SURVEILLANCE
• Coordinate physician visits every 3 to 6 months for the first 3 years, every 6 months during years 4 and 5, and subsequently at the discretion of the physician after treatment of colorectal carcinoma [57].
• Physician visits should focus on the initial risk assessment, followed by the implementation of a surveillance strategy and periodic counseling based on estimated risk and feasibility of surgical interventions like hepatic resection [57].
• For patients at lower risk of recurrence (stages I and Ia) or those with co morbidities impairing future surgery, only visits yearly or when symptoms occur are recommended [58]
• For patients at lower risk of recurrence (stages I and Ia) should have a colonoscopy before or within 6 months of initial surgery, repeated yearly if villous or tubular adenomas >1 cm are found; otherwise, repeat every 3 to 5 years [58]
• Postoperative serum CEA, CEA every 3-6 mo for 2 y, then every 6 mo for a total of 5 y for T2 or greater lesions, if the patient is a candidate for surgery or systemic therapy [56]
• Since fluorouracil-based therapy may falsely elevate CEA values, waiting until adjuvant treatment is finished to initiate surveillance is advised [57].
• If serial CEA level is increasing advise physical examination, colonoscopy and CT chest, abdomen and pelvis [56]
• If findings are negative consider PET scan and reevaluate chest/ abdominal/pelvic CT in 3 months [56]
• If metachronous tumor is documented treat accordingly [56]
• Routine blood tests (i.e., complete blood counts or liver function tests) are not recommended for surveillance [57].
• Periodic fecal occult blood testing or X Ray chest is not recommended [57].
• Patients who are at higher risk of recurrence, and who could be candidates for curative-intent surgery, should undergo annual CT of the chest and abdomen for 3 years after primary therapy for colon and rectal cancer [57].
• A pelvic CT scan should be considered for rectal cancer surveillance, especially for patients who have not been treated with radiotherapy
• All patients with colon and rectal cancer should have a colonoscopy for the pre- or perioperative documentation of a cancer- and polyp-free colon. Following the surgical treatment of colorectal cancer, a colonoscopy in 1 y: If abnormal, repeat in 1 y. If negative for polyps, repeat in 3 y, then every 5 y. If no preoperative colonoscopy due to obstructing lesion, colonoscopy in 3-6 months should be done [57]
• For patients of rectal cancer who have not received pelvic radiation, flexible sigmoidoscopy of the rectum every 6 months for 5 years is recommended [57].