Local recurrence of a tumour is more common in rectal than
colon primaries. It may be identified early in the asymptomatic
phase by follow up monitoring or may present with similar
symptoms to the primary lesion. Blood loss through the rectum,
mucous discharge, altered bowel habit, and straining are
common features of recurrent rectal cancer. Pain and urinary
symptoms are features of localised pelvic recurrence. Recurrent
intra-abdominal disease can present as small or large bowel
obstruction, and recurrence at other sites may be indicated by
focal features such as hepatic capsular pain, jaundice, dyspnoea,
localised bone pain, or neurological symptoms. Systemic
features of weight loss, anorexia, nausea, and asthenia are
symptoms commonly associated with advanced colorectal
cancer. The tumour is often palpable on rectal or abdominal
examination, and malignant ascites may also be evident.

The management of patients with advanced colorectal cancer
involves a combination of specialist active treatment, symptom
control measures, and psychosocial support. Active treatment
comprises an individual plan (often combining palliative
surgery), cytotoxic chemotherapy, and radiation therapy.
The outcome measures of the impact of active treatment
have traditionally been survival, response, and toxicity.