Colorectal cancer follow up

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

The aims of follow-up are to diagnose in the earliest possible stage any metastasis or tumors that develop later but did not originate from the original cancer (metachronous lesions)

The aims of follow-up are to diagnose in the earliest possible stage any metastasis or tumors that develop later but did not originate from the original cancer (metachronous lesions).

The U.S. National Comprehensive Cancer Network and American Society of Clinical Oncology provide guidelines for the follow-up of colon cancer^[1][2]:

• A medical history and physical examination are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years

• Carcinoembryonic antigen blood level measurements are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years, but are only advised for patients with T2 or greater lesions

• A CT-scan of the chest, abdomen and pelvis can be considered annually for the first 3 years for patients who are at high risk of recurrence (for example, patients who had poorly differentiated tumors or venous or lymphatic invasion) and are candidates for curative surgery

• A colonoscopy may be performed after 1 year; the exception is if it could not be performed during the initial staging because of an obstructing mass, in which case it should be performed after 3 to 6 months.

• To view the guidelines for colonoscopy surveillance after the primary tumor resection, click here here

Routine PET or ultrasound scanning, chest X-rays, complete blood count or liver function tests are not recommended. These guidelines are based on recent meta-analyses showing that intensive surveillance and close follow-up can reduce the 5-year mortality rate from 37% to 30%.^[3][4][5]

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