Hopegirl wrote:I’m sorry but I have another question. How can I tell if I have reoccurrences or not? ...
I think that the first person to ever know if you have a recurrence would be the technician who does your CT scans every 6 months, not you. The CT scan is the procedure generally used to confirm the presence of a recurrence. I don't think that you would be able to tell on the basis of any symptoms, because I don't think you would have any symptoms before the next CT scan.
The literature on colorectal cancer recurrence shows that, in general, most CRC patients in the 5-year surveillance period do not have any symptoms at all from a metastasis before the CT scan that initially confirms the met's presence. The newly formed metastasis is so small at the very beginning that it is unlikely to cause any kind of problem or symptom. The noticeable symptoms of a recurrence usually come much later, after a met has increased greatly in size and has begun to interfere with other organ functions.
You are now in the 5 year surveillance period under a schedule that requires a CT scan every 6 months. This schedule is an aggressive monitoring schedule, with scans done twice as frequently as scans recommended for persons at ordinary risk for a recurrence. With your scans this frequent, it is unlikely that a met occurring within a short 6 month time frame could become large enough to cause any noticeable problem, unless you had a particularly aggressive type of cancer. Nonetheless, you should always monitor your own health and report to your doctor any new and persistent changes in your health.
There are two main kinds of recurrence, local and distant.
- Local recurrences are ones that occur near the place where the original tumor was located. This type of recurrence is not usually called a metastasis, however. Rather, it is usually an extension of the original tumor that probably emerged because of poor surgical procedure in removing the original tumor. If the surgeon did not remove all of the cancer of the original tumor (for example, if there were involved margins in the resected specimen), then a residual cancer will eventually emerge and grow large enough to be noticed on a CT scan. Local recurrences, if they do occur, usually occur within 2 years of surgery.
- Distant recurrences are ones that occur in remote places like the liver, lungs, or in the peritoneum.They are the recurrences that are usually termed metastases (mets). They can occur at any time, even years after the original surgery. They originate from circulating tumor cells or micro-metastases that have traveled to remote places and that eventually develop into large metastases, often when systemic inflammation in the body has increased markedly due to very poor diet or long-term sedentary lifestyle (lack of exercise). Whether the recurrence appears in the liver or in the lungs or somewhere else usually depends on where the original tumor was located and how close the tumor was to the main lymphatic vessels going either to the liver or to the lungs or elsewhere.
While it is unlikely that you will have symptoms alerting you to a new met, it is always possible that a new met is located in such an awkward place that it will start causing problems even while it is small. Also, a local recurrence located at or near the anastomosis join could cause some inflammation, pain or narrowing of the anastomosis and generate problems with normal bowel movements. So, it always pays to be alert to any new, and persistent changes in your health, just in case.
By the way, did you have a CEA tumor-marker test done before
your surgery? If so, was it in the abnormal range? As of now, all of your post-treatment CEAs have been in the normal range. It would be interesting to know if your CEA was also normal before your surgery. If so, this would suggest that CEA is not a particularly good marker for you, since, in that case, it did not fluctuate up and down according to the amount of cancer you had in your body.