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Surveillance after colorectal cancer resection

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


Colorectal cancer (CRC) is the third most common cause of cancer death in the United States; an estimated 135,430 new cases are diagnosed each year, of which 95,520 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 CRC 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 2017. | This topic last updated: Jul 24, 2017.
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  1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  2. McAfee MK, Allen MS, Trastek VF, et al. Colorectal lung metastases: results of surgical excision. Ann Thorac Surg 1992; 53:780.
  3. Saito Y, Omiya H, Kohno K, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg 2002; 124:1007.
  4. Ike H, Shimada H, Ohki S, et al. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up. Dis Colon Rectum 2002; 45:468.
  5. Rizk NP, Downey RJ. Resection of pulmonary metastases from colorectal cancer. Semin Thorac Cardiovasc Surg 2002; 14:29.
  6. Goldberg RM, Fleming TR, Tangen CM, et al. Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med 1998; 129:27.
  7. Quentmeier A, Schlag P, Smok M, Herfarth C. Re-operation for recurrent colorectal cancer: the importance of early diagnosis for resectability and survival. Eur J Surg Oncol 1990; 16:319.
  8. Ovaska J, Järvinen H, Kujari H, et al. Follow-up of patients operated on for colorectal carcinoma. Am J Surg 1990; 159:593.
  9. Pita-Fernández S, Alhayek-Aí M, González-Martín C, et al. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis. Ann Oncol 2015; 26:644.
  10. Graham RA, Wang S, Catalano PJ, Haller DG. Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy. Ann Surg 1998; 228:59.
  11. Mokhles S, MAcbeth F, Farewell V, et al. Br J Surg 2016; :1259.
  12. Ohlsson B, Breland U, Ekberg H, et al. Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum 1995; 38:619.
  13. Mäkelä JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg 1995; 130:1062.
  14. Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 1997; 84:666.
  15. Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology 1998; 114:7.
  16. Rodríguez-Moranta F, Saló J, Arcusa A, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 2006; 24:386.
  17. Wang T, Cui Y, Huang WS, et al. The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective, randomized clinical study. Gastrointest Endosc 2009; 69:609.
  18. Pietra N, Sarli L, Costi R, et al. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 1998; 41:1127.
  19. Secco GB, Fardelli R, Gianquinto D, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 2002; 28:418.
  20. Grossmann EM, Johnson FE, Virgo KS, et al. Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial. Surg Oncol 2004; 13:119.
  21. Primrose JN, Perera R, Gray A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA 2014; 311:263.
  22. Wattchow DA, Weller DP, Esterman A, et al. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer 2006; 94:1116.
  23. Rosati G, Ambrosini G, Barni S, et al. A randomized trial of intensive versus minimal surveillance of patients with resected Dukes B2-C colorectal carcinoma. Ann Oncol 2016; 27:274.
  24. Renehan AG, Egger M, Saunders MP, O'Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 2002; 324:813.
  25. Figueredo A, Rumble RB, Maroun J, et al. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer 2003; 3:26.
  26. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2007; :CD002200.
  27. Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum 2007; 50:1783.
  28. Baca B, Beart RW Jr, Etzioni DA. Surveillance after colorectal cancer resection: a systematic review. Dis Colon Rectum 2011; 54:1036.
  29. Renehan AG, O'Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ 2004; 328:81.
  30. Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 2013; 31:4465.
  31. Earle C, Annis R, Sussman J, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer. Recommendations from cancer Care Ontario (CCO) available online at https://www.cancercare.on.ca/cms/one.aspx?objectId=280721&contextId=1377 (Accessed on November 22, 2013).
  32. Labianca R, Nordlinger B, Beretta GD, et al. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v70.
  33. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv22.
  34. Törnqvist A, Ekelund G, Leandoer L. The value of intensive follow-up after curative resection for colorectal carcinoma. Br J Surg 1982; 69:725.
  35. Castells A, Bessa X, Daniels M, et al. Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study. Dis Colon Rectum 1998; 41:714.
  36. Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 2006; 24:5313.
  37. British Columbia MEdical Association Guidelines. Followup of colorectal polyps or cancer. http://www.bcguidelines.ca/pdf/colorectal_followup.pdf (Accessed on November 26, 2013).
  38. Fletcher RH. Carcinoembryonic antigen. Ann Intern Med 1986; 104:66.
  39. Arnaud JP, Koehl C, Adloff M. Carcinoembryonic antigen (CEA) in diagnosis and prognosis of colorectal carcinoma. Dis Colon Rectum 1980; 23:141.
  40. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 1996; 14:2843.
  41. Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest 2005; 23:338.
  42. Nicholson BD, Shinkins B, Pathiraja I, et al. Blood CEA levels for detecting recurrent colorectal cancer. Cochrane Database Syst Rev 2015; :CD011134.
  43. Hara M, Kanemitsu Y, Hirai T, et al. Negative serum carcinoembryonic antigen has insufficient accuracy for excluding recurrence from patients with Dukes C colorectal cancer: analysis with likelihood ratio and posttest probability in a follow-up study. Dis Colon Rectum 2008; 51:1675.
  44. Zeng Z, Cohen AM, Urmacher C. Usefulness of carcinoembryonic antigen monitoring despite normal preoperative values in node-positive colon cancer patients. Dis Colon Rectum 1993; 36:1063.
  45. Bhattacharjya S, Aggarwal R, Davidson BR. Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen - a prospective study. Br J Cancer 2006; 95:21.
  46. Park IJ, Choi GS, Lim KH, et al. Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level. Ann Surg Oncol 2009; 16:3087.
  47. Minton JP, Hoehn JL, Gerber DM, et al. Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 1985; 55:1284.
  48. McCall JL, Black RB, Rich CA, et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum 1994; 37:875.
  49. Hine KR, Dykes PW. Serum CEA testing in the post-operative surveillance of colorectal carcinoma. Br J Cancer 1984; 49:689.
  50. Martin EW Jr, Cooperman M, Carey LC, Minton JP. Sixty second-look procedures indicated primarily by rise in serial carcinoembryonic antigen. J Surg Res 1980; 28:389.
  51. Bruinvels DJ, Stiggelbout AM, Kievit J, et al. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 1994; 219:174.
  52. Benson AB 3rd, Desch CE, Flynn PJ, et al. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 2000; 18:3586.
  53. Treasure T, Monson K, Fiorentino F, Russell C. The CEA Second-Look Trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer. BMJ Open 2014; 4:e004385.
  54. Kievit J, van de Velde CJ. Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation. A Markov analysis. Cancer 1990; 65:2580.
  55. Desch CE, Benson AB 3rd, Somerfield MR, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005; 23:8512.
  56. Duffy MJ, van Dalen A, Haglund C, et al. Clinical utility of biochemical markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines. Eur J Cancer 2003; 39:718.
  57. Anthony T, Simmang C, Hyman N, et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum 2004; 47:807.
  58. Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 2003; 124:544.
  59. Litvak A, Cercek A, Segal N, et al. False-positive elevations of carcinoembryonic antigen in patients with a history of resected colorectal cancer. J Natl Compr Canc Netw 2014; 12:907.
  60. Moertel CG, Fleming TR, Macdonald JS, et al. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993; 270:943.
  61. Alexander JC, Silverman NA, Chretien PB. Effect of age and cigarette smoking on carcinoembryonic antigen levels. JAMA 1976; 235:1975.
  62. Sajid KM, Parveen R, Durr-e-Sabih, et al. Carcinoembryonic antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers. J Pak Med Assoc 2007; 57:595.
  63. Guadagni F, Roselli M, Cosimelli M, et al. TAG-72 (CA 72-4 assay) as a complementary serum tumor antigen to carcinoembryonic antigen in monitoring patients with colorectal cancer. Cancer 1993; 72:2098.
  64. von Kleist S, Hesse Y, Kananeeh H. Comparative evaluation of four tumor markers, CA 242, CA 19/9, TPA and CEA in carcinomas of the colon. Anticancer Res 1996; 16:2325.
  65. Carpelan-Holmström M, Louhimo J, Stenman UH, et al. Estimating the probability of cancer with several tumor markers in patients with colorectal disease. Oncology 2004; 66:296.
  66. Kerber A, Trojan J, Herrlinger K, et al. The new DR-70 immunoassay detects cancer of the gastrointestinal tract: a validation study. Aliment Pharmacol Ther 2004; 20:983.
  67. Small-Howard AL, Harris H. Advantages of the AMDL-ELISA DR-70 (FDP) assay over carcinoembryonic antigen (CEA) for monitoring colorectal cancer patients. J Immunoassay Immunochem 2010; 31:131.
  68. Shimwell NJ, Wei W, Wilson S, et al. Assessment of novel combinations of biomarkers for the detection of colorectal cancer. Cancer Biomark 2010; 7:123.
  69. Cordero OJ, Imbernon M, Chiara LD, et al. Potential of soluble CD26 as a serum marker for colorectal cancer detection. World J Clin Oncol 2011; 2:245.
  70. Ayude D, Fernández-Rodríguez J, Rodríguez-Berrocal FJ, et al. Value of the serum alpha-L-fucosidase activity in the diagnosis of colorectal cancer. Oncology 2000; 59:310.
  71. Young GP, Pedersen SK, Mansfield S, et al. A cross-sectional study comparing a blood test for methylated BCAT1 and IKZF1 tumor-derived DNA with CEA for detection of recurrent colorectal cancer. Cancer Med 2016; 5:2763.
  72. Glimelius B, Påhlman L, Cervantes A, ESMO Guidelines Working Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v82.
  73. Graffner H, Hultberg B, Johansson B, et al. Detection of recurrent cancer of the colon and rectum. J Surg Oncol 1985; 28:156.
  74. Peethambaram P, Weiss M, Loprinzi CL, et al. An evaluation of postoperative follow-up tests in colon cancer patients treated for cure. Oncology 1997; 54:287.
  75. Jahn H, Joergensen OD, Kronborg O, Fenger C. Can Hemoccult-II replace colonoscopy in surveillance after radical surgery for colorectal cancer and after polypectomy? Dis Colon Rectum 1992; 35:253.
  76. Ahlquist DA, Wieand HS, Moertel CG, et al. Accuracy of fecal occult blood screening for colorectal neoplasia. A prospective study using Hemoccult and HemoQuant tests. JAMA 1993; 269:1262.
  77. New Zealand Guidelines Group: Guidance on surveillance for people at increased risk of colorectal cancer. http://www.health.govt.nz/publication/guidance-surveillance-people-increased-risk-colorectal-cancer (Accessed on November 22, 2013).
  78. Bleeker WA, Mulder NH, Hermans J, et al. Value and cost of follow-up after adjuvant treatment of patients with Dukes' C colonic cancer. Br J Surg 2001; 88:101.
  79. Jeffery GM, Hickey BE, Hider P. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2002; :CD002200.
  80. Tepper JE, O'Connell M, Hollis D, et al. Analysis of surgical salvage after failure of primary therapy in rectal cancer: results from Intergroup Study 0114. J Clin Oncol 2003; 21:3623.
  81. Chau I, Allen MJ, Cunningham D, et al. The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol 2004; 22:1420.
  82. Mortazavi A, Shaukat A, Othman E, et al. Postoperative computed tomography scan surveillance for patients with stage II and III colorectal cancer: worthy of further study? Am J Clin Oncol 2005; 28:30.
  83. Sobhani I, Tiret E, Lebtahi R, et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer 2008; 98:875.
  84. Ringland CL, Arkenau HT, O'Connell DL, Ward RL. Second primary colorectal cancers (SPCRCs): experiences from a large Australian Cancer Registry. Ann Oncol 2010; 21:92.
  85. Passman MA, Pommier RF, Vetto JT. Synchronous colon primaries have the same prognosis as solitary colon cancers. Dis Colon Rectum 1996; 39:329.
  86. Kahi CJ, Boland CR, Dominitz JA, et al. Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2016; 150:758.
  87. Safi F, Beyer HG. The value of follow-up after curative surgery of colorectal carcinoma. Cancer Detect Prev 1993; 17:417.
  88. Barillari P, Ramacciato G, Manetti G, et al. Surveillance of colorectal cancer: effectiveness of early detection of intraluminal recurrences on prognosis and survival of patients treated for cure. Dis Colon Rectum 1996; 39:388.
  89. Juhl G, Larson GM, Mullins R, et al. Six-year results of annual colonoscopy after resection of colorectal cancer. World J Surg 1990; 14:255.
  90. Green RJ, Metlay JP, Propert K, et al. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089. Ann Intern Med 2002; 136:261.
  91. Mulder SA, Kranse R, Damhuis RA, et al. The incidence and risk factors of metachronous colorectal cancer: an indication for follow-up. Dis Colon Rectum 2012; 55:522.
  92. Cali RL, Pitsch RM, Thorson AG, et al. Cumulative incidence of metachronous colorectal cancer. Dis Colon Rectum 1993; 36:388.
  93. Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 1997; 40:15.
  94. Ramsey SD, Howlader N, Etzioni R, et al. Surveillance endoscopy does not improve survival for patients with local and regional stage colorectal cancer. Cancer 2007; 109:2222.
  95. Fisher DA, Jeffreys A, Grambow SC, Provenzale D. Mortality and follow-up colonoscopy after colorectal cancer. Am J Gastroenterol 2003; 98:901.
  96. Rulyak SJ, Lieberman DA, Wagner EH, Mandelson MT. Outcome of follow-up colon examination among a population-based cohort of colorectal cancer patients. Clin Gastroenterol Hepatol 2007; 5:470.
  97. Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2006; 130:1865.
  98. Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol 1993; 88:825.
  99. Imperiale TF, Wagner DR, Lin CY, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000; 343:169.
  100. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004; 351:2704.
  101. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329:1977.
  102. Winawer SJ, Zauber AG, O'Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 1993; 328:901.
  103. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369:1095.
  104. Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med 2014; 174:1675.
  105. Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol 2012; 107:1495.
  106. Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly patient. Am J Gastroenterol 2011; 106:1197.
  107. Wilson JA. Colon cancer screening in the elderly: when do we stop? Trans Am Clin Climatol Assoc 2010; 121:94.
  108. Westwood M, Joore M, Grutters J, et al. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technol Assess 2013; 17:1.
  109. Piscaglia F, Nolsøe C, Dietrich CF, et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33:33.
  110. Tsikitis VL, Malireddy K, Green EA, et al. Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial. J Clin Oncol 2009; 27:3671.
  111. Chao M, Gibbs P. Caution is required before recommending routine carcinoembryonic antigen and imaging follow-up for patients with early-stage colon cancer. J Clin Oncol 2009; 27:e279.
  112. El-Shami K, Oeffinger KC, Erb NL, et al. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin 2015; 65:428.
  113. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42:1409.
  114. Stoffel EM, Mangu PB, Gruber SB, et al. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines. J Clin Oncol 2015; 33:209.
  115. Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Dis Colon Rectum 2014; 57:1025.
  116. Balmaña J, Balaguer F, Cervantes A, et al. Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 24 Suppl 6:vi73.
  117. Sieber OM, Lipton L, Crabtree M, et al. Multiple colorectal adenomas, classic adenomatous polyposis, and germ-line mutations in MYH. N Engl J Med 2003; 348:791.