Updated clinical practice guidelines now call for annual CT scanning of the chest and abdomen in colorectal cancer patients who are at high risk for recurrence and who would be candidates for further resection if metastases were found.
An expert panel of the American Society of Clinical Oncology revisited the issue of stage II or III colon or rectal cancer surveillance because treatment and monitoring of the disease have changed since the previous clinical practice guidelines were issued in 2000. There have been substantial advances in tumor respectability and patient survival, “supporting more aggressive follow-up after diagnosis and treatment,” the panel noted.
The previous guidelines recommended against CT surveillance based on evidence that identification of lung and liver metastases on CT did not influence survival. But the panel's review of studies published since 1999 showed a 25% lower mortality in patients with stage II or III colorectal cancer who have CT monitoring, because it can identify such metastases at an early enough stage to now allow limited but curative surgical resection.
The updated guidelines also now recommend considering annual pelvic CT scanning for surveillance of patients with rectal cancer who have unfavorable prognostic factors, especially those who were not treated with radiotherapy. The data do not justify such surveillance for lower-risk patients, according to the panel.
The guidelines have been published and are posted online at www.jco.org
Updated guidelines for patients, titled “Follow-Up Care for Colorectal Cancer,” are available on the patient Web site, at www.plwc.org
The new guidelines call for serum testing for carcinoembryonic antigen (CEA) every 3 months for at least 3 years after initial diagnosis and treatment. Colonoscopy is recommended postoperatively to document freedom from carcinomas and polyps, as well as at year 3 and at 5-year intervals thereafter.
The guidelines also address American Gastroenterological Association recommendations for more frequent colonoscopy in certain high-risk patients.
The new guidelines recommend regular primary care visits every 3–6 months for the first 3 years, every 6 months during years 4 and 5, and as often as the physician deems necessary thereafter.