What happens after treatment for colorectal cancer?
For some people with colorectal cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives. Our document Living With Uncertainty: The Fear of Cancer Recurrence gives more detailed information on this.
For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. Our document When Cancer Doesn't Go Away, talks more about this.
Even if your treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have. To some extent, the frequency of follow up visits and tests will depend on the stage of your cancer and the chance of it coming back.
It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think about their cancer coming back, this could happen.
Should your cancer come back, our document When Your Cancer Comes Back: Cancer Recurrence can give you information on how to manage and cope with this phase of your treatment.
Medical history and physical exam
Your doctor will probably recommend a physical exam every 3 to 6 months for the first 2 years after treatment, then every 6 months or so for the next few years. People who were treated for early-stage cancers may need less frequent exams.
In most cases, your doctor will recommend a colonoscopy within a year after surgery. If the results are normal, most patients don’t need another one for 3 years. If the results of that exam are normal, then future exams often can be about every 5 years.
Whether or not your doctor recommends imaging tests will depend on the stage of your disease and other factors. CT scans may be done regularly, such as once a year, for those at higher risk of recurrence, especially in the first 3 years after treatment. People who had tumors in the liver or lungs removed might be tested even more frequently.
Blood tests for tumor markers
Carcinoembryonic antigen (CEA) and CA 19-9 are substances called tumor markers that can be found in the blood of some people with colorectal cancer. Doctors often check levels of these markers before treatment begins. If they are elevated at first and then go down to normal after surgery, they can be checked again when you come in for follow-up. If the tumor marker level goes up again, it can be a sign that the cancer has come back, and colonoscopy or imaging tests may be done to try to locate the site of recurrence. Tumor markers tend to be most useful in the first 2 years after treatment, when recurrences are most likely to occur. If tumor marker levels weren’t elevated when the cancer was found, they aren’t helpful as a sign of the cancer coming back.
If the cancer does recur at some point, further treatment will depend on where the cancer is located, what treatments you've had before, and your health. For more information on how recurrent cancer is treated, see the sections "Treatment of colon cancer,by stage" and “Treatment of rectal cancer by stage.” For more general information on dealing with a recurrence, you may also want to see our document When Your Cancer Comes Back: Cancer Recurrence.
For patients with a colostomy or ileostomy
If you have a colostomy or ileostomy, you may feel worried or isolated from normal activities. Whether your stoma is temporary or permanent, an enterostomal therapist (a health care professional trained to help people with colostomies and ileostomies) can teach you how to care for it. You can ask the American Cancer Society about programs offering information and support in your area. For more information, see our documents Colostomy: A Guide and Ileostomy: A Guide.
Seeing a new doctor
At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who does not know anything about your medical history. It is important that you be able to give your new doctor the details of your diagnosis and treatment. Make sure you have this information handy:
- A copy of your pathology report(s) from any biopsies or surgeries
- If you had surgery, a copy of your operative report(s)
- If you were hospitalized, a copy of the discharge summary that doctors prepare when patients are sent home
- If you had radiation therapy, a copy of your treatment summary
- If you had chemotherapy or targeted therapies, a list of your drugs, drug doses, and when you took them
- Copies of imaging studies such as CT scans, MRI scans, or PET scans. Often these can be placed on a DVD
The doctor may want copies of this information for his records, but always keep copies for yourself.
Last Medical Review: 10/15/2014
Last Revised: 08/13/2015