Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer

Abstract

Current evidence suggests improved rates of curative secondary treatment following identification of recurrence among patients who participate in a surveillance program after initial curative resection of colon or rectal cancer. The newer data show that surveillance CEA, chest and liver imaging,and colonoscopy can also improve survival through early diagnosis of recurrence; thus, these modalities are now included in the current guideline. Although the optimum strategy of surveillance for office visits, CEA, chest and liver imaging, and colonoscopy is not yet defined, routine surveillance does improve the detection of recurrence that can be resected with curative intent. Recommended surveillance schedules are shown in Table 4. However, the factors to be considered when recommending surveillance include underlying risk for recurrence, patient comorbidity, and the ability to tolerate major surgery to resect recurrent disease or palliative chemotherapy, performance status, physiologic age, preference, and compliance. The success of surveillance for early detection of curable recurrence will depend on patient and provider involvement to adhere to the surveillance schedule and avoid unnecessary examination. It should be noted that, after curative resection of colorectal cancer, patients are still at risk for other common malignancies(lung, breast, cervix, prostate) for which standard screening recommendations should be observed and measures to maintain general health (risk reduction for cardiovascular disease, eg, cessation of smoking, control of blood pressure and diabetes mellitus, balanced diet, regular exercise and sleep, and flu vaccines) should be recommended.

A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent

“…This is at odds with certain guidance that recommends the use of regular proctosigmoidoscopy in the follow-up of rectal cancer patients. 67 This analysis demonstrates clear differences between right-colonic, left-colonic and rectal primary tumours. Right-colonic tumours resulted in fewer isolated recurrences in the liver, in the lung or locally than recurrences from left-colonic or rectal tumours.…”

“…65 The present lack of evidence has resulted in conflicting guidance with respect to whether or not the same surveillance strategy should be offered to patients irrespective of the site and stage of the primary tumour. Some guidance suggests additional follow-up strategies for rectal cancer, 66,67 whereas others recommend much less intensive follow-up for rectal cancer than for colon cancer. 68,69 Furthermore, much uncertainty exists with respect to whether or not early-stage cancers should be followed up at all, owing to the low likelihood of recurrence.…”

Development of an enzyme-linked immunosorbent assay for detection of CDCP1 shed from the cell surface and present in colorectal cancer serum specimens

“…In addition, when malignant cases were stratified by stage, the level of ShE-CDCP1 was significantly higher in patients with stage II to IV tumors. In contrast, the current blood biomarker for recurrence of colorectal cancer, CEA, was elevated only in stage IV cases [33]. The apparent correlation of elevated ShE-CDCP1 with stage II to IV disease may result from the disruption of normal organ architecture that occurs during progression of colorectal cancer.…”

“…While these data suggest that ShE-CDCP1 could be useful for diagnosis of stage II to IV colorectal cancers, analysis of pretreatment bloods from larger patient cohorts is necessary to accurately assess this possibility. Currently there is no blood biomarker for colorectal cancer; the biomarker CEA is employed clinically to monitor for recurrent colorectal cancer [33]. Whether ShE-CDCP1 serum levels are more specific and sensitive than CEA concentration at detecting recurrent colorectal cancer requires analysis of post-treatment samples from large patient cohorts.…”

“…Diagnosis was established by pathologist assessment of colon tissue specimens that were collected at the same time as blood. Clinical data collected was age and gender for all cases and, for colorectal cancers, stage and the concentration of the biomarker carcinoembryonic antigen (CEA) which is employed clinically to monitor for recurrent colorectal cancer [33]. The concentration of ShE-CDCP1 in these samples was assessed using the optimized and validated ELISA.…”