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Surveillance after colorectal cancer resection

Authors
Beverly Moy, MD, MPH
Brian C Jacobson, MD, MPH
Section Editors
Kenneth K Tanabe, MD
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Colorectal cancer (CRC) is the third most common cause of cancer death in the United States; an estimated 134,490 new cases are diagnosed each year, of which 95,270 are colon and the remainder are rectal cancers [1]. Global country-specific data on incidence and mortality are available from the World Health Organization GLOBOCAN database.

Surgical resection is the primary treatment for the 80 percent of CRCs that present with nonmetastatic disease, and the most powerful tool for assessing prognosis is pathologic analysis of the resected specimen. Despite potentially curative surgery and the use of modern adjuvant chemotherapy and/or radiation therapy (RT), more than 40 percent of patients who present with stage II or III disease (table 1) will have a disease recurrence following primary therapy. (See "Adjuvant therapy for resected stage III (node-positive) colon cancer" and "Adjuvant therapy for resected rectal adenocarcinoma" and "Neoadjuvant chemoradiotherapy and radiotherapy for rectal adenocarcinoma".)

There has been and continues to be considerable variability among physicians in the use of follow-up studies after potentially curative resection of CRC and in the guidelines from major societies and expert groups. Multiple surveillance strategies have been published at costs ranging from a few hundred to several thousand dollars per patient.

Intensive postoperative surveillance programs have been justified in the hope that early detection of asymptomatic recurrences will increase the proportion of patients who are potentially eligible for curative therapy. A survival benefit from such an approach has in fact been shown in several meta-analyses. Furthermore, periodic imaging can detect early, potentially resectable recurrences.

This topic review will cover the rationale for intensive posttreatment surveillance in the first five years after treatment, data on the effectiveness of various surveillance strategies, and current recommendations for posttreatment surveillance in patients with resected CRC, including recommendations from expert groups. Recommendations for secondary prevention (dietary modification, exercise, use of aspirin and other nonsteroidal anti-inflammatory drugs) and management of long-term colorectal cancer survivors are discussed separately. (See "The roles of diet, physical activity, and body weight in cancer survivorship" and "Adjuvant therapy for resected stage III (node-positive) colon cancer", section on 'Aspirin and other NSAIDs' and "Approach to the long-term survivor of colorectal cancer".)

                                         

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 06 00:00:00 GMT+00:00 2016.
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