E-mail:
Password:

Get a Colorectal cancer follow-up plan from your doctor – and keep the appointments and tests described in it. Early detection of a return makes positive treatment results more likely. (For information about follow-up plans, see the document in To Learn More). 

You have had a partial response (please make the bullet points in the rest of this section single space)

• The tumor(s) responded to treatment. The tumor is either smaller or stopped growing. The tumor is not eliminated completely.
• Speak with your doctor and other specialists to find out if there are other r treatments you should be on..
• At the least, get a cancer follow-up plan from your doctor. (For information about follow-up plans, see the document in To Learn More).

 “Your cancer is stable” or you have stable disease ”: 

• The tumor did not decrease, but is no longer growing either. 
• Speak with your doctor and other specialists to find out if there is another treatment you should be taking. Ask about cutting edge treatments that are only available through a clinical trial. At the least, get a cancer follow-up plan from your doctor. (For information about clinical trials and follow-up plans, see the documents in To Learn More). 

“Your tumor is still growing”: 

• The treatment did not stop tumor growth.
• Speak with your doctor and other specialists to find out if there is another treatment you should be taking – including cutting edge treatments available through clinical trials. At the least, get a cancer follow-up plan from your doctor. (For information about clinical trials and follow-up plans, see the documents in To Learn More). 

“The cancer has metastasized” 

During treatment, your doctor may learn that your cancer has spread beyond the initial site. Speak with your doctor and other specialists to find out if there is another treatment you should be on – including cutting edge treatments available through clinical trials. For information about clinical trials, how to find them and how to assess them, see the document in To Learn More. To be matched with a clinical trial for colorectal cancer, click here.  

Follow Up Exams and Tests

Your follow-up plan will tell you when follow-up appointments will be scheduled.

The first tests and imaging studies such as a CT scan, an MRI test or a PET scan are usually delayed for a few months after the end of treatment because the radiotherapy continues to have a cell killing effect for several months. Tests and imaging studies will then be repeated.

To learn about what to expect at follow-up visits, click here. 

Side Effects

During the first 6 months after the end of radiation treatment, the following are common continuing side effects.

• Allergies: If you had food allergies prior to treatment, they may become better or worse. If you didn’t have food allergies, some may appear. 
• Blood counts: Both white and red blood cells may remain low or below normal for months or years.
• Bowel cramping and intestinal blockages recede or diminish for most people. For some people this symptom continues for a long period of time. For some people, it is permanent.
• Diarrhea: Persistent diarrhea after surgery is common. If you had the entire colon removed, there is no cure for diarrhea but changes in diet may lessen the frequency or looseness of your stool. For everyone else, click here to learn how to cope with diarrhea. 
• Eyes:  
  • Dry or watery eyes may continue for months.
  • If you previously had herpes or shingles (varicella zoster) you may have a reactivation which can result in a permanent change in eyesight. Call your doctor right away if you experience eye pain or impaired vision with a rash on your face or scalp. Antiviral drugs can help.
• Fatigue: May continue for years after treatment.
  • Fatigue generally continues for at least as long as the time between diagnosis and end of treatment.
  • There are tips for coping with fatigue (See the document in "To Learn More.") 
• Fertility: May improve over months or years following treatment, or it may never recover.
• Hair: The hair on your head will not be affected by radiation for colorectal cancer. However, with radiation treatment to the pelvis, there may be a thinning out of the hair on your lower abdomen or pubic area or you may lose hair entirely. If you do lose hair, it will generally not grow back. If it does, it may be a different color or texture.
• Incontinence: is not usually a major side effect of external radiation. Incontinence is treated by wearing a pad or a diaper. If incontinence continues or becomes unbearable, there are medical steps to take. If this occurs, speak with your doctor. For practical ways to deal with incontinence, click here.
• Neuropathy (pain, burning, weakness or numbness in the hands or feet): may continue for weeks or months. If you had platinum based therapy (for example, oxaliplatin) neuropathy may be permanent in some people.
• Rectal soreness or bleeding:
  • It is not unusual to have rectal bleeding for a while after radiation treatment due to the ulceration of the rectal wall where the radiation dosage is concentrated. Rectal bleeding can usually be treated with enemas containing steroids or by laser.
  • There may be rectal soreness.  A diet which is low in fibrous foods often will help to allow healing. Symptoms may be lessened with steroid enemas or suppositories.
• Urinating difficulty may be a short term effect of radiation treatment.

Men

• Erectile function: If you experience erectile dysfunction during treatment, it may continue. Erectile dysfunction can go on for 2 – 5 years. For a small percentage of men, it may become permanent. To learn more about erectile dysfunction and what can be done about it temporarily or permanently, click here.  
• Orgasms:  After radiation therapy, there may be a change in the sensation Of the ejaculate.
  • The ejaculation is often described as different than that was encountered prior to the treatment.
  • There will be ejaculation of seminal fluid.  However, there will be a permanent decrease in semen volume.

Contact your cancer doctor if:

• You experience any of the above conditions and the tips provided in related documents don’t help.
• If any of the conditions are so severe that they interfere with your daily living.
• Unexpected symptoms appear. Also let your primary care doctor know about these symptoms in case they do not relate to colorectal cancer.

You experience any of the symptoms listed in the section: “If These Symptoms Appear, Contact Your Doctor” 

For possible long term effects of radiation treatment, see: Colorectal Cancer: Post Treatment 6 Months Plus 

Recovery

Immediately after surgery there will be a period during which the incision and internal organs heal. The length of time the healing process takes depends on the surgery that was performed, the condition of your body and your health history. If there is evidence of infection, or if you are undergoing additional cancer treatments such as chemotherapy, there may be a delay in the healing of the incision and  It may take longer for you to recover

Your surgeon should be able to give you a ballpark estimate of how long your recovery period will be. Most people can return to full activities after 10-14 days if the surgery is laproscopic and 4-6 weeks with a traditional incision or open surgery.

It is generally recommended that you do not drive while you are recovering from abdominal surgery.

Your doctor will advise you when you can resume work, and exercise. If you have an ostomy you should be able to resume normal activities as tolerated. .

Follow Up Exams and Tests

Your follow-up plan will tell you when follow-up appointments will be scheduled. To learn about what to expect at follow-up visits, click here. (Link to the new section above: Follow up visits and tests for colon and rectal cancer)

After surgery, the first tests and imaging studies such as a CT scan, an MRI test or a PET scan will vary depending on the stage of your cancer and your treatment plan. 

Additional Treatments

If the cancer has spread beyond the colon or rectum, radiation and/or chemotherapy may be recommended.

• Ask your doctor how long you can reasonably wait to make a decision about additional treatment.
• Use the time to get a second opinion and to be sure you make the best choice of a specialist to provide the treatment before proceeding. Second opinions are generally covered by health insurance. (To learn more about a second opinion, click here). 

If there was no spread outside the colon, consider consulting with a medical oncologist and a radiation oncologist to find out if they would recommend additional treatment based on the results of your surgery and any additional diagnostic tests you may have had.. This is known as a second opinion. Second opinions are generally covered by health insurance. (To learn more about a second opinion, click here).

Side Effects

Following is a list of side effects that are not uncommon in the first 6 months following surgery. Contact your doctor immediately if something unexpected occurs or if a side effect unduly affects your life.

• Abdominal pain and cramping. Abdominal or pelvic supportive tissues can be stretched, constricted or weakened.
• Bowel movements can be difficult or painful .
• Damage to nerves can cause pain or bowel, sexual and urinary dysfunction.
• Diarrhea: Persistent diarrhea after surgery is common. If you had the entire colon removed, there is no cure for diarrhea but changes in diet may lessen the frequency or looseness of your stool. For everyone else, click here to learn how to cope with diarrhea.
• Erectile dysfunction. If you had nerve-sparing surgery, it may take 6 to 12 months or even 24 months before you will be able to achieve an erection. However, sexual activity can usually be resumed within 6 weeks following surgery. (There are techniques to give you an erection. Click here). Keep in mind that intercourse is not the only way to achieve intimacy. Click here for information. 
• Fistulae: A fistulae is an abnormal connection which can form between two organs during healing following surgery. This condition can be corrected by surgery. Contact your surgeon if you notice urine leakage from the vagina or rectum or feces or fecal odor in the vagina or in urine.
• Fluid retention: The build-up of fluid in the legs and elsewhere in the body may signal lymphedema  - swelling of a body part due to lymphatic fluid that cannot move. Less commonly, a build-up of fluid could also signal heart, liver or kidney failure. The build-up of fluid in the abdomen or chest may signal a recurrence of disease. If your doctor gave you instructions to follow for reducing the possibility of lymphedema, follow those instructions for the period indicated. To learn about lymphedema, click here.
• Hernia: A hernia is a bulging of tissue beneath a section of skin on the abdomen or near an incision. A hernia can become life threatening if a segment of bowel ruptures. If you feel or see a bulge, contact your surgeon without delay. Hernias can be fixed.
• Fecal Incontinence 
  • Fecal incontinence may occur after a colectomy. It generally lessens as you heal – gradually improving for up to 6 to 12 months after surgery. 
  • Incontinence after other surgeries should resolve soon after surgery. Incontinence is treated by wearing a pad or a diaper or other device.
• Urinary incontinence may occur after colon or rectal surgery but it should improve as you heal.  If incontinence becomes permanent, there are surgical techniques to consider. To learn about exercises you can do to help,  click here and here.
• Kidney or Liver Damage: 
  • Kidney or liver damage may occur from some surgeries.
  • Symptoms which may indicate kidney or liver damage include changes in urination, fever, nausea or your skin or eyes seem jaundiced (yellow or suntanned.) 
  • Kidney or liver damage is treatable.

For possible long term effects of surgery , see: Colorectal Cancer: Post Treatment 6 Months Plus 

You probably feel worse at the end of treatment than you did when you were first diagnosed.

You have either gained or lost weight. 

It is likely to take longer than expected to return to feeling normal - and much longer than you wish. However, most side effects resulting from chemotherapy do not do any lasting harm and will gradually go away after you finish treatment.

Follow Up Exams and Tests

Your follow-up plan will tell you when follow-up appointments will be scheduled. To learn about what to expect at follow-up visits, click here. (Link to the new section above: Follow up visits and tests for colon and rectal cancer)

The first tests and imaging studies such as a CT scan, an MRI test or a PET scan. respectively. Tests and imaging studies will be performed 1-3 months after treatment ends depending on your particular situation.

Side Effects

Following is a list of symptoms in alphabetical order that may continue or appear within the first six months after the end of chemotherapy treatment:

• Aches and pains such as muscle stiffness and joint pain are not unusual. They decline over time.
• Allergies: If you had food allergies, they may become better or worse 
• Blood counts: Red and white blood cell counts may remain low or below normal for months. (As long as your cell counts are low, take extra precautions to avoid infections. Learn how by clicking here.) 
• Bowel cramping recede or diminish for most people. For some it persists for a long period of time. For some people, it is permanent.
• “Chemo brain” (a general fuzziness in thinking and recall) may begin during treatment and persist after treatment has ended or it may occur after treatment ends. Chemo brain will likely go away, although for some people it is permanent. For information about how to reduce the effect of chemo brain, click here..
• Diarrhea: Persistent diarrhea after chemotherapy is common. If you had the entire colon removed, there is no cure for diarrhea but changes in diet may lessen the frequency or looseness of your stool. Click here to learn how to cope with diarrhea. 
• Fatigue is likely to continue for at least as long as the time between diagnosis and end of treatment. It may continue for years. There are tips for coping with fatigue, click here. If fatigue becomes overwhelming, speak with your doctor or an oncology nurse knowledgeable about cancer fatigue.
  • Fertility: may improve over months or years following treatment, or it may never recover.
  • Neuropathy (pain, burning, weakness or numbness in the hands or feet) may continue for weeks or months. If you had platinum based therapy (for example oxaliplatin), neuropathy may continue for years.
  • Hair: When hair regrows, it may look different. The color or texture may be changed. It may be thicker or thinner, curlier or straighter than before treatment. Eventually it is likely to return to normal.

If you received Fluorouracil (5-FU):, Watch for:

• Symptoms of heart disease. Signs of heart difficulty show up differently in men and women. Watch for chest pain or tightness, swollen arms or legs, numbness in your hands or arms, difficulty breathing, dizziness or unusual heart rhythms.
• Numbness, tingling or pain in the hands or feet which may continue for months following end of treatment. The only current treatment for this symptom is pain medication. To learn about pain control, click here. 

If you received platinum based drugs such as oxaliplatin, watch for :

• Numbness, tingling or pain in the hands or feet which may continue for months following end of treatment. The only current treatment for this symptom is pain medication. To learn about pain control, click here. 

If you received treatment for infections with aminoglycoside, antibiotics gentamycin, tobramycin, amikacin , or with vancomycin: there can be temporary or permanent hearing loss, vertigo, dizziness or ringing in the ears. These symptoms are treatable. Let your doctor know if you experience any of them.

It takes a while to get used to having an ostomy. 

As soon as your body heals, you can resume every thing you enjoyed doing before the surgery – including exercise, sitting in a hot tub, and sexual activity.

 Presumably, before you left the hospital you learned how to care for the stoma, the skin around the stoma, an ostomy pouch, and the health of your altered digestive tract. If you didn’t learn this information from an oncologist or a specially trained enterostomal therapist (ET) nurse, consider contacting an ET nurse. They know all the latest techniques and resources. To find an ET nurse in your area, go to www.wocn.org , click on “Patient Information”, then click on “Find A Nurse In Your Area”. 

Experience indicates that it is helpful to talk with other people with ostomies (ostamates) about their experiences. Ostomates can also give you tips you may not have learned from the ET. For example, most people find it easiest to clean the stoma and surrounding skin when the digestive tract is least active. For many people, this in the morning before breakfast.  You can find other ostomates through: 

• The Colon Cancer Alliance Buddy Program. Call 877.422.2030 or click here .
• The “visitor” program of the United Ostomy Associations of America  which can put you in touch with local support groups. It also has a magazine, The Phoenix, which covers practical aspects of living with an ostomy. www.Ostomy.org or call 800.826.0826
• A local or online support group for colorectal cancer ostomates
• Your oncologist
• A social worker at your treatment center 

An ostomy is likely to make you feel isolated from people who do not have one and to bring up a variety of emotions. Make sure that emotions don’t keep you from taking proper care of yourself or your ostomy. Start by reading our information about emotions and dealing with them. Click here when you are ready. 

Information you should know includes how to take care of the stoma, the skin around the stoma, how to choose, empty and clean appliances that attach to the stoma,  the health of your altered digestive tract, and the effect of various foods on your digestive system. For practical information,see the sections of our document: Colorectal Cancer; Ostomy 

If you completed treatment and there are still signs of colorectal cancer, don’t give up.

The higher the number of the stage at diagnosis, the more likely you will need more than one treatment to get rid of cancer.

If you underwent chemotherapy, there may be other drugs available and other combinations of drugs. You can also try cutting edge treatments available through Clinical Trials. To learn about clinical trials, click here. 

If the cancer cannot be eliminated completely, you can still live for years – enough time for another treatment to come along from the world’s constantly improving medical system. To learn more about what is commonly referred to as advanced cancer, click here. 

Even if you had a second opinion before, this is a good time to get a second opinion from the best. (Most health insurance pays for second and even third and fourth opinions).

• Consider getting an opinion from a NCI certified comprehensive cancer center. NCI centers use a multi-disciplinary approach in which a team of doctors with different backgrounds review your case. If travel is difficult, you may be able to send copies of your medical records. Since pathology reports may contain errors, you will need slides of your cancer which are easy to obtain. To locate a NCI comprehensive cancer center, click here . 
• Free transportation may be available. Click here.
• The hospital or the American Cancer Society may have free lodging available. To contact the American Cancer Society, call 800.ACS.2345

Do your best to lead a cancer prevention lifestyle including eating well, exercising and getting appropriate rest. For more information about a cancer prevention lifestyle, click here. Also take the other steps described in the summary of this document to maximize your body’s fighting ability.

If you have tried several types of treatment and the cancer has not been cured

This is likely to be the most difficult time in your battle with cancer.

It is time to weigh the possible benefits of another treatment against the downsides.

Whether it is time to shift the focus to care which is more concerned with your quality of life than curing the cancer is up to you. Some people insist on a treatment even if there is only something like a 1 in 100 chance that it will work. . To learn more about it, click here. 

No matter what you decide: never, never give up hope. Even if the hope if no longer about a cure, there is the hope of being with the people you love and whatever immediate goals you have.

NOTE: If your doctor gives you a short life expectancy, keep in mind that unless you are in the last week or so of life, it is only an estimate based on statistics. Statistics are about what happens to large numbers of people based on what has happened – not what will happen with current and new medical technology – much less what will happen to any particular individual.  To learn more about statistics, click here.