What is included in the long-term monitoring of patients with colon cancer?

Updated: Apr 15, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Pooled analysis from several large adjuvant trials showed that 85% of colon cancer recurrences occur within 3 years after resection of primary tumor, with 95% occurring within 5 years. Therefore, patients with resected colon cancer (stage II and III) should undergo regular surveillance for at least 5 years following resection. [136] Recommendations for post-treatment surveillance, from the European Society for Medical Oncology (ESMO), [137] the American Society for Clinical Oncology (ASCO), [136] and the National Comprehensive Cancer Network (NCCN) [93] are compared in Table 2, below.

Table 2. Surveillance recommendations for stage II and III colon cancer (Open Table in a new window)

Parameter

Organization

ESMO [JSMO](2013)

ASCO (2013)

NCCN (2016)

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

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

Chest CT*

Every 6-12 mo for first 3 y

Every 1 y for 3 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, then every 5 y if negative

Abdominal CT*

Every 6-12 mo for first 3 y

Every 1 y for 3 y

Every 6-12 mo for up to 5 y; scans to include chest and pelvis

ESMO = European Society of Medical Oncology; JSMO = Japanese Society of Medical Oncology; ASCO = American Society of Clinical Oncology; NCCN = National Comprehensive Cancer Network; 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.

Followup should be guided by the patient’s presumed risk of recurrence and functional status. Testing at the more frequent end of the range should be considered for patients at high risk. Patients with severe comorbid conditions that make them ineligible for surgery or systemic therapy should not undergo surveillance testing. [136]


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