Monitoring
Radiologic evaluation
(eg CT scan, MRI) and tumor marker level determination should be done at least
every 8 to 12 weeks in patients actively receiving treatment. Detecting relapse in
advance is the main goal. A rise in CEA level is usually the first signal of
recurrence and is most effective in patients with elevation preoperatively.
Surveillance recommendations for rectal cancer include
the following:
- Proctoscopy with endoscopic ultrasound or MRI with contrast is recommended every 3 to 6 months for the first 2 years then every 6 months for a total of 5 years in patients with rectal cancer who underwent transanal local excision only
- Digital rectal examination and
proctoscopy or flexible sigmoidoscopy every 3 to 4 months for 2 years, then every
6 months for a total of 5 years
- Flexible sigmoidoscopy is recommended for 3 to 6 months after the first endoscopic submucosal dissection assuming prior colonoscopy
- Second follow-up endoscopy is recommended 3 to 6 months after the first surveillance exam or colonoscopy if 1 year from endoscopic submucosal dissection
- Surveillance with flexible sigmoidoscopy is recommended every 3 to 6 months for a total of 5 years from endoscopic submucosal dissection
- Rectal MRI every 6 months for up to 3 years
Colorectal cancer surveillance includes the following:
- History, physical examination every 3 to 6 months for 2 years, then every 6 months for a total of 5 years
- CEA test at baseline, then every 3 to 6 months for 2 years, then every 6 months for a total of 5 years if cancer is potentially resectable for isolated metastases
- Colonoscopy at 1-year
post-resection or every 3 to 6 months after resection if not done preoperatively
due to an obstructing lesion
- If follow-up colonoscopy reveals advanced adenoma, repeat colonoscopy in 1 year
- If no advanced adenoma is seen, repeat at 3 years, then every 5 years thereafter
- More frequently done if colorectal presented before 50 years of age
- Important also in identifying and removing metachronous polyps, especially in the first 2 years after resection
- CT scan of the chest, abdomen and pelvis every 3 to 6 months for 2 years then every 6 to12 months for 5 years among stage IV patients and every 6 to 12 months for 5 years among stage II at high risk of recurrence and III patients; important in monitoring potentially resectable metastases, primarily in the liver and lung
- Endoscopic surveillance for patients who underwent endoscopic removal of polyps with invasive cancer should be individualized