NCCN Guidelines for Patients
Colon Cancer, Version 1.2017
Metastases at recurrence
Ongoing colonoscopies are also part of follow-up
care. You may never have had a total colonoscopy
if your gut was blocked. If so, get a colonoscopy
within 3 to 6 months after treatment. If you had a
total colonoscopy before, get tested 1 year after
You’ll need a colonoscopy less often if results are
normal. The next test is advised in 3 years. If these
results are normal, get tested every 5 years.
If an advanced adenoma is found, another
colonoscopy within 1 year is advised. Advanced
adenomas include polyps with a ruffled structure
(villous), a polyp larger than the width of an AAA
battery (>1 cm), or a polyp with pre-cancerous cells
Side effect care
You may still have some side effects when follow-up
care is started. Ask your cancer doctor how long they
may last. Some side effects may appear months or
years after treatment has ended. Ask your doctor
what’s your chance that you’ll get these late side
There may be ways to help relieve side effects.
There are medicines and other methods to decrease
diarrhea. A medicine called duloxetine may help
painful neuropathy. Fatigue may be helped with
exercise or methods to conserve energy. Ask your
doctor about other ways to treat side effects.
It’s important to take care of other health issues
besides colon cancer. Take steps to prevent or detect
other diseases early. Such steps can include getting
immunizations like the flu shot.
Cancer screening is also important. Get a skin
cancer exam. Ladies—learn how to do a breast self-
exam. A mammogram may also be needed. Men—it
may be time to get screened for prostate cancer.
Start or keep a healthy lifestyle. Limit your alcohol
use. Quit smoking. Protect yourself from the sun. Be
at a healthy weight. Eat healthfully. Healthy eating
includes eating a balanced diet, eating the right
amount of food, and drinking enough fluids.
Many people benefit from some exercise. Exercise
tones muscles, lowers stress, and improves health.
Exercise programs differ between people based on
their needs. Talk with your treatment team about
which exercises would be best for you.
Metastases at recurrence
This section explains treatment options for colon
cancer that returns in the liver or lungs. Options
for colon cancer that can be treated with surgery
are explained first. However, most people with
metastases can’t have surgery. If you can’t have
surgery, treatment options are explained on page 54.
presents surgical options for liver or lung
metastases at recurrence. Surgery is only an option
if 1) all tumors can be fully removed and 2) your liver
won’t be too small after surgery.
To enlarge your liver, you may receive portal vein
embolization. Portal vein embolization is the blocking
of the blood vessel to the liver tumor. This blockage
causes the healthy part of the liver to grow larger.
This procedure will be done before surgery.
Surgery with chemotherapy is advised for
metastases. The best order of chemotherapy and
surgery is unknown. Thus, two options are given.
Option 1 starts primary treatment. It may consist of
metastasectomy. Local therapy to the liver or lung
may be added. Local therapy includes ablation and
SBRT. Local therapy without surgery is also an