You’ve Been Diagnosed With Colon Cancer—What’s Next?

Advice for first steps and long-term thinking

Whether it comes through a routine colonoscopy or because of worrisome symptoms, facing a diagnosis of colon cancer is never easy. You probably have questions about your short-term options and long-term outlook.

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Patients who have no symptoms but receive a diagnosis through a screening often feel blindsided, says oncologist Alok Khorana, MD, Cleveland Clinic’s Director of GI Malignancies. And those whose diagnosis is triggered by symptoms such as gastrointestinal bleeding have their own set of anxieties.

Below, experts offer reassurances about the prognosis of this disease — and advice about how you should approach your treatment and long-term care management.

Know that colon cancer develops over years

Most patients will think: “I have cancer. Can I get this taken care of tomorrow?”

The reality is that colon cancer develops over years, not days. In fact, a polyp can take as long as 10 years to develop into cancer, Dr. Khorana says.

Patients also have a good chance of surviving this disease. Five-year survival rates range from 70 percent to 97 percent when diagnosis comes in early stages, which is why screening is so important, Dr. Khorana says. The 10-year survival rate is about 10 percent for stage IV colon cancer, but even these patients have a better outlook today thanks to new treatments and targeted therapies.

“The majority of colon cancer patients will be cured from the cancer,” Dr. Khorana says, “and it’s important that we reassure patients about it, because that’s the biggest worry.”

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Emre Gorgun, MD, colorectal surgeon, stresses that these positive outcomes depend on an early diagnosis. “If your primary care physician doesn’t recommend [a colonoscopy] when you turn 50, ask for one. And make sure you stay up-to-date on your colonoscopies.”

Don’t rush in choosing a team — or treatment

Because most colon cancer isn’t immediately life-threatening, it’s important to develop a precise diagnosis and care plan, Dr. Khorana says.

Ask for a second opinion. And if your hospital offers support and navigation services that go beyond medical treatment, take advantage of them.

You may also need additional imaging and other tests to refine a diagnosis. And if your cancer has hereditary red flags, your doctor may refer you for genetic counseling. In addition, search for institutions that perform high volumes of treatment for colon or rectal cancer; they generally have better outcomes and fewer complications, Dr. Khorana notes.

“Much of what we do with colon cancer is a team approach: a colorectal surgeon, a medical oncologist and radiation oncologist,” he says. “It’s important to meet with all three disciplines so they can make a recommendation on whether you need just an operation, or additional chemotherapy and radiation before or after the operation.”

Dr. Gorgun points to another major patient fear: whether they’ll need a permanent colostomy or stoma. This procedure creates an alternative opening in the large intestine for waste to pass through following colon or rectal cancer surgery.

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Most patients with colon cancer should able to avoid a permanent stoma, he says. “Stomas are a bigger question in patients with rectal cancer, and the need for one is largely determined by the location of the tumor in the rectum.” Patients who have tumors located close to the anal opening are more likely to need a colostomy — but even in those cases they may be avoidable, he adds.

Stick with healthy habits

If you ate well and exercised often before a diagnosis, you may be skeptical about how much those healthy habits matter. But be patient and stick with them, Dr. Khorana urges. If your habits were questionable beforehand, ask for help making changes.

Why? Because data suggest lifestyle changes after surgery — such as getting regular exercise — can drive down the risk of cancer coming back, Dr. Khorana says.

“Our recommendation is to do regular cardiovascular exercise, 20 to 30 minutes most days of the week,” he says. “Eat plenty of fresh fruits and vegetables, not too much red meat.”

Your treatment schedule may temporarily change those healthy habits. But even then, you can get help, such as advice on maintaining your weight during chemotherapy. It’s just one of many examples of how to strategize for the best long-term outcomes, starting with your diagnosis and continuing long after your treatment.

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