Recurrent colon cancer is a colon cancer that comes back after successful treatment. Recurrence after surgery is one of the primary causes of death in colon cancer.1
Every survivor's experience with colon cancer is unique, with each person having different struggles and fears. Reducing the risk of colon cancer recurrence involves taking reasonable steps to prevent the remerging of cancer cells in your body. In this article, we've compiled essential tips and insights to help you safeguard your gut health after colon cancer and reduce the risk of recurrence.
Understanding recurrent colon cancer
How common is recurrence in colon cancer?
Some tumours have higher recurrence rates regardless of treatment success. Here is a list of cancers with higher recurrence rates:2,3,4
- Glioblastoma multiforme, a type of brain cancer, has more than 90% recurrence rate
- Ovarian epithelial cancer has a recurrence rate of around 85%
- Colon cancer can recur in about 30% to 40% of the patients
Timeline for colon cancer recurrence
Approximately 60–80% of recurrences occur within the first two years after resection, whilst 95% occur within the first four years. After five years of being disease-free, the possibility of a recurrence is very low. Therefore, follow-up in some countries is limited to 5 years.5 Despite this, you should be aware that recurrence can appear anytime, regardless of duration, despite these statistics.
Types of recurrence
The types of recurrence in colon cancer are:6
- Local- It occurs at the original site of surgical resection within the colon
- Regional- It appears at the site of draining lymph nodes and/or near the colon
- Distant- These are Recurrences occurring at places away from the colon. Around 50% of these distant recurrences are reported in the liver and 20% in the lung. Other sites of recurrence include the ovaries, brain, and bones.
When is colon cancer most likely to recur?
The known risk factors for colon cancer recurrence are:1,7
- Tumour stage- The recurrence rate can rise to as high as 49% in stage 3 and from around 6 % in stage 1 colon cancers
- Tumour size- A tumour with a size more than 5 cm poses more risk of recurrence
- Lymph node status- Recurrence risks are higher for those with positive lymph nodes
- Tumour numbers- Multiple tumours in the colon have a higher risk of recurrence post-surgery
- Metastasis- Before treatment, if colon cancer spreads to other parts of the body, particularly the liver, the likelihood of recurrence is higher
- Age- Colorectal cancer patients younger than 50 years have less risk of recurrence
- Raised carcinoembryonic antigen (CEA) levels: If a test for CEA shows levels of ≥5 ng/ml, it shows a risk of recurrence
- Genetic- If a patient has certain genes, it makes them more susceptible to recurrence.
Proven strategies to reduce colon cancer recurrence risk
Let's explore the role of regular check-ups, diet, exercises, and other factors in reducing the risk of recurrence of colon cancer.
Staying informed of the risk of recurrence
Don't let colon cancer recurrence catch you off guard. Being proactive and staying aware of early warning signs can help manage the disease better. Below is a list of signs and symptoms to look out for to see if your cancer has recurred.
Signs and symptoms suggesting a return of colon cancer include:4
- Pain in abdomen
- Altered bowel
- Blood in stool
- Weight loss
- Back pain
- Loss of appetite
- Difficulty in breathing
Recurrent colon cancer can be asymptomatic sometimes. In that case, you are more likely to have better outcomes.4
Do not miss your follow-up appointments
Generally, follow-up is recommended every 3 to 6 months for five years after the treatment. It is important to attend these follow-up appointments to help guide treatment choices as a patient, helping make choices to prevent recurrence. Along with physical examination, follow-up tests include:4
- Monitoring CEA level - This is a test to check how well the previous treatment you have received is working in your body by monitoring the level of this antibody in the blood.
- Imaging such as abdominal or pelvic computed tomography(CT) - This scan will see whether tumours are forming again in the colon or have spread to other organs such as the chest, lymph nodes, lungs or liver.
- Colonoscopy - An instrument is inserted into the anus to see if any tumours have formed in the colon.
- Chest X-ray - To see if any tumours have formed in the chest.
Compliance with medication
You should follow the doctor's advice and take your medicine as prescribed. Effective monitoring of post-operative therapy doses and managing adverse effects of anticancer drugs demands unwavering dedication and a strong will.
Take care of what you eat
The diet after colostomy or surgery will vary compared to after having a full recovery. Cancer Research UK suggests eating frequent but small meals during an initial period. It must include food rich in protein and carbohydrates but low in fibre.
Once your bowel returns to normal, your diet should aim at overall well-being and reducing bowel cancer recurrence. Below are some healthy dietary tips and choices to make for those with colon cancer. These include:
- Check whether you have any dietary restrictions post-surgery
- Take food high in proteins such as fish, poultry, eggs and legumes
- Try to include food with omega-3 fatty acids like fish, walnuts, olive oil, etc.
- Eat plenty of fibre-containing foods such as whole grains, fruits and vegetables
- Take folate-rich vegetables such as dried beans and dark green vegetables
- Limit your intake of red meat such as beef, lamb or pork, and processed food
- Add vitamin D-rich food such as fatty fish, liver, and egg yolk to your diet
- Include fruits or vegetables with antioxidant properties, such as carrots, citrus fruit, grapes, watermelons, papaya, apricots and pumpkin
- Add dietary supplements if needed to prevent a nutritional deficiency
Being physically active
A high level of physical activity can help reduce the risk of developing colon cancer by 40%.8 You can stay fit by engaging in activities that are both fun and keep you healthy. These examples include:
- Taking stairs in place of a lift or escalator
- Using bicycles or walking to commute to your workplace
- Taking short walks while chatting or talking over the phone
- Using a pedometer to motivate yourself to walk more
- Following your hobbies such as dancing, swimming, cycling, etc
- Try to do more outdoor activities
The general physical activity recommendations by the American Cancer Society for cancer survivors are to:
- Start to slowly and gradually increase the amount of physical activity over time
- Try accumulating at least 150-300 minutes of moderate physical activity or 75-150 minutes of vigorous exercise weekly
- Engage in physical exercise for at least 10 minutes at a time, at least several times a week
- Incorporate resistance training exercises and stretching at least two days a week
Controlling your weight
Obesity increases the risk of bowel cancer. Some statistics to illustrate this include:
- In the UK, 11 out of 100 people with colon cancer are obese
- The risk of colorectal cancer is 60% higher in obese people compared to those with a normal weight.9
- According to research, for every 10 cm increase in waist circumference, the risk of colon cancer increases by 25%9
To manage your weight, specific advice includes:
- Doing regular exercise
- Avoiding sugary drinks, processed food and alcohol
- Snack on fruits and salads in place of cookies and crisps
If you are a smoker, you are likely to develop polyps (projecting growths in the bowel). Some of these polyps may progress to cancer at a later stage. Around 7 per cent of colon cancers in the UK are linked to tobacco smoking.
Quitting smoking is not easy for everyone. You should consult your doctor if self-control is difficult. In the UK, you can also use NHS stop smoking services for available options to control your addiction and withdrawal symptoms.
Reduce your alcohol intake
Alcohol is categorised as a class 1 carcinogen (a cancer-causing agent). Excessive alcohol consumption can damage the epithelial cells in the colon, leading to DNA damage and potential tumour growth. Additionally, it can suppress your immune system, leading to colon cancer progression. Also, there is an increased risk of liver metastasis (the tumour spreading to the liver)among heavy drinkers.10
If you drink alcohol frequently, aim to have at least two alcohol-free days a week. Limit your daily intake and avoid binge drinking.
Managing your stress
Chronic stress is known to cause health issues, but its association with colon cancer risk and recurrence is unknown. There are various studies on the impact of stress on cancer, but none of the research has yielded fruitful results in confirming its direct role.
However, stress may influence your lifestyle and activities. Unhealthy habits like heavy drinking, excessive eating and smoking can easily sneak in when stress levels are high. So, if you want to stay healthy and prevent recurrence, make sure to prioritise stress management in your daily routine. Here are some of the ways to manage your stress:
- Interact with social support groups of cancer survivors
- Consider practising deep breathing exercises and yoga
- Make sure you eat well and spend time outdoors
- Tailored psychotherapy interventions can also help reduce stress
Is recurrent cancer the same as new cancer or second cancer?
The recurrence of the cancer may occur at a distant location or the original site. Recurrent cancer's type, treatment and outcome differ significantly from new cancer in the same site.
What is the survival rate of recurrent colon cancer?
It depends upon the type of recurrence. One study found 5-year survival rates of 90% for localised recurrence, 70% for regional recurrence and 10% for distant recurrence in colorectal cancer.6
Is recurrent colon cancer more aggressive?
Recurrence of colon cancer is associated with a higher risk of cancer-related death. Also, early colon cancer recurrence or return within two years has a worse outcome than late recurrence.11
Recurrent colon cancer typically affects which site?
The common sites of recurrent colon cancer are the liver, lungs, peritoneum and localised pelvic area.11
Recurrent colon cancer is an aggressive cancer that returns after treatment of colon cancer. It is not rare to see a recurrence within five years of treatment.
Staying informed about early warning signs of colon cancer recurrence is crucial for better management. Following up with regular physical examinations and tests can detect recurrence at the earliest.
The likelihood of recurrence depends on risk factors and other variables. Regular check-ups, diet management, and lifestyle modification can help reduce the risk of colon cancer recurrence.
- Liu Y, Du W, Guo Y, Tian Z, Shen W. Identification of high-risk factors for recurrence of colon cancer following complete mesocolic excision: An 8-year retrospective study. PLoS One [Internet]. 2023;18(8):e0289621. Available from: http://dx.doi.org/10.1371/journal.pone.0289621
- Fabian D, Guillermo Prieto Eibl M, Alnahhas I, Sebastian N, Giglio P, Puduvalli V, et al. Treatment of glioblastoma (GBM) with the addition of tumor-treating fields (TTF): A review. Cancers (Basel) [Internet]. 2019;11(2):174. Available from: http://dx.doi.org/10.3390/cancers11020174
- Corrado G, Salutari V, Palluzzi E, Distefano MG, Scambia G, Ferrandina G. Optimizing treatment in recurrent epithelial ovarian cancer. Expert Rev Anticancer Ther [Internet]. 2017;17(12):1147–58. Available from: http://dx.doi.org/10.1080/14737140.2017.1398088
- Duineveld LAM, van Asselt KM, Bemelman WA, Smits AB, Tanis PJ, van Weert HCPM, et al. Symptomatic and asymptomatic colon cancer recurrence: A multicenter cohort study. Ann Fam Med [Internet]. 2016;14(3):215–20. Available from: http://dx.doi.org/10.1370/afm.1919
- van den Berg I, Coebergh van den Braak RRJ, van Vugt JLA, Ijzermans JNM, Buettner S. Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study. World J Surg Oncol [Internet]. 2021;19(1). Available from: http://dx.doi.org/10.1186/s12957-021-02207-4
- Xu W, He Y, Wang Y, Li X, Young J, Ioannidis JPA, et al. Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med [Internet]
- Zare-Bandamiri M, Fararouei M, Zohourinia S, Daneshi N, Dianatinasab M. Risk factors predicting colorectal cancer recurrence following initial treatment: A 5-year cohort study. Asian Pac J Cancer Prev [Internet]. 2017 [cited 2023 Sep 15];18(9):2465–70. Available from: https://journal.waocp.org/article_49934.html
- Pericleous M, Mandair D, Caplin ME. Diet and supplements and their impact on colorectal cancer. J Gastrointest Oncol [Internet]. 2013;4(4):409–23. Available from: http://dx.doi.org/10.3978/j.issn.2078-6891.2013.003
- Ma Y, Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8(1):e53916. doi: 10.1371/journal.pone.0053916. Epub 2013 Jan 17. PMID: 23349764; PMCID: PMC3547959
- Phipps AI, Robinson JR, Campbell PT, Win AK, Figueiredo JC, Lindor NM, et al. Prediagnostic alcohol consumption and colorectal cancer survival: The Colon Cancer Family Registry. Cancer [Internet]. 2017;123(6):1035–43. Available from: http://dx.doi.org/10.1002/cncr.30446
- Ryuk JP, Choi G-S, Park JS, Kim HJ, Park SY, Yoon GS, et al. Predictive factors and the prognosis of recurrence of colorectal cancer within 2 years after curative resection. Ann Surg Treat Res [Internet]. 2014;86(3):143. Available from: http://dx.doi.org/10.4174/astr.2014.86.3.143