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Managing Long-term Follow-up Cured Colon Cancer

Published on 23 January 2017 back to previous

Q: What Do I Tell the Surgeons Who Insist on Annual Colonoscopies for Patients With Cured Colon Cancer, Even for Those 5 to 10 Years Past Therapy?

A: Recommendations on the use of surveillance colonoscopy after resection of colorectal cancer were produced jointly by the U.S. Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (ACS). They constitute the updated recommendations of both organizations. These guidelines were endorsed by the Colorectal Cancer Advisory Committee of the ACS and by the governing boards of the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy and represent the evidence-based recommendations for the surveillance of patients with a history of colorectal cancer (Table 1 and Table 2).

In general, patients who undergo surgical resection of Stage I, II, or III colon and rectal cancers, or curative-intent resection of Stage IV cancers are candidates for surveillance colonoscopy. Patients who undergo curative endoscopic resection of Stage I colon cancers are also candidates for surveillance colonoscopy. Patients with Stage IV colon or rectal cancer that is unresectable for cure are generally not candidates for surveillance colonoscopy because their chance of survival from their primary cancer is low, and the risks of surveillance outweigh any potential benefit.

It is important to realize that historically there have been two primary goals for surveillance of patients with a history of resected colorectal cancer that have prompted clinicians to perform frequent surveillance procedures. The first is the detection of early recurrence of the primary tumor at a stage that will permit curative treatment. The second goal is to search for and identify metachronous colorectal cancers. In regard to detection of recurrences of the initial primary cancer, serial measurements of carcinoembryonic antigen are widely used. In addition, recent meta-analyses of randomized controlled trials suggest that annual chest x-rays and CT scans of the liver can improve survival from the original primary cancer by early detection of surgically curable recurrences.

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This article was sourced at Helio Gastroenterology.
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