Colon cancer happens when abnormal cells grow in your colon (your large intestine) and form a tumor.

Colon cancer recurrence means your cancer has come back after a period of remission. It’s also called a relapse.

Recurrence usually happens when a few of the original cancer cells survived the initial treatment. Though a doctor or other healthcare professional can’t find these cells, they eventually grow or spread enough to be found by diagnostic tests.

Recurrence is different from another common term used in cancer: refractory. Refractory means that your cancer isn’t responding to treatment. Doctors refer to cancer that returns after a period of remission and doesn’t respond to more treatment as relapsed refractory cancer.

Recurrence might occur months or years after the your initial treatment. The recurrent colon cancer might come back to the same location in your body or show up somewhere else in your body. Even if the cancer returns to a different part of your body outside your colon, it’s still referred to as recurrent colon cancer.

Colon cancer recurrence occurs in about 30% to 40% of people who completed colon cancer treatment. Initial treatment may have included surgery and chemotherapy.

Most of these recurrences occur during the first 2 or 3 years after treatment. About 95% of recurrences happen within 4 years of surgery.

In one study of 446 people treated for colon cancer in the Netherlands, 17% of people had a colon cancer recurrence. In 58% of those people, doctors identified the recurrence during a scheduled follow-up visit. In the remaining people, doctors noticed the recurrence during a unscheduled appointment due to new symptoms, such as stomach pain, changes in bowel movements, and weight loss.

Your chances of recurrence may be higher if the cancer has already spread to your lymph nodes or other organs, such as your liver and lungs.

Your initial treatment for colon cancer may have included surgery and chemotherapy. After treatment, your medical team may have told you that your cancer is in remission. This means they can no longer find the cancer in your body.

If the cancer returns after time, you may not have any symptoms at all. A doctor might only find the cancer recurrence while running tests during a checkup appointment. This is why it’s important that you meet with a doctor regularly (about every 3 to 6 months), even if you’re in complete remission.

If you do experience symptoms of colon cancer recurrence, they’ll be the same as the common symptoms of colon cancer. Symptoms of colon cancer recurrence may include:

Second cancers after colon cancer

A second cancer is different from a cancer recurrence. A second cancer is unrelated to your first cancer. The new cancer may have started in different kinds of cells and will look different under a microscope compared with your primary colon cancer.

For example, after getting treatment for colon cancer, a doctor may discover a tumor in your stomach. If the tumor started in the cells of your stomach and they’re not colon cancer cells that have spread to your stomach, it’s a second cancer.

Having a second cancer after colon cancer is rare, but it can happen. The treatment for the second cancer would be different than your treatment plan for recurrent colon cancer.

People with colon cancer may have an increased risk of the following cancers:

  • rectal cancer
  • stomach cancer
  • oral cancer
  • cancer of the small intestine
  • anal cancer
  • uterine cancer
  • kidney cancer
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If you were treated for colon cancer and are in remission, a doctor will schedule frequent follow-up visits to make sure the cancer hasn’t recurred. Recurrent colon cancer doesn’t always cause symptoms, so it’s important to attend all follow-up appointments. If you do notice any symptoms, meet with a doctor right away.

During these appointments, a doctor will likely take a physical exam and run a few tests. These may include:

You may start to have follow-up appointments less frequently 2 years after surgery as your risk of recurrence falls.

Similar to the treatment plan for the initial diagnosis of colon cancer you receive, treatment for recurrent colon cancer might include a combination of surgery and systemic therapies, such as chemotherapy.

If your cancer recurrence is localized (in the same place as the original tumor), a doctor may suggest surgery to remove the part of your intestine with cancer.

If the cancer has spread, a doctor might recommend systemic therapy. Systemic therapies circulate throughout your body to kill cancer cells. Doctors can use multiple system therapies or can use them in combination with surgery.

Doctors may use some systemic therapies only if chemotherapy doesn’t work. Examples of systemic therapies approved for metastatic or recurrent colon cancer include:

  • bevacizumab (Avastin)
  • cetuximab (Erbitux)
  • ramucirumab (Cyramza)
  • panitumumab (Vectibix)
  • regorafenib (Stivarga)
  • encorafenib and binimetinib (Braftovi and Mektovi)

A doctor may also recommend newer drugs known as immunotherapies. These work by activating your immune system to help fight cancer cells. Examples of immunotherapies for treating colon cancer include:

There are also ongoing clinical trials for recurrent colon cancer to study new drugs or assess existing treatment combinations. Ask a doctor if you’re a good candidate for a clinical trial in your area.

If your cancer recurs, you may feel disbelief or confusion, especially if you did everything you had to do during your treatment plan. It’s important to understand that you didn’t do anything wrong. It’s not possible to completely prevent cancer recurrence.

Be sure to attend each of your follow-up appointments with a doctor. Pay close attention to any new symptoms, such as changes in your bowel movements. These actions can help a doctor diagnose a recurrence as early as possible.

Though there’s no sure way to prevent a recurrence, there are a few lifestyle and diet changes that may lower your risk:

  • Consume a few servings weekly of tree nuts, such as cashew nuts, almonds, and walnuts. Studies have linked these foods with a significantly lower risk of recurrence.
  • Increase your dietary fiber.
  • Take low doses of aspirin daily.
  • Keep up a moderate weight.
  • Eliminate heavily processed grains and limit your sugar intake.
  • Eat a healthy, balanced diet consisting of fruits, vegetables, beans, nuts, whole grains, lean protein, and healthy fats.
  • Quit smoking.

Though there has been conflicting evidence, a 2022 study found that eating red or processed meat didn’t increase the risk of disease recurrence or death from colon cancer.

Your outlook depends on various factors, such as if the cancer has spread (metastasized) to other parts of your body. A doctor may define the scope of your colon cancer recurrence as local, regional, or distant metastatic recurrence:

  • Local recurrence: This refers to colon cancer relapse at the site of your original tumor.
  • Regional recurrence: This means the cancer has spread to the lymph nodes near the site of your original tumor.
  • Distant metastatic recurrence: This means the cancer recurred and spread to other parts of your body, such as your liver, lung, ovaries, adrenal glands, bone, or brain.

The 5-year survival rates are estimated to be roughly 90% for localized recurrence, 70% for regional recurrence, and 10% for distant metastatic recurrence.

Keep in mind that these are just estimates based on previous data. Some people with recurrent colon cancer survive much longer than 5 years. Advances in treatments, including immunotherapies, will continue to improve these rates.

In general, the earlier identification of a recurrence means a better outlook for people with it. The time to cancer recurrence is also important. A shorter period before recurrence often means a more aggressive disease and a worse outlook for people with it.

People who are over the age of 70 years when they receive a diagnosis of recurrence also have a worse outlook.

In one study, people who didn’t experience any symptoms with their recurrence had a significantly higher overall survival than those who had symptoms.

While treatment of colon cancer is often successful at first, these results don’t always last. Despite being in remission, colon cancer can recur. Recurrent colon cancer typically happens within 5 years after initial treatment.

When cancer recurs, there’s a chance that it has already spread to other parts of your body. Though the outlook for people with it is poor, it’s important not to give up hope. The development of new treatments, including immunotherapies, continues to help improve the outlook for those with it.