Colorectal Cancer: Recurrence: Managing Medical Care

When colorectal cancer recurs, there are ways to help control the spread of the cancer and extend life while managing colorectal cancer symptoms without diminishing your quality of life. While all recurrences are treatable, there is currently no cure possible when the cancer has spread to distant places within the body. However, even then, life can be extended and quality of life can be improved.

The first thing your doctors will do is suggest tests to find out why the cancer recurred. For instance,

• Was it a failure of the initial treatment in the colorectal?
• Did the colorectal cancer go somewhere else in the body (metastasize)? (Note: when cancer metastasizes, it is still known by the name of the original cancer site because the cells are the same).
• Is it a different cancer all together?

The tests and the doctors who will be involved will likely be the same as when a diagnosis of colorectal cancer was first made.  Tests usually include a biopsy  and imaging devices such as a CT Scan. 

Treatment options depend on how your first appearance of disease was treated. For example,

• If you were treated with surgery alone, a second surgery may be recommended which is then followed by chemotherapy and/or radiotherapy.
• If a second surgery is believed to be too risky, chemotherapy and/or radiotherapy may be recommended.
• If only one organ is affected, therapy which targets that organ may be recommended.
• If you were previously given chemotherapy, your oncologist may not consider it to be the best choice for treating a recurrence. Instead, a different drug is usually suggested.
• If the tumor cannot be removed, combined chemotherapy and radiotherapy may be used to reduce the size of the tumor. Sometimes the combination reduces the tumor enough so that it can then be removed.

For a description of the available tests and treatments, and how to make a reasoned decision click here 

• Once a treatment decision is made, visit our document: Colorectal Cancer: Newly Diagnosed: Treatment Decision to Start of Treatment. 
• Once treatment starts, read: Colorectal Cancer: In Treatment. 

If standard treatments will not work, there are cutting edge treatments which are available through clinical trials (controlled scientific studies involving humans) or treatments available in other countries.

As you review the information about making a treatment decision:

• Keep in mind the amount of time your doctor says that you have to make a treatment decision.  Use the time to get a second opinion and to do whatever research you want to do - including checking guidelines from the National Comprehensive Cancer Network (NCCN) (www.nccn.org ), the suggestions from the treatment helper available through the American Cancer Society (www.cancer.org ), and possibly hiring a firm to research alternatives and give you an opinion. 
  • A second opinion should be from an experienced, independent expert, such as one available at an academic center or a NCI designated Comprehensive Cancer Center. or an educational institution. At the least, the opinion should be from another type of cancer doctor than the one who initially recommended a treatment. For instance, if you saw a medical oncologist (one who specializes in the use of drugs to treat cancer), see a radiation oncologist (a cancer doctor who specializes in the use of radiation for the treatment of cancer). This is so even if you already had surgery or chemotherapy. For more information about second opinions, click here. 
  • Free transportation is available if needed although you may not need to go yourself. It may be enough to send your medical record and slides of your cancer.
  • Second opinions are usually covered by health insurance.
• Do not dismiss out-of-hand the option of “watchful waiting” because you are dealing with a recurrence. Doing no treatment now may be a reasonable decision. For instance, if you are having no symptoms or only mild ones that do not interfere with your daily living, and you have another health condition which is likely to end your life before the colorectal cancer. 
• It is also your choice to stop trying to eliminate or at least minimize cancer. You can switch to care known as palliative care which is more about quality of life than cure. The choice about whether to switch to palliative care, and when, is totally up to you. There is no right and wrong. This subject is covered in our document: Nearing End of Life 

Discuss the treatment decision in depth with a urologic oncologist and your family.

Dealing with a treatment decision for a recurrence is subject is likely to be difficult emotionally. Some people prefer denial and don’t want to think about making a treatment decision. The difficulty with denial in this situation is that making no decision is actually making a decision: a decision not to treat. That is your right if that’s what you choose. We are only suggesting that you actually think about it and make a conscious choice.  (For suggestions about coping with emotions that surface, click here. 

 If you have questions about:

• Paying for treatment, read Survivorship A to Z information about finances by clicking here.
• Whether health insurance covers, and how to maximize use of your insurance, click here.  
• Documents you need to execute in order to keep control over your medical care even if you become unable to communicate (which can happen to any of us regardless of our health), click here. 

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