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a. DISTAL RECURRENCE OR METASTASES
Liver
The commonest site of metastases of colorectal cancer is the liver. We believe
that the cancer spreads there via the blood stream once it has firstly spread to
the lymph nodes around the bowel.
Liver metastases can be treated with surgery and patients who have their liver
metastases completely excised have a 30% chance of survival. Complete excision
is not always possible but even if the metastases are too widespread there are
ways of reducing their size by “ablation” treatments.
Ablation can be done with radiofrequency, laser, cryoprobe etc. and it has been
shown that it can slow the progress of the disease and increase survival.
Lungs
Metastases in the lungs usually occur after the liver has already been affected.
Small lung metastases can be excised in the same way as the liver ones with a
chance of cure. When metastases of the lung and the liver are too extensive then
the option is chemotherapy. Unfortunately chemotherapy can only slow down the
progress of recurrent colorectal cancer but cannot offer cure.
Bones
Bone metastases are rare and they are usually treated with radiotherapy and
chemotherapy. They are usually sign of advanced disease.
Brain, peritoneal and generalised lymphatic metastases are more rare but difficult
to cure. Chemotherapy is the only option.
Even if there is no hope for long term cure, research has shown that
chemotherapy for recurrent colorectal cancer not only offers a survival benefit but
it also improves quality of life of the patient.
In cases of very advanced colorectal cancer palliative care may be the only
indicated treatment. Although it cannot provide cure it can relieve most of the
patient’s symptoms and in particular pain. Specialist palliative care teams operate
in all cancer units and their work is invaluable for the final days of those patients
who are unfortunate.
b. LOCAL RECURRENCE
Local recurrence is mainly a problem in rectal cancer and it occurs either inside
the rectum or in the pelvis. The main problem is pain or oedema (swelling) of the
legs. Surgery can sometimes be successful in removing local recurrence although
cure is rare.
Research shows that surgery in combination with chemotherapy and radiotherapy
offers a survival advantage, therefore this option should be examined in all cases
of recurrent rectal cancer.
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Treatment of recurrence of colorectal cancer