Colon cancer recurrences frequently not found until symptoms cause discomfort

When colorectal cancer comes back after initial surgical intervention, chances are it won’t be detected until troubling symptoms prompt the patient to make an unscheduled interval visit.

That’s the conclusion researchers in the Netherlands came to after retrospectively analyzing the cases of 74 patients there who underwent curative surgery only to have their cancer recur over a six-year period ending in December 2012.

In 43 of the 74 patients (58 percent), the recurrent disease was detected during a scheduled follow-up visit. Most of these (95 percent; n = 41) presented no symptoms.

However, in some 42 percent of the cases (n = 31), the recurrent cancer was found during non-scheduled visits augmented by imaging, tumor marker testing and/or colonoscopy.

Most of these patients, 26 (84 percent), went in with one or more of three particular symptoms—abdominal pain, altered bowel movements and/or weight loss.

The researchers, led by Laura Duineveld, MD, of the University of Amsterdam, further found that patients with asymptomatic recurrences had significantly higher overall survival compared with patients with symptomatic recurrences.

Their study report posted online May 16 in the Annals of Family Medicine.

Duineveld et al. point to primary-care physicians as key to achieving better anticipation of colorectal cancer recurrence.

Primary-care docs taking care of patients whose colon cancer might recur “should be aware of the relatively high rate of symptomatic recurrences and of typical presenting symptoms,” they conclude.

“Considering the fact that primary care-led follow-up might be more cost-effective and that more generalist care is desired in the care of patients after their initial treatment, the role of coordinating follow-up care might be shifted toward primary-care physicians,” they add in their discussion.

“To date, little evidence on a more prominent role for [primary-care physicians] in follow-up of colon cancer patients exists; possible influences on patients’ satisfaction and quality of life should be further assessed.”