When cancer comes back after treatment

Bowel cancer that comes back after treatment is called recurrent bowel cancer. The cancer can come back in the bowel close to the original site (local recurrence) or in another part of the body (advanced or secondary cancer). Areas of secondary cancer are also called metastases (metastatic disease).

This page tells you why bowel cancer can come back, what signs to look out for, how recurrent cancer is diagnosed and how it's treated. There's also information on coping with recurrent bowel cancer.

Speak to your healthcare team if you're worried about your cancer coming back or if you have any questions about your treatment and care.

Why can cancer come back?

Doctors make every effort to remove or destroy all cancer cells with treatment such as surgery, radiotherapy or chemotherapy. But sometimes some microscopic cancer cells may have spread to other parts of the body before treatment or may have been left behind at the original site.

The stage of your cancer and the treatment you've had will affect the chance of the cancer coming back. People who've survived bowel cancer are at a higher risk of getting bowel cancer again. If the cancer does come back, it'll most likely be within three to five years of diagnosis.

People who've survived bowel cancer have a higher risk of getting a separate new bowel cancer, compared to the general population. This may be because they still have some of the risk factors of bowel cancer.

Wanting to know what has caused your cancer to come back is a natural response to being diagnosed with recurrent bowel cancer. You may be worried that you've done something to cause this to happen, but this is unlikely. We don't yet know how to stop cancer coming back. There's some evidence that eating a healthy diet, doing regular exercise and keeping to a healthy weight may help to reduce your risk of cancer coming back after treatment, but we need more research before we can say this for sure. Speak to your healthcare team before changing your diet or starting any new type of exercise.

Diagnosing recurrent bowel cancer

When you finish treatment, your healthcare team will tell you how you will be followed up. Your follow-up aims to pick up:

• non-cancerous growths (polyps) in the bowel that may develop into a new cancer
• cancer that has come back in the bowel or another part of the body

If your healthcare team think your cancer may have come back, they'll do more tests to find out where it is. These tests may include scans, blood tests and a colonoscopy when small samples of bowel tissue (biopsies) can be taken for testing. You can read about colonoscopy on our hospital tests page.

Speak to your healthcare team straight away if you have any new symptoms that you're worried about. Don't wait for your next follow-up appointment.

Treatment for recurrent bowel cancer

Your healthcare team will speak to you about your treatment options and help you decide which treatment would be best for you. Your doctor will look at:

• the type and size of your cancer and where in the body it has come back
• your overall health
• what treatment you've already had and how well it worked
• which side effects you had from your original treatment
• the symptoms you have now
• how long ago you finished treatment
  
  

When you're choosing a treatment, you and your doctor will need to think about:

• the benefits of each treatment
• possible risks and side effects
• how each treatment could affect your quality of life
• whether treatment can be offered locally or if you might need to travel

Speak to your doctor about what they hope you'll gain from the treatment, for example curing the cancer or controlling symptoms.

If there's a chance of curing the cancer, your doctor may offer you surgery, radiotherapy, chemotherapy or a combination of treatments. If the cancer can't be cured, you may have treatment for advanced bowel cancer.

Treating symptoms

You may have treatment to keep any symptoms under control. This treatment is called palliative care, supportive care or symptoms management. You may have palliative care on its own or with treatment for advanced bowel cancer.

Tell your healthcare team about any symptoms you're having, including any new or changing symptoms.

Treatments to control symptoms include surgery, radiotherapy, chemotherapy and biological therapies.

As well as having treatment to keep the cancer or symptoms under control, you may like to think about taking part in a clinical trial.

Living with recurrent bowel cancer

A new or recurrent cancer can be difficult to cope with when you have already been through treatment for cancer. You may have thought that the cancer had gone and your life may have started to get back to normal. You may have some of the same feelings you had when you were first diagnosed with bowel cancer. Your emotions may feel even stronger this time.

If you're having trouble coping, speak to your healthcare team. They may be able to refer you to a counsellor or psychologist. Family and friends can also be a great support. Some people like to speak to others in the same situation through online forums or local support groups. Visit our online community to talk about your experiences, share knowledge and get support from other people.

You can also get advice and support with work, money and childcare.

More information

• British Association for Counselling and Psychotherapy
  For information about counselling and psychotherapy and details of local therapists.
• Macmillan Cancer Support
  Provides information on why cancers come back. They also have an online community and have details of local support groups.

 

Updated August 2023