Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.

It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. Even with no recurrences, people who have had cancer learn to live with uncertainty.

Follow-up care

During and after your treatment, it is very important to keep all follow-up appointments. In these visits, your doctors will ask about symptoms, do physical exams, and may order blood tests or imaging tests such as CT scans.

Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is a good time for you to ask your health care team any questions you need answered and to discuss any concerns you might have. Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. Be sure to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.

To some extent, the frequency of follow up visits and tests will depend on the stage of your cancer and the likelihood of recurrence.

Medical history and physical exam

Your doctor will likely recommend getting a history and physical exam every 3 to 6 months for the first 2 years after treatment, then every 6 months or so for the next few years. People who were treated for early stage cancers may need less frequent exams.

Colonoscopy

In most cases, your doctor will recommend a colonoscopy within a year after surgery. If this is normal, it should be repeated in 3 years. If that exam is normal, then future exams should be done about every 5 years.

Imaging tests

Whether or not your doctor recommends imaging tests will depend on the stage of your disease and other factors. CT scans may be done regularly, such as once a year, for those at higher risk of recurrence, especially in the first 3 years after treatment. Testing may be even more frequent in people who had tumors in the liver or lungs removed.

Blood tests for tumor markers

Carcinoembryonic antigen (CEA) and CA 19-9 are substances found in the blood of some people with colorectal cancer. Tests for one or both of these substances are sometimes useful if you have any symptoms that suggest the cancer may have come back. Many doctors order these tests every 3 to 6 months to detect recurrences before you have symptoms. Usually these are most important in the first 2 years after treatment, when recurrences are most likely to occur. If tumor marker levels start to rise, colonoscopy or imaging tests may be done to try to locate a recurrence.

If the cancer does recur at some point, further treatment will depend on where the cancer is located, what treatments you've had before, and your health. For more information on how recurrent cancer is treated, see the sections Treatment by stage of colon cancer and Treatment by stage of rectal cancer.  For more general information on dealing with a recurrence, you may also want to see our document, When Your Cancer Comes Back: Cancer Recurrence.

For patients with a colostomy

If you have a colostomy, you may feel worried or isolated from normal activities. Whether your colostomy is temporary or permanent, an enterostomal therapist (a health care professional trained to help people with their colostomies) can teach you about the care of your colostomy. You can ask the American Cancer Society about programs offering information and support in your area. For more information, see our document, Colostomy: A Guide.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. Your original doctor may have moved or retired, or you may have moved or changed doctors for some reason. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:

• A copy of your pathology report(s) from any biopsies or surgeries
• If you had surgery, a copy of your operative report(s)
• If you were hospitalized, a copy of the discharge summary that doctors must prepare when patients are sent home
• If you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
• If you had chemotherapy or targeted therapies, a list of your drugs, drug doses, and when you took them

It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment.

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