Colorectal Cancer Survivorship

Screening Recommendations and Follow-Up Care for Colorectal Cancer Survivors

If you’re a colorectal cancer survivor, you’re not alone. More than 1 million people in the U.S. are survivors of colorectal cancer, according to the American Cancer Society. In fact, among survivors, it’s the second most common cancer type for men and the third most common cancer type for women. Taking steps to effectively and efficiently manage your own care can play an important role in staying healthy and minimizing symptoms. Here are a few screening and long-term care recommendations for colorectal cancer survivors:

  • Always go to your follow-up appointments.
  • You will probably have follow-up exams every 3-6 months following treatment depending on the stage of your cancer.
  • After some time goes by without a recurrence, your healthcare team will probably lessen checkups to only once or twice a year.
  • Follow your recommended screening schedule.
  • Your screening scheduled will depend on the stage of your colorectal cancer and other aspects of your medical history.
  • You will mostly likely have a colonoscopy one year after surgery. Then another colonoscopy every three years.
  • At the time of your appointments, you may do routine blood work so your doctor can check your overall health.
  • For the first few years following treatment, your doctor may also recommend computerized tomography (CT) scans every few months. A CT scan is an imaging test that takes multiple x-rays from different angles to create a 3-D image of organs and tissues.
  • Annual bloodwork may be recommended as colorectal surgeries can have an effect on metabolism. These lab values can check to make sure you are getting all the essential nutrients and electrolytes your body needs.
  • If you have a colostomy from treatment, you will have special follow up with an enterostomal therapist to teach you how to care for your ostomy.
  • If your ostomy is temporary, you will have a follow-up procedure to remove the ostomy and reconstruct your colon.
  • If you change your primary care physician, make sure your new doctor has all your medical records and history.
  • Tell your doctor about any side effects.
  • Some side effects occur after treatment ends. Let you healthcare team know of any and all changes so they can help you manage them effectively.
  • Keep your health insurance if at all possible.
  • Follow-up care, especially imaging, can be very expensive if you do not have health insurance.

Immunizations for Colorectal Cancer Survivors

What are immunizations?

Immunizations help your body build a resistance to specific diseases. Most immunizations work by introducing a small, safe amount of the disease to your immune system. This way if you are ever exposed to the disease, your body’s immune system already knows how to fight it. Most immunizations are vaccines given as a shot or series of shots.

Many people receive one-time immunizations when they are children for diseases such as chickenpox. Some immunizations, such as tetanus shots, need boosters to keep them effective. Other immunizations, such as flu vaccines, need to be received annually.

What are the risks of vaccines?

As with any treatment or medication, vaccines can cause side effects. Each vaccine carries risk for different side effects. Most side effects are minor such as pain where you receive the shot and mild fever. There are risks for serious side effects, but vaccines are carefully tested for safety. In most cases, the great benefits of vaccines outweigh the minor risks. To learn more, visit the Centers for Disease Control and Prevention (CDC) at www.cdc.gov. Talk to your healthcare team about the risks and benefits of vaccines to determine what is best for you.

I’m a colorectal cancer survivor, what immunizations do I need?

For colorectal cancer survivors, immunizations are especially important because cancer treatments weaken the body’s immune system. Below is the immunizations schedule recommended by the CDC for people with weakened immune systems, such as cancer survivors.

Influenza (flu) - Annually

Tetanus, diphtheria, pertussis (Td/Tdap) - One Tdap vaccine with Td booster every 10 years.

Varicella (chickenpox)*Should NOT get vaccine**

HPV vaccine (women and men)*- 3 doses through age 26

Zoster (shingles) - Should NOT get vaccine**

Measles, mumps, rubella (MMR)*- Should NOT get vaccine**

Pneumococcal (PCV13) - 1 dose

Pneumococcal (PPSV23) - 1 or 2 doses

Meningococcal - 1 or more doses

Hepatitis A* - 2 doses

Hepatitis B*- 3 doses

Source: Center for Disease Control

*These vaccines are only for adults who did not get them as children.

**If you received these vaccines before your cancer diagnosis, there is no harm done. In fact, it is good that you are protected from these diseases. If you have not received these vaccines, it is not safe to receive them with a weakened immune system.

If you are planning to travel outside of the United States, check the recommended vaccines for where you are going. You may need additional immunizations.

Always consult with your oncologist before receiving any vaccine.

What else do colorectal cancer survivors need to know about immunizations? Influenza (Flu)

If you are a colon cancer survivor, the CDC recommends getting the annual flu vaccine. However, only get the flu shot; do NOT get the nasal spray version. The nasal spray version contains live viruses so it is not safe for people with a compromised immune system.

Caregivers or anyone living with a colorectal cancer survivor should also receive the flu vaccine to lower the risk of infection.

Pneumococcal

There are two pneumococcal vaccines: PVV13 and PPSV23. For cancer survivors, doses of each may be needed. Ask your healthcare team about the best pneumococcal schedule for you.

Meningococcal, Hepatitis A and B

These vaccines are recommended for adults with certain jobs, lifestyles, or other health factors that increase their risk of these diseases. Your healthcare team can tell you if you are at a higher risk.

Varicella, Zoster, and MMR

As shown in the chart above, people with a compromised immune system, such as colorectal cancer survivors currently or recently out of treatment, should NOT receive these vaccines.

Smoking Cessation

Why is smoking bad?

Smoking increases your risk for heart disease, stroke, and emphysema. Smoking also increases your risk for a number of cancers, including:

  • Lung
  • Oral
  • Nasal and Paranasal
  • Throat
  • Esophageal
  • Bladder
  • Kidney
  • Pancreatic
  • Ovarian
  • Cervical
  • Colorectal
  • Stomach

If you’re a colorectal cancer survivor, smoking can increase your risk of recurrence.

Why should I quit?

Quitting smoking has almost immediate benefits. Here are some of the benefits of quitting smoking:

20 minutes - Blood pressure and heart rate drop

12 hours - CO2 levels in blood stream return to normal*

3 months – 9 months - Circulation and lung function improve

1 year - Risk of heart disease cut in half

5 years - Risk of mouth, throat, esophageal, and bladder cancer cut in half

10 years - One-half as likely to die from lung cancer, and risk of laryngeal and pancreatic cancer decreases

15 years - Risk of heart disease is the same as a non-smoker’s

Source: smokefree.gov

*If the CO2 (carbon dioxide) levels in your bloodstream are high, your lungs have to work harder to return these levels to normal. When you exhale, CO2 leaves your body.

How can I quit?

The first step is to talk to your healthcare team about the best quitting strategies for you.

With smoking, your body builds up a dependency on nicotine, a chemical found in tobacco. As you quit smoking, your body will go through withdrawals from nicotine. Some common symptoms and side effects of withdrawal include:

  • Cravings
  • Feelings of sadness
  • Stress and anxiety
  • Difficulty sleeping
  • Restlessness
  • Weight gain

Here are some tips to help you manage the side effects of withdrawal:

  • With your doctor’s permission, you may wish to use nicotine replacement therapies (NRT).

NRTs give you a small, decreasing dose of nicotine without smoking to help you wean yourself off nicotine and minimize withdrawal symptoms.

  • NRTs come in many forms such as gum, lozenges, inhalers, and patches.
  • Some NRTs are available without a prescription, but always talk to your healthcare team first.
  • Other prescription medications are available to help you quit. Check with your doctor to see if these may be right for you.
  • Tell your friends and family that you are trying to quit.
  • They can support you and hold you accountable.
  • Ask a friend or family member you trust to be your “sponsor.” If you feel the urge to smoke, you can call them to talk until the craving passes.
  • If your friends or family members smoke, ask them not to smoke around you and not to offer you cigarettes. This will only make achieving your goal harder.
  • Join a support group or online support group to connect with other people trying to quit.
  • Change your routine.

For example, if you always have a cigarette with your coffee, find a new morning routine. Try watching the news with your coffee, or replace your cigarette with a healthy snack.

  • Know your triggers and have a plan.
  • What triggers your cravings—stress, food, other people smoking?
  • Avoid triggers if at all possible.
  • If you encounter a trigger, have a plan to keep yourself from smoking such as chewing gum, counting to 10, or calling a friend.
  • If you have a setback, don’t be too hard on yourself. Get back on track as soon as possible. However, do not use a slip as an excuse to start smoking regularly again.
  • Do not use other tobacco products or e-cigarettes as a replacement for smoking.
  • Other tobacco products can also increase your risk for cancer and diseases.
  • E-cigarettes have not been studied enough to know their safety. The chemicals inhaled with e-cigarette use may have their own risks.

Resources for Quitting

Smokefree.gov

Call (800) Quit-Now to connect with your state’s helpline.

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