If my cancer comes back, where will it be?

According to current statistics, 57% of colorectal cancer patients in the UK survive at least 10 years (ie are considered cured). That figure has more than doubled in the last 40 years and is getting better each year.

Success is due to better understanding of the condition, new surgical techniques, better after-care, earlier diagnosis, improved chemotherapy and so on.

However, even if – like me – your surgeon removed all of the primary tumour and it doesn’t look like it spread (hadn’t come through the colon wall, is not in your lymph nodes or blood) – or, they removed all the primary tumour and you successfully completed chemo – you still might have a nagging question: what if it comes back?

Let’s look at this issue to help you contain your fears.

If the surgeon did not get good margins during surgery, then there’s a risk that you will develop a tumour at the surgical site. Surgeons err on the side of caution and cut well beyond what looks like healthy tissue to stop this happening. If it does happen though, you will simply need more treatment.

It’s also possible that during surgery a few cancer cells got out of your colon and into your body. Again, surgeons make a lot of effort to ensure this doesn’t happen, but it’s possible. If it does happen then you run the risk of developing secondary tumours somewhere else in your body. (These cancer cells don’t necessarily develop into tumours since your immune system could mop them up and adjunct chemo should kill them.)

If colorectal cancer is in your blood, lymph system, or has already escaped into your wider body then you either have. or may develop, secondary tumours. This is what doctors call ‘metastasis’ and that is why you may be recommended to have adjunct chemo and/or further surgery.

If you need facts to feel in control – like I do – then you will want to know where will these secondary tumours develop?

Colorectal cancer is most likely to develop secondary tumours in the liver. That is by far the most common site. But, as the Hitchhiker’s Guide said: don’t panic! There’s a lot that the medical profession can do with your liver – it can be radically resectioned (lumps chopped out of it) and they can blast you with chemo to shrink or clear up secondary tumours and so on. When colorectal cancer does move to the liver it is most likely to be a lone tumour. It doesn’t mean it will appear beyond the liver.

Of those unlucky enough to get secondary tumours (ie the cancer has spread):

  • 70% get them in the liver for both colon and rectal cancer
  • 32% of those with colon cancer and 47% of those with rectal cancer get secondary tumours in the thorax
  • 21% of those with secondary tumours from colon cancer get them in the peritoneum
  • 12% of those with secondaries from rectal cancer get them in their bones.
  • rarely, secondaries from colorectal cancer develops in the brain or nervous system (5% with colon cancer, and 8% with rectal cancer).

Now please remember this does not mean that 70% of colorectal patients get liver cancer. It means that of those whose cancer has spread, most will get secondary cancers in the liver. Remember, approximately two-thirds of those with colorectal cancer are cured via surgery with or without adjunct chemo.

However, around 20% of patients already have a secondary tumour – commonly in the liver – when they are diagnosed. Others will unluckily develop a secondary tumour in the few years following surgery. This is more likely if the cancer has spread to lymph nodes (detected during the biopsy of removed lymph nodes) or blood supply (detected via a blood test to measure CEA levels). It is why your colorectal team may recommend adjunct chemo. And it’s also why you will be on a follow up surveillance programme. You cannot afford to skip your surveillance checks because these are designed to detect any spread so that it can be treated as early as possible.

What this also means is that you need to be aware of what it will feel like if you get a secondary tumour elsewhere. If your bone weary tiredness returns, then you need to mention this to your team during your next check up. If you get breathless, or you’re looking yellow, or you’re feeling nauseous or vomiting, or you have unexplained weight loss then go get it checked out.

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