Follow-Up after Surgery
Patients who have undergone resections for cure are followed closely to look for evidence of symptomatic or asymptomatic tumor recurrence that may be amenable to curative resection in a small number of patients. The optimal cost-effective strategy is not clear. Two randomized trials reported that intense follow-up with yearly colonoscopy, abdominal CT, and chest radiography did not improve overall outcome compared with most standard follow-up protocols. Patients should be evaluated every 3-6 months for 3-5 years with history, physical examination, and CEA determinations.
Patients who had a complete preoperative colonoscopy should undergo another colonoscopy 1 year after surgical resection. Patients who did not undergo full colonoscopy preoperatively should undergo colonoscopy within 3-6 months postoperatively to exclude other synchronous colorectal neoplasms and 1 year thereafter.
Thereafter, surveillance colonoscopy should be performed every 3-5 years to look for metachronous polyps or cancer. Because of the high incidence of local tumor recurrence in patients with rectal cancer, sigmoidoscopy should be performed every 3-6 months for 3 years. New onset of symptoms or a rising CEA warrants investigation with chest and abdominal CT to look for recurrent or metastatic disease that may be amenable to therapy. For patients with a rising CEA with unrevealing CT imaging, a PET scan is more sensitive for the detection of occult metastatic disease.
The stage of disease at presentation is the most important determinant of long-term survival: stage I, > 90%; stage II, 70-80%; stage III with fewer than four positive lymph nodes, 67%; stage III with more than four positive lymph nodes, 33%; and stage IV, 5-7%. For each stage, rectal cancers have a worse prognosis. For those patients whose disease progresses despite therapy, meticulous efforts at palliative care are essential.
- Colorectal Cancer definition
- Risk Factors
- Colorectal cancer Risk Factors
- General Considerations
- Incidence and Location
- Variations in Incidence Within Countries
- Anatomy and Pathogenesis
- Diagnosis and Screening
- Clinical Findings
- Differential Diagnosis
- Screening for Colorectal Neoplasms
- Classification Systems
- Colorectal Neoplasms Treatment
- Follow-Up after Surgery
- Risk factors for colorectal Neoplasia
Rebecca A. Barnetson and Malcolm G. Dunlop
Colon Cancer Genetics Group, University of Edinburgh, School of Molecular and Clinical Medicine and MRC Human Genetics Unit, Western General Hospital, Edinburgh, U.K.
Banerjee S et al. CT colonography for colon cancer screening. Gastrointest Endosc. 2006 Jan;63(1):121-33. [PMID: 16377329]
Barclay RL et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006 Dec 14;355(24):2542-50. [PMID: 17167137]
Bernold DM et al. Advances in chemotherapy for colorectal cancer. Clin Gastroenterol Hepatol. 2006 Jul;4(7):808-21. [PMID: 16797250]
Callery MP. Combined modality therapy for rectal cancer. Gastroenterology. 2005 May;128(5):1516-7. [PMID: 15887133]
Colon Cancer - National Cancer Institute - Cancer Net: http://cancernet.nci.nih.gov.
Davila RE et al. ASGE guidelines: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006 Apr;63(4):546-57. [PMID: 16564851]
Farrar WD et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006 Oct;4(10): 1259-64. [PMID: 16996804]
Lieberman D. Screening for colorectal cancer in average-risk populations. Am J Med. 2006 Sep;119(9):728-35. [PMID: 16945604]
Meyerhardt JA et al. Systematic therapy for colorectal cancer. N Engl J Med. 2005 Feb 3;352(5):476-87. [PMID: 15689586]
Morikawa T et al. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005 Aug;129(2):422-8. [PMID: 16083699]
Nicholson FB et al. The role of CT colography in colorectal cancer screening. Am J Gastroenterol. 2005 Oct;100(10):2315-23. [PMID: 16181386]
Ouyang DL et al. Noninvasive testing for colorectal cancer: a review. Am J Gastroenterol. 2005 Jun;100(6):1393-403. [PMID: 15929776]
Psaty BM et al. Risks and benefits of celecoxib to prevent recurrent adenomas. N Engl J Med. 2006 Aug 31;355(9):950-2. [PMID: 16943408]
Regula J et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006 Nov 2; 355(18):1863-72. [PMID: 17079760]
Rex D et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US multi-society task force on colorectal cancer. Gastroenterology. 2006 May;130(6):1865-71. [PMID: 16697749]
Schoenfeld P et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005 May 19;352(20):2061-8. [PMID: 15901859]
Twelves C et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 2005 Jun 30;352(26):2696-704. [PMID: 15987918]
Weitz J et al. Colorectal cancer. Lancet. 2005 Jan 8-14;365 (9454):153-65. [PMID: 15639298]