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Colon Cancer: What Happens After Treatment?

June 08, 2020

Dr. Brian Byrne
Medical Oncologist
Hartford HealthCare Cancer Institute

There are two big events in June that always remind me of why I chose to become an oncologist.

The first is the annual ASCO (American Society of Clinical Oncology) meeting that usually takes place in Chicago, but this year was on my back porch (meeting occuring virtually). This is where the latest clinical trials are presented that hopefully demonstrate improvements in cancer care around the world. This acknowledges the science behind the disease.

The second event, National Cancer Survivors Day, celebrates all patients diagnosed with cancer. This takes place on the first Sunday in June and reminds us all that there is life after cancer.  It recognizes cancer survivors as having life goals and wanting some “normalcy” in their lives.

As an oncologist, one of the diseases I frequently see is colon cancer. Colorectal cancer is one of the most common cancers in the United States, with over 150,000 people diagnosed a year. It is slightly more common in men than women. The rate of diagnosis is increasing in people younger than 45. Although the death rate from colon cancer continues to decline, it is still the second-most common cause of cancer death in the U.S.

Treatment for colorectal cancer varies depending on the stage of the cancer. For early stage cancers, the backbone of treatment remains surgery. This can be combined with chemotherapy to help increase the cure rate. For some patients, a shorter course of chemotherapy with three months instead of the traditional six months may be appropriate to lessen long-term side effects.  This is based on newer clinical trial data.

In rectal cancer, treatment often involves a combination of chemotherapy, radiation and surgery. Treatment can cause long term side effects such as numbness and tingling in hands and feet (neuropathy), rectal dysfunction and/or bleeding, or the need for use of an ostomy. If one suffers from neuropathy, please discuss with your physician. There are treatment options that may be appropriate to help with these symptoms. There are ongoing studies looking at preventing neuropathy.

Once the active treatment is completed your physician will recommend a plan for surveillance to detect an early recurrence and prevent a second cancer. It is recommended that all patients undergo a colonoscopy one year after diagnosis. Follow-up after this is based on the finding at the time of this colonoscopy.

For instance, if polyps are found an earlier colonoscopy may be recommended. For patients with locally advanced disease, physicians will recommend blood work with a test called a CEA (carcinoembryonic antigen) every three to six months and a CT scan once a year for five years. A CEA can help detect early recurrences that can potentially be cured with aggressive treatment.

As a cancer survivor, there are several lifestyle changes one can make to help reduce the risk of recurrence or the development of a second colon cancer. A first step is to maintain a healthy weight. There is data that shows being overweight or obese can lead to an increased risk of recurrence or death from colon cancer. But there are many benefits to maintaining a healthy weight, such as reducing risk of heart disease, diabetes, and secondary cancers.

Physical activity level can be associated with improvement in colon cancer outcomes, including lower risk of recurrence and dying from colon cancer. Exercise is also an important part during the active treatment phase in reducing fatigue and improving quality of life. The American Cancer society recommends 150 minutes of physical activity weekly with exercise five days per week or more.  Before starting any exercise program, please consult with your physician to make sure it is safe for you.

Another step is eating a healthy diet. The traditional food pyramid we learned about in school was changed to the food plate in 2010.  Half the plate should be made of fruit and vegetables with slightly more vegetables. The other half of the plate should be grains and protein. Grains should take up more than the protein. Protein should be rotated between fish, pork, chicken and beef. Proteins can also include beans, peas, nuts, and seeds.

Dairy is also recommended as part of a healthy diet. Colon cancer risk may be linked to the consumption of red or processed meat.  For that reason many experts feel intake of these protein sources should be de-emphasized in favor of leaner sources such as fish, chicken or legumes.

Stopping smoking and decreasing alcohol intake is another lifestyle change that should be made, if needed. Alcohol intake is associated with many cancers. The current recommendation by the American Cancer Society is for men to drink no more than 2 alcoholic beverages a day. For women, the recommendation is one. Smoking is associated with an increased risk of dying from colon cancer.

There are many health benefits from quitting such as lower chance of heart disease and improved breathing. This should be a part of any survivorship plan. Resources are available to help with quitting.

There is no current data that supplements decrease the risk of recurrence of colon cancer. Some studies show having a higher level of vitamin D leads to improved outcomes. But it is not clear if taking vitamin D improves outcomes.

Our oncology team is committed to help support you and your family after your therapy, hopefully for many years to come.

Dr. Brian Byrne is a Medical Oncologist with the Hartford HealthCare Cancer Institute. For more information about cancer treatment click here.

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