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Multicenter Study
. 2016 May;14(3):215-20.
doi: 10.1370/afm.1919.

Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study

Laura A M Duineveld  1 , Kristel M van Asselt  2 , Willem A Bemelman  3 , Anke B Smits  4 , Pieter J Tanis  3 , Henk C P M van Weert  2 , Jan Wind  2
Affiliations
Multicenter Study

Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study

Laura A M Duineveld et al. Ann Fam Med. 2016 May.

Abstract

Purpose: Follow-up after colorectal cancer treatment with curative intent aims to detect recurrences and metachronous tumors in a timely manner. The objective of this study is to assess how recurrent disease presents and is diagnosed within scheduled follow-up according to the national guideline for the Netherlands.

Methods: In a retrospective study of consecutive patients with colorectal cancer who were treated in 2 hospitals in the Netherlands, we identified patients with colon cancer who underwent surgery with curative intent between January 2007 and December 2012. Patients who developed recurrent disease were included for further analyses.

Results: From a total of 446 patients who were been treated for colon carcinoma with curative intent, 74 developed recurrent disease (17%). In 43 of those patients (58%), recurrent disease was detected during a scheduled follow-up visit, with 41 (95%) being asymptomatic. Tumor marker testing, imaging, and colonoscopy identified all of these recurrences. In the remaining 31 patients with recurrent disease (42%), recurrence was found during non-scheduled interval visits; 26 (84%) of these patients were symptomatic. The most prevalent symptoms were abdominal pain, altered defecation, and weight loss. Patients with asymptomatic recurrences had a significantly higher overall survival compared with patients with symptomatic recurrences.

Conclusions: In this cohort, 42% of the recurrences after initial curative treatment for colon cancer were found during non-scheduled interval visits, mainly based on symptoms. Primary care physicians who take care of patients whose colon cancer might recur should be aware of the relatively high rate of symptomatic recurrences and of typical presenting symptoms.

Keywords: colon cancer; follow-up; recurrent disease.

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Figures

Figure 1
Figure 1
Overall survival in patients with asymptomatic and symptomatic recurrences. RD = recurrent disease. Note: The overall survival was determined from the date of the surgical resection of the primary colon cancer in patients with asymptomatic and symptomatic recurrent disease (P = .001). Points identified as censored represent dates of last follow-up for patients lost to follow-up after detection of recurrence.
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References

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