Research ArticleOriginal Research

Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study

Laura A. M. Duineveld, Kristel M. van Asselt, Willem A. Bemelman, Anke B. Smits, Pieter J. Tanis, Henk C. P. M. van Weert and Jan Wind
The Annals of Family Medicine May 2016, 14 (3) 215-220; DOI: https://doi.org/10.1370/afm.1919

Article Figures & Data

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.

Tables

  • Table 1

    Reasons for Exclusion (n = 303)

    ReasonNo. (%)
    Stage IV disease146 (48.2)
    No participation in follow-up programa78 (25.7)
    Hereditary colon carcinoma32 (10.6)
    Death within 30 days postoperatively25 (8.3)
    Carcinoma in patients with inflammatory bowel disease17 (5.6)
    Other treatment regimenb5 (1.7)

    • ↵a No reason given (n = 31), because of age (n = 22), return to hospitals close to patients’ residences (n = 10), comorbidity (n = 5), lived in nursing home (n = 4), patients’ request for no participation in follow-up program (n = 4), and stage IV disease of another primary tumor (n = 2).

    • ↵b Treatment with hyperthermic intraperitoneal chemotherapy, because of high risk of recurrences in patients without metastasis at diagnosis.

  • Table 2

    Characteristics of Patients With Symptomatic vs Asymptomatic Recurrences

    CharacteristicsAll Patients With Recurrences n = 74Patients With Symptomatic Recurrences n = 28Patients With Asymptomatic Recurrences n = 46P Value
    Age, median (range), y69 (43–88)68 (46–88)70 (43–86).48
    Tumor stage at diagnosis, No. (%)
     Stage I5 (6.8)1 (3.6)4 (8.7).64
     Stage II27 (36.5)11 (39.3)16 (34.8).70
     Stage III42 (56.8)16 (57.1)26 (56.5).96
    Primary tumor location, No. (%)
     Right colon, including hepatic flexure29 (39.2)14 (50)15 (32.6).14
     Transverse colon3 (4.1)1 (3.6)2 (4.3)>.99
     Left colon, including splenic flexure and rectosigmoid colon42 (56.8)13 (46.4)29 (63).16
     More than 1 location4 (5.4)2 (7.1)2 (4.3).63
    Time to recurrence detection, median (range), mo13.7 (2–48)13.7 (4–46)13.7 (2–48).58
    Type of visit where recurrence was detected, No. (%)
     Scheduled follow-up43 (58.1)2 (7.1)41 (89.1)<.001
     Interval visit31 (41.9)26 (92.9)5 (10.9)<.001
    Recurrence location, No. (%)
     Liver29 (39.1)7 (25)22 (47.8).05
     Peritoneum19 (25.7)9 (32.1)10 (21.7).12
     Lung18 (24.3)8 (28.6)9 (19.6).22
     Local19 (25.7)7 (25)12 (26.1).65
     Second primary (metachronous) colorectal tumor9 (12.2)2 (7.1)7 (15.2).30
     Anastomosis10 (13.5)5 (17.9)5 (10.9).39
     Lymph nodes17 (23)12 (42.9)5 (10.9).002
     More than 1 location26 (35.1)16 (57.1)10 (21.7).002

    • Note: Percentages are calculated within the group of recurrences; eg, total, symptomatic, or asymptomatic (n = 74, n = 28 and n = 46 respectively).

  • Table 3

    Abnormal Diagnostic Test Results in Patients With Recurrent Disease During Scheduled Follow-Up Visits (n = 43)

    TestNo. (%)
    CEA tumor marker19 (44.2)
    Abdominal ultrasound17 (39.5)
    Colonoscopy7 (16.3)
    Chest x-ray5 (11.6)
    CT scan3 (7)
    More than 1 modalitya7 (16)

    • CEA = carcinoembryonic antigen; CT = computed tomography.

    • ↵a Combinations included CEA testing with abdominal ultrasound (n = 5), CEA testing with chest x-ray and abdominal ultrasound (n = 1), and CEA testing with CT scan (n = 1).

  • Table 4

    Symptoms Reported During Interval Visits Leading to Detection of Recurrent Disease (n = 26)

    SymptomNo. (%)
    Abdominal pain15 (57.7)
    Altered defecation11 (42.3)
    Weight loss6 (23.1)
    Pain in back or pelvis4 (15.4)
    Fatigue2 (7.7)
    Dyspnea2 (7.7)
    Loss of appetite2 (7.7)
    Othera3 (11.6)
    >1 symptom14 (53.8)

    • ↵a Other complaints were urine retention, hematuria, or cough.

Additional Files

  • The Article in Brief

    Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study

    Laura A. Duineveld , and colleagues

    Background This study evaluates how recurrent colon cancer presents and is diagnosed during the first five post-operative years.

    What This Study Found Among 446 patients treated for colon cancer with curative intent, 74 patients (17 percent) developed recurrent disease. Fifty-eight percent of recurrences were detected during scheduled follow-up visits with 95 percent of patients asymptomatic at the time of detection; forty-two percent of recurrences were found during non-scheduled interval visits, with 84 percent of patients presenting with well-known symptoms (abdominal pain, altered defecation, and weight loss). Patients with asymptomatic recurrences had a significantly higher overall survival rate compared with patients with symptomatic recurrences, which were more often multisite recurrences. Tumor marker testing, imaging and colonoscopy identified all of the recurrences.

    Implications

    • The authors conclude that primary care physicians who take care of colon cancer patients should be aware of the relatively high rate of symptomatic recurrences and typical presenting symptoms.
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