Doctors recommend follow-up testing to detect recurring cancer after the completion of treatment. General guidelines include:
Physical Examination. Most colorectal cancer recurrences happen within 3 years after surgery. Patients should see their doctors for a physical examination every 3 - 6 months for the first 2 years following surgery, every 6 months through the fifth year, and at the doctor's and patient's discretion during subsequent years.
Colonoscopy. Patients should have a colonoscopy 1 year after surgery. If the results are normal, patients should then receive a colonoscopy 3 years later and then every 5 years. Patients with abnormal results or who have hereditary types of cancer may need more frequent screenings.
A flexible sigmoidoscopy is recommended every 6 months for 5 years for patients with Stage II or III rectal cancer who did not receive radiation therapy.
Carcinoembryonic Antigen Levels. Carcinoembryonic antigen (CEA) levels should be measured every 3 -6 months after surgery for 2 years in patients, and then every 6 months up to 5 years for patients with Stage II or III cancer. High CEA levels in the blood may indicate that the cancer has recurred or has spread to other parts of the body.
Imaging Tests. Patients at high risk for cancer recurrence should receive an annual computerized tomography (CT) scan of the chest, abdomen, and pelvis for the first 3 years after treatment. The CT scan can help determine if cancer has spread to the lungs or liver. Patients who have had rectal cancer, and did not have radiation therapy, should receive a pelvic CT scan. The scan is not recommended for most lower-risk patients with Stage I or II colorectal cancer. PET scans are not routinely recommended.
Other Tests. The American Society of Clinical Oncology does not recommend other follow-up blood tests such as complete blood count, liver function tests, and fecal occult blood tests. There appears to be no additional benefit for these tests.
Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.