Colorectal cancer: Treatment, Second cancer and Recurrence, Follow-up, Lowering the risk of getting a second cancer and recurrence of cancer and Survival Rates


Malignant tumors can spread to other parts of the body if left untreated. The chances of a complete cure depend enormously on how early the cancer is diagnosed and treated.

July 26, 2018

Malignant tumors can spread to other parts of the body if left untreated. The chances of a complete cure depend enormously on how early the cancer is diagnosed and treated.

Treatment of colorectal cancer:

Treatment will depend on several factors, including the size, location, and stage of the cancer, whether or not it is recurrent, and the current overall state of health of the patient. Treatment options include chemotherapy, radiotherapy, and surgery.

Surgery for colorectal cancer:

The most common treatment for colorectal cancer is surgery in which the affected malignant tumors and any nearby lymph nodes will be removed, to reduce the risk of cancer spreading. Usually the bowel is sewn back together. But sometimes the rectum is removed completely and a colostomy bag is attached for drainage. The colostomy bag collects stools. This is usually a temporary measure, but it may be permanent if it is not possible to join up the ends of the bowel.
Surgery may successfully remove the cancer if it is diagnosed in early stage. In some cases although surgery does not stop the cancer, it will ease the symptoms.

Chemotherapy:

Chemotherapy uses chemicals that interfere with the cell division process by damaging proteins or DNA in order to damage and kill cancer cells. The rapidly dividing cells, including healthy ones are targeted in these treatments. The healthy cells can usually recover from any chemically induced damage, but cancer cells cannot.
Chemotherapy for colorectal cancer is usually given after surgery if the cancer has spread to lymph nodes as the medicines travel through the whole body. This way, chemotherapy may help reduce the risk of cancer recurrence and death from cancer. Sometimes chemotherapy may be used before surgery as well to shrink the tumor. Chemotherapy before surgery is more common in rectal cancer than in colon cancer. Chemotherapy can also be given to relieve symptoms of colorectal cancer that has spread to other areas of the body in advanced stage.
Treatment occurs in cycles, so the body has time to heal between doses. Hair loss, nausea, fatigue and vomiting are the most common side effects. To reduce these side effects combination therapies are often used which involve mixing multiple types of chemotherapy or combining chemotherapy with other treatments.

Radiation therapy:

Radiation therapy damages and kills cancer cells by focusing high energy gamma rays on them. Radioactive gamma rays are emitted from metals such as radium, or from high energy x-rays. Radiotherapy can be used as a standalone treatment to shrink a tumor before an operation so that they can be removed more easily or destroy cancer cells. It can also be used alongside other cancer treatments to to relieve symptoms of colorectal cancer.
Radiation treatments are used if early stage rectal cancer has penetrated the wall of the rectum or traveled to nearby lymph nodes. This is one of the standard treatment options for the initial management of rectal cancer followed by surgery. Mild skin changes resembling sunburn or suntan, nausea, vomiting, diarrhea, fatigue, appetite and weight loss are common side effects of radiation therapy. Most side effects resolve a few weeks after completing treatment.

Targeted therapy:

This is a kind of chemotherapy that specifically targets the proteins that encourage the development of some cancers. They may have fewer side effects than other types of chemotherapy. Drugs that may be used for colorectal cancer include bevacizumab and ramucirumab.

Immunotherapy:

Immunotherapy with antibodies such as pembrolizumab (Keytruda) and nivolumab (Opdivo) can be used for some patients with advanced colon cancer. Whether a colon cancer has the chance to respond to these immunotherapies can be determined by a specific test of the tumor tissue.

Palliative care:

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used along with aggressive treatments, such as surgery, chemotherapy and radiation therapy. People with cancer may feel better and live longer when palliative care is used along with other appropriate treatments . This can be used soon after diagnosing the disease.

Ablation:

Ablation can destroy a tumor without removing it. It can be carried out using radio-frequency, ethanol, or cryosurgery which can be delivered using a probe or needle that is guided by ultrasound or CT scanning technology.

Recovery:

Malignant tumors can spread to other parts of the body if left untreated. The chances of a complete cure depend enormously on how early the cancer is diagnosed and treated.
The recovery of a patient depends on the following factors:
  • the stage when diagnosis was made
  • whether the cancer created a hole or blockage in the colon
  • overall health of a patient
The cancer may return in some cases.

Second cancer and Recurrence of Colorectal Cancer:

Along with a number of health problems, the major concern is recurrence of cancer for colorectal cancer survivors. Cancer that comes back after treatment is called a recurrence. But some cancer survivors develop a new, unrelated cancer later. This is called a second cancer.
People who have had colorectal cancer can still get the same types of cancers that other people get. In fact, they might be at higher risk for certain types of cancer.
People who have had colon cancer can get any type of second cancer, but they have an increased risk of certain cancers, including:
  • A second colon cancer in different location
  • Rectal cancer
  • Stomach cancer
  • Small intestine cancer
  • Anal cancer
  • Bile duct cancer
  • Uterine cancer
  • Kidney cancer
  • Cancer of the ureter
People who have had rectal cancer can get any type of second cancer, but they are at increased risk of certain cancers, including:
  • Colon cancer
  • Small intestine cancer
  • Anal cancer
  • Lung cancer
  • Vaginal cancer
  • Kidney cancer
The increased risk with some of these cancers may be due to similar risk factors, such as diet, obesity, and physical activity. Genetics may also be a factor. For example, people with Lynch syndrome have an increased risk of many of these cancers.

Follow-up after Colorectal Cancer Treatment:

Follow-up visits to gastroenterologist or cancer specialist (oncologist) should be regular after completing treatment for colorectal cancer. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include:
  • Colonoscopy within three months after your surgery
  • Colonoscopy one year after surgery and every three years after that.
  • Test for occult or hidden blood in your stool every year, followed by colonoscopy if the test result is positive.
An immunochemical screening tool measurement of carcinoembryonic antigen (CEA) level is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream which is referred to as a tumor marker. This is present in increased amounts in people with colon cancer. Blood CEA levels should be measured before colon cancer surgery. If the levels are elevated prior to surgery, it is appropriate to test it at intervals of two to three months for a time after surgery.Increasing levels of serum CEA may be an indication of recurrece of colon cancer and further evaluation is required.
If you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, the duration for continuing the tests is indefinite. If you develop new severe health problems that would make you unfit to undergo treatment for a recurrence of your colon cancer, then you should discontinue screening tests.

Lowering the risk of getting a second cancer and recurrence of cancer:

There are steps that you can take to lower your risk and stay as healthy as possible. A number of lifestyle measures that can be changed to reduce the risk of developing colorectal cancer. These can also prevent recurrence as well as development of a second cancer.

Regular screenings:

Those who have had colorectal cancer before, who are over 50 years of age, who have a family history of this type of cancer, or have Crohn's disease should have regular screenings.

Nutrition:

Follow a diet with plenty of fiber, fruit, vegetables, and good quality carbohydrates and a minimum of red and processed meats. Switch from saturated fats to good quality fats, such as avocado, olive oil, fish oils, and nuts.

Exercise:

Moderate, regular exercise has been shown to have a significant impact on lowering the risk of a person developing colorectal cancer.

Maintain Bodyweight:

Being overweight or obese raises the risk of many cancers, including colorectal cancer. Therefore try to maintain a healthy weight.

Dietary supplements:

Colorectal cancer survivors with higher levels of vitamin D in their blood might have better outcomes than those with lower levels. Vitamin D can be obtained from sun exposure, in certain foods, or in a vitamin pill.
Calcium supplements can lower the risk of colorectal polyps in people who have previously had polyps. Calcium and vitamin D might work together to reduce colorectal cancer risk, as vitamin D helps in absorption of calcium the body.
A diet that is high in magnesium can reduce colorectal cancer risk, especially among women.
However, no dietary supplements have been shown to clearly help lower the risk of colorectal cancer progressing or coming back. But definitely they have many health benefits. But if you are thinking about taking any type of nutritional supplement, talk to your health care team first. They can help you decide which ones you can use safely while avoiding those that could be harmful.

Limit Alcohol Consumption:

Drinking alcohol has been linked with an increased risk of getting certain type of cancer including colorectal cancer, especially in men. People who drink alcohol should limit their intake to no more than one drink a day for women and no more than two drinks a day for men. This can help lower their risk of getting colorectal cancer. But for people who have had cancer treatment, the effects of alcohol on recurrence risk are largely unknown.

Quitting smoking:

Long term smoking is linked to an increased risk of colorectal cancer, as well as many other cancers and health problems. Quitting smoking may help lower you risk of colorectal cancer and many other types of cancer, too.
Aspirin could be effective in boosting the immune system in patients suffering from breast, skin and bowel cancer. But the dose and duration of time that would be needed to reduce the risk of colon cancer is unclear. However, taking aspirin daily has some risks, including gastrointestinal bleeding and ulcers. So doctors typically don't recommend this as a prevention strategy unless you have an increased risk of colon cancer.
Other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen also have a lower risk of colorectal cancer and polyps. For some people in their 50s who have a high risk of heart disease, a low dose aspirin is found to be beneficial. In these case, the aspirin may also have the added benefit of reducing the risk of colorectal cancer. However, check with your doctor before starting any of them on a regular basis due to the serious side effects of aspirin or other NSAIDs.

Survival Rates for Colorectal Cancer, by Stage:

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. The time period is usually 5 years. It can not predict how long you will live, but may help give you a better understanding about how likely it is that your treatment will be successful. The 5 year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. However, many of these people live much longer than 5 years after diagnosis as your outlook can vary based on a number of factors specific to you.    
  • The 5 year survival rate for people with stage 1 colorectal cancer is about 88%.
  • For people with stage 2 colorectal cancer, survival rate is about 81 to 50 percent.
  • The 5 year survival rate for stage 3 colorectal cancers is about 30 to 65 percent depending upon the depth of invasion of the primary tumor and the numbers of nodes found to have been invaded by colon cancer cells.
  • Rectal cancers that have spread to other parts of the body are often harder to treat and tend to have a poorer outlook. Metastatic, or stage 4 colorectal cancers, have a 5 year survival rate of about 13%. However, there are often many treatment options available for people with this stage of cancer.