used to remove it. To learn more, see Surgery.
- Chemotherapy. These medicines kill cancer cells that have spread to other parts of your body. They also can relieve pain caused by the cancer. To learn more, see
Medications.
- Radiation therapy. X-rays can be used to shrink colorectal tumors that may be
causing blockages. They can also reduce bleeding or pain. To learn more, see Other Treatment.
- Targeted therapy. This treatment uses medicines called monoclonal antibodies to treat colorectal cancer. It is often given along with chemotherapy. To learn more, see Medications.
- Clinical trials. These are studies of new or different ways
to treat cancer.
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 control
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
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.
End-of-life 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:
Prevention
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 3
Initial treatment for colorectal
cancer is followed by regular doctor visits and screening to help find the
cancer if it returns.
Home Treatment
Managing side effects
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:
- Nausea or vomiting, such as ginger tea, peppermint candy or gum. Be sure to drink enough fluids so that you
don't get dehydrated.
- Pain, such as over-the-counter pain
relievers, heat packs, or cold packs. Talk to your doctor before using any home treatment for pain. To learn more, see the topic
Cancer Pain.
- Diarrhea, such as taking small, frequent sips of water and bites of salty crackers.
- Constipation, such as getting plenty of water and fiber in your diet. Don't use a laxative without first
talking to your doctor.
Other problems that can be treated at home include:
- Sleep problems. If you have trouble
sleeping, try having a regular bedtime, getting exercise daily, and avoiding
caffeine late in the day.
- Feeling very tired. If you lack energy or become weak easily, try to get extra rest. Plan your schedule to
make the most of the energy you have.
- Mouth sores. Watch what you eat and drink. Rinse your mouth regularly with mouthwash or a liquid
antacid.
In general, healthy habits such as eating a balanced diet and getting enough sleep and
exercise may help control your symptoms.
Managing stress
Having cancer can be
very stressful. Finding new ways to handle stress may help you feel better.
For example, you could:
- Try techniques to reduce your stress, such as yoga and visualization exercises.
- Talk about your feelings. Your cancer
treatment center may offer counseling services and support groups.
- Ask your doctor to help you find other sources of support and information.
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.
Medications
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).
Medicine choices
The most commonly used medicines are:
- Bevacizumab (Avastin).
- Capecitabine (Xeloda).
- Fluorouracil (5-FU).
- Irinotecan (Camptosar).
- Leucovorin (Fusilev).
- Oxaliplatin (Eloxatin).
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
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.
Surgery choices
- Bowel resection.The surgeon cuts out the cancer in the colon or rectum as well as the parts
of the colon or rectum that are next to it. Then the two healthy ends of the
colon or rectum are sewn back together.
- Liver resection. The surgeon cuts
out cancer that has spread to the liver, as well as parts of the liver that are
next to the cancer. If the cancer in your liver is too large to remove with surgery, you may be given chemotherapy. It can shrink the tumor so it can be removed.
- Lung, adrenal, or ovarian resection, depending on where the cancer has spread and whether you are a good candidate for this surgery.
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.
Other Treatment
Radiation treatment
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.
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:
- Radiofrequency ablation. A small wire that sends out radio waves is inserted into the
tumor. The radio waves destroy the cancer that has spread to the liver without harming healthy
tissue.
- Cryosurgery. This may be done in
surgery for cancer that has spread to the liver. Liquid nitrogen
is used to freeze and destroy cancer cells.
- Embolization. This shrinks a cancer that has spread to the liver by
cutting off its blood supply.
- Interstitial radiation therapy. In
this type of internal radiation treatment, radioactive material sealed in
needles, wires, seeds, or catheters is placed directly into the tumor or body
tissue.
- Intra-arterial hepatic chemotherapy. The surgeon implants a small pump in the belly that
delivers chemotherapy right into the tumor. The pump can be left in place as
long as needed.
Clinical trials
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.
Complementary therapies
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.
Other Places To Get Help
Organizations
American Cancer Society (ACS)
250 Williams Street NW
Atlanta, GA 30303
www.cancer.org
National Cancer Institute (U.S.)
www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)
References
Citations
- American 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 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.
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerKenneth Bark, MD - General Surgery, Colon and Rectal Surgery