Which organizations have issued guidelines on follow-up care for survivors of stage II and stage III colorectal cancer and how do the recommendations compare?

Updated: Oct 08, 2019
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Answer

Guidelines on follow-up care for survivors of stage II and stage III colorectal cancer were issued by the following organizations:

  • Cancer Care Ontario endorsed by American Society of Clinical Oncology (ASCO)
  • European Society of Medical Oncology (ESMO)
  • National Comprehensive Cancer Network (NCCN)
  • American Society of Colon and Rectal Surgeons (ASCRS)

All four guidelines agree that patients with resected colon cancer (stage II and III) should undergo regular surveillance for at least 5 years following resection, and that surveillance should include regular reviews of medical history, physical examination, and carcinoembryonic antigen assays, as well as colonoscopy and abdominal and chest computed tomography (CT [23, 24, 10, 25] The frequency of the surveillance testing differs as shown in the table below.

Table.1 (Open Table in a new window)

Parameter

Organization

ESMO (2013) [24]

ASCO (2013) [26]

NCCN  (2016) [10]

ASCRS (2015) [25]

History and physical exam

Every 3-6 mo for 3 y, then every 6 -12 mo at 4 and 5 y

Every 3-6 mo for 3 y, then every 6 mo to 5 y

Every 3-6 mo for 2 y, then every 6 mo to 5 y

Every 3-6 mo for 2 y, then every 6 mo to 5 y

CEA

Every 3-6 mo for 3 y, then every 6 -12 mo at 4 and 5 y

Every 3 mo for 3 y*

Every 3-6 mo for 2 y, then every 6 mo to 5 y

Every 3-6 mo for 2 y, then every 6 mo to 5 y

Chest CT*

Every 6-12 mo for first 3 y

Every 1 y for 3 y

Every 1 y for 5 y

Every 1 y for 5 y

Colonoscopy**

At y 1 after surgery, and every 3-5 y thereafter

At 1 y, then every 5 y, dictated by the findings on the previous colonoscopy

At 1 y, 3 y, and 5 y if negative

At y 1 after surgery, and every 3-5 y dictated by the findings on the first postoperative examination.

Abdominal CT*

Every 6-12 mo for first 3 y

Every 1 y for 3 y

Every 1 y for 5 y; scans to include pelvis

Every 1 y for 5 y

ESMO = European Society of Medical Oncology; ASCO = American Society of Clinical Oncology; NCCN = National Comprehensive Cancer Network; American Society of Colon and Rectal Surgeons = ASCRS CEA = carcinoembryonic antigen; CT = computed tomography * For patients at high risk for recurrence (eg, lymphatic or venous invasion, or poorly differentiated tumors). **Colonoscopy should be performed 3-6 mo postoperatively if preoperative colonoscopy was not done, due to an obstructing lesion; otherwise, colonoscopy in 1 y; if abnormal, repeat in 1 year; if no advanced adenoma (ie, villous polyp, polyp >1 cm, or high-grade dysplasia), repeat in 3 y, then every 5 y.


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