Colorectal Cancer Follow Up

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