title: Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study.
abstract: Follow-up after colorectal cancer treatment with curative intent aims to detect recurrences and metachronous tumors in a timely manner. The objective of this study is to assess how recurrent disease presents and is diagnosed within scheduled follow-up according to the national guideline for the Netherlands.
  
  
  
  In a retrospective study of consecutive patients with colorectal cancer who were treated in 2 hospitals in the Netherlands, we identified patients with colon cancer who underwent surgery with curative intent between January 2007 and December 2012. Patients who developed recurrent disease were included for further analyses.
  
  
  
  From a total of 446 patients who were been treated for colon carcinoma with curative intent, 74 developed recurrent disease (17%). In 43 of those patients (58%), recurrent disease was detected during a scheduled follow-up visit, with 41 (95%) being asymptomatic. Tumor marker testing, imaging, and colonoscopy identified all of these recurrences. In the remaining 31 patients with recurrent disease (42%), recurrence was found during non-scheduled interval visits; 26 (84%) of these patients were symptomatic. The most prevalent symptoms were abdominal pain, altered defecation, and weight loss. Patients with asymptomatic recurrences had a significantly higher overall survival compared with patients with symptomatic recurrences.
  
  
  
  In this cohort, 42% of the recurrences after initial curative treatment for colon cancer were found during non-scheduled interval visits, mainly based on symptoms. Primary care physicians who take care of patients whose colon cancer might recur should be aware of the relatively high rate of symptomatic recurrences and of typical presenting symptoms.
authors.affiliation: Department of Primary Care, Academic Medical Centre, Amsterdam, the Netherlands l.a.duineveld@amc.uva.nl.
authors.forename: Laura A M
authors.initials: LA
authors.lastname: Duineveld
authors.affiliation: Department of Primary Care, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Kristel M
authors.initials: KM
authors.lastname: van Asselt
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Anke B
authors.initials: AB
authors.lastname: Smits
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: Department of Primary Care, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Henk C P M
authors.initials: HC
authors.lastname: van Weert
authors.affiliation: Department of Primary Care, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Wind
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002277:Carcinoma / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009426:Netherlands; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor
keywords: colon cancer; follow-up; recurrent disease