If, like me, you got to one year clear of colon cancer you’re probably just starting to breathe again. For a long time you’ve been holding your breath. Firstly, there’s the shock of what’s happened to you to deal with, then there’s the need to heal, and finally there’s that lurking feeling – but what if it comes back?
The good, and bad, thing about colon cancer is that it doesn’t stop growing, switch off or go dormant. That means if it’s spread, or if some has been missed, then it’s going to come back fairly quickly. The first two years are the risky period – 80% of recurrence occurs during this period with the first year being the most risky. After two years the risk profile drops significantly. But let’s explore what’s known about recurrence so that you can get that anxiety under control.
There are four main risks after surgery:
- the surgery didn’t/couldn’t remove all the tumour
- the tumour had already spread to remote parts of the body (possibly as ‘micro-metastases’ which are too small to see or spot)
- some cancer cells escaped into the body during surgery
- the surgeon didn’t get sufficient margins and the tumour is growing back at the incision site.
There’s also an increased risk of you getting an entirely new incidence of colon cancer once you’ve had it once. If you’ve been found to have the genetic form of the condition, for example, then your risk is elevated. But, in any case, you should be having regular colonoscopies, CT scans and blood tests, which are aimed at nipping any problems in the bud before polyps can grow into tumours.
The harsh truth is that some colon cancer patients will suffer a recurrence. Up to 80% of recurrence is within two years and 90% is within four. Early recurrence (within 2 years) is associated with a poorer outcome though.
A Korean study, for example, looked at 1,216 patients with colorectal cancer (628 with colon cancer and 588 with rectal cancer). 18.3% of patients suffered recurrent cancer during the surveillance period. Of those that suffered recurrence, 18% had local recurrence, and 78% had distant metastases. Of those with mets, 34% were in the liver, 25% in the lungs, 10% in the peritoneum and 12% in other organs.
The five year survival for those with early recurrence was 35% and for late recurrence 79%. Early recurrence is defined as recurrence within 2 years of surgery.
Your doctor should have informed you whether you were in the high or low risk group for recurrence. If your cancer had spread to your lymph nodes, blood or through your colon wall then the risk is higher that it will recur than if it was contained within the colon with no lymph node involvement. Higher risk patients usually have chemo; whereas some lower risk patients may not have had chemo.
The good news is that only 0.01% of patients get recurrent colon cancer after 5 years. Thus if you make it to 5 years cancer free you would be extremely unlucky to get it again. That doesn’t mean there’s not risk, but the risk is minimal. Compare a risk of 0.01% with that of the average lifetime risk of colon cancer of 4.5%.
So how should you feel 1 year cancer free?
Don’t count your chickens before they’re hatched, but also recognise that there are things to celebrate.
- You just outlived your likely prognosis! Every day you get now is a wonderful gift.
- Your risk profile goes down a massive 50%.
- You are on track for a cure.
Well done to you – you’re officially CRC+1. Best wishes that all stays well. But, most importantly, enjoy each day because (with or without cancer) it’s easy to take them for granted.