QUESTION: A 65-year-old man diagnosed with stage III sigmoid colon cancer underwent low anterior resection followed by six months of adjuvant chemotherapy. He is currently attending regular follow-ups with no signs of recurrence on surveillance examinations. However, the patient complains of loose stools and tingling sensations in his hands and feet. What advice can be provided regarding appropriate management of these symptoms and the necessary care for cancer survivors?

ANSWER: Antidiarrheal medications like loperamide and calcium polycarbophil can be effective. Duloxetine is currently the most evidence-based first-line treatment for chemotherapy induced peripheral neuropathy.

REVIEW: By 2030, the global incidence of colorectal cancer (CRC) is expected to increase by 60%, reaching 2.2 million cases annually [1]. With successful treatments improving the 5-year survival rate to 65%, the management and care of CRC survivors have become a critical challenge for healthcare providers [2]. Cancer survivorship entails essential care aimed at managing treatment-related symptoms and complications, preventing recurrence, and monitoring for new cancers.

Nearly half of CRC survivors experience chronic diarrhea [3]. Patients undergoing low anterior resection for rectal cancer or resection and anastomosis of the lower gastrointestinal tract often report increased bowel frequency, incontinence, perianal irritation, and incomplete evacuation. Similarly, resection of the ascending colon can lead to loose stools due to the loss of water and electrolyte absorption. It should be noted that these symptoms may improve over time as part of the adaptation process after surgery, but in some cases, medication may be helpful [4,5]. Antidiarrheal medications like loperamide and calcium polycarbophil can be effective [3]. For radiation proctitis-induced diarrhea, loperamide or diphenoxylate/atropine serves as first-line treatment [3]. Dietary modifications, such as avoiding raw vegetables and adopting a low-fat or elemental diet, can also help [5].

Chemotherapy-induced neuropathy, particularly from oxaliplatin used in FOLFOX or CAPEOX regimens, is a significant concern for CRC survivors. This condition can manifest as various sensory symptoms, including numbness, tingling, a pins-and-needles sensation, heightened sensitivity to touch, and even severe pain from light contact. In some cases, patients may experience a complete loss of sensation in the affected areas. While neuropathy often improves over time, symptom management is crucial. Duloxetine is currently the most evidence-based first-line treatment [6]. Other options, such as tricyclic antidepressants, gabapentin, pregabalin, baclofen, amitriptyline, and compounded topical gels, may provide some relief. However, treatments like vitamins, acetyl-L-carnitine, or acupuncture lack sufficient evidence and are not recommended [7].

Cancer survivors, including those with CRC, face a range of issues that require comprehensive monitoring beyond the primary disease. Adjuvant treatments such as chemotherapy and radiation therapy can contribute to various long-term complications. Though cardiovascular morbidity does not show a marked increase among long-term CRC survivors, attention to cardiovascular health is crucial. Adjuvant chemotherapy for CRC is not highly associated with acute or chronic cardiotoxicity but may exert some effects Obesity and sedentary lifestyles are linked to increased CRC risk and may accelerate cardiovascular disease progression in CRC survivors. Thus, lifestyle modifications are imperative for these patients [8].

Patients with persistent urinary retention or dysfunction after CRC surgery should be referred to a urologist. Symptoms such as incontinence, frequent or urgent urination, dysuria, and hematuria may develop after pelvic radiation therapy, though evidence for effective treatment remains insufficient [9]. Additionally, CRC survivors may face mental health issues, cognitive impairments, or sexual dysfunction, which require specialist referrals and tailored care [10].

To reduce the risk of recurrence after CRC survival, several lifestyle modifications are recommended. First, increased physical activity has been shown to lower the risk of CRC by 20 to 30%. Exercise not only aids in preventing obesity but also promotes intestinal motility, which can improve gastrointestinal function after colorectal surgery. Specifically, engaging in moderate-intensity exercise that induces sweating, such as 30 minutes of activity 3 to 5 times per week, is beneficial [11]. In addition to exercise, other lifestyle changes are critical. Limiting alcohol consumption is important, as even moderate intake (e.g., 10 g of alcohol per day) has been associated with a 9% increase in CRC risk [12]. Maintaining a healthy weight and avoiding unhealthy dietary choices, such as animal fats and processed meats, further contribute to reducing recurrence risk and supporting overall health [13].

In conclusion, with increasing survival rates, supportive care during CRC survivorship is essential. Comprehensive, high-quality, and multidisciplinary support across all areas of survivorship care is necessary to optimize health outcomes and quality of life for CRC survivors.

None.

No potential conflict of interest relevant to this article was reported.