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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Metastatic disease

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

(high-grade dysplasia).

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.

Other care

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.

Guide 14

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

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