Colorectal Cancer Guidelines
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Guidelines on colorectal screening have been issued by the following organizations:
While all the guidelines recommend routine screening for colorectal cancer and adenomatous polyps in asymptomatic adults starting at age 50, they differ with regard to frequency of screening and age at which to discontinue screening, as well as the preferred screening method. For high-risk patients, the recommendations differ regarding the age at which to begin screening, as well as the frequency and method of screening.
A joint guideline developed by the American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology recommends that screening for colorectal cancer and adenomatous polyps start at age 50 years in asymptomatic men and women. [1]
In addition, individuals with any of the following colorectal cancer risk factors should undergo colonoscopy at an earlier age and more frequently than average risk individuals:
Screening options for average-risk adults consist of tests that detect adenomatous polyps and cancer, and tests that primarily detect cancer. Any one of these tests can be used for screening.
Tests that detect adenomatous polyps and cancer, and their recommended frequency, include the following:
Tests that primarily detect cancer, and their recommended frequency, include the following:
In June 2017 the US Multi-Society Task Force on Colorectal Cancer issued updated screening recommendations that divide screening tests into three tiers, based upon their effectiveness. [2]
Tier 1 tests consist of the following:
Tier 2 tests consist of the following:
Tier 3 testing is capsule colonoscopy every 5 years. Septin 9 testing is not recommended.
Suggested timing of initial screening and intervals for subsequent testing for different risk populations are as follows:
For patients with a family history of colorectal cancer or advanced adenoma that was diagnosed before age 60 years in one first-degree relative or at any age in two first-degree relatives, testing should begain with colonoscopy at an age10 years younger than the youngest age at diagnosis of a first-degree relative, or age 40, to be repeated every 5 years.
In patients with one first-degree relative with colorectal cancer, advanced adenoma, or an advanced serrated lesion diagnosed at age 60 or older, screening should begin with a tier 1 test at age 40 and continue at the same intervals as inaverage-risk patients.
Colonoscopy screening should be discontinued in patients aged 75 or older with prior negative screening tests or whose life expectancy is less than 10 years, or in those 85 years or older without prior screening.
American Cancer Society update
In May 2018 the ACS revised its colorectal screening guidelines, advising that regular screening for people at average risk start at age 45 years. [3] Additional ACS recommendations include the following:
The USPSTF recommends that screening for colorectal cancer start at age 50 years and continue until age 75 years (A recommendation). For adults aged 76 to 85 years, the decision to screen should be individualized, taking into account the patient’s overall health and prior screening history (C recommendation). [4]
The USPSTF advises that screening is more likely to benefit older patients who have never been screened than those who have undergone screening, and is more likely to benefit patients who are healthy enough to undergo treatment for colorectal cancer treatment and who do not have other medical conditions limiting their life expectancy. [4]
The USPSTF does not recommend colorectal cancer screening for adults older than 85 years. [4]
The USPSTF notes that colorectal screening is substantially underused. As part of a strategy to increase screening rates, the guidelines provide a range of screening options rather than a ranking of tests.
Stool-based screening tests and intervals are as follows:
Direct visualization screening tests and intervals are as follows:
In 2015, the American College of Physicians recommended that average-risk adults aged 50 to 75 years should be screened for colorectal cancer by one of the following strategies [5] :
Interval screening with fecal testing or flexible sigmoidoscopy in adults having 10-year screening colonoscopy is not recommended. Average-risk adults younger than 50 years, older than 75 years, or with an estimated life expectancy of less than 10 years should not be screened.
The guidelines of the American College of Gastroenterology make a distinction between screening tests for cancer prevention and those for cancer detection. [6] The specific guidelines for colorectal cancer screening are as follows:
Alternative cancer detection tests recommended in the ACG guidelines are as follows:
Alternative cancer detection tests in the ACG guidelines are as follows:
For screening purposes, patients with one first-degree relative diagnosed with colorectal cancer or advanced adenoma at age 60 years or older are considered at average risk. For patients with a single first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60 years, or those with two first-degree relatives with colorectal cancer or advanced adenomas, the guideline recommends colonoscopy every 5 years, beginning at age 40 years or at 10 years younger than the age at diagnosis of the youngest affected relative.
The National Comprehensive Cancer Network (NCCN) has released separate guidelines for average-risk and high-risk individuals. [7, 8] For average individuals, the recommendations are nearly identical to those of the joint American Cancer Society (ACS), US Multi-Society Task Force on Colorectal Cancer, and American College of Radiology.
The NCCN criteria for average risk are as follows [7]
The NCCN guidelines provide screening recommendations for patients at increased risk due to any of the following [7] :
The guidelines also specify recommendations for patients with the following high-risk syndromes [8] :
Individuals meeting one or more of the following criteria should receive further evaluation for high-risk syndromes:
Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is a common autosomal dominant syndrome characterized by early age at onset, neoplastic lesions, and microsatellite instability (MSI). Guidelines for Lynch syndrome screening have been developed by the National Cancer Institute (Bethesda guidelines) and the NCCN. [9]
The American Gastroenterological Association recommends testing all patients with colorectal cancer for Lynch syndrome. The tumor should be tested for MSI or with immunohistochemistry for MLH1, MSH2, MSH6, and PMS2 proteins. [10]
The European Society for Medical Oncology (ESMO) guidelines for familial risk-colorectal cancer [11] , which have been endorsed by the American Society of Clinical Oncology (ASCO) [12] includes the following recommendations:
If loss of MLH1/PMS2 protein expression is observed, analysis of BRAF V600E mutation or analysis of methylation of the MLH1 promoter should be conducted to rule out a sporadic case. If tumor is MMR deficient and somatic BRAF mutation is not detected or MLH1 promoter methylation is not identified, testing for germline mutations is indicated.
If loss of any of the other proteins (MSH2, MSH6, PMS2) is observed, germline genetic testing should be carried out for the genes corresponding to the absent proteins (eg, MSH2, MSH6, EPCAM, PMS2, or MLH1).
Full germline genetic testing for Lynch syndrome should include DNA sequencing and large rearrangement analysis.
The American College of Gastoenterology recommendations are in general agreement with ESMO. [13]
Revised Bethesda guidelines for Lynch syndrome and microsatellite instability
Because cancers with MSI account for approximately 15% of all colorectal cancers, in 1996 the National Cancer Institute developed the Bethesda guidelines for the identification of individuals with HNPCC who should be tested for MSI. These guidelines were most recently revised in 2002. [14]
The American College of Gastroenterology has published guidelines for surveillance of patients who have had adenomas detected and removed at colonoscopy. [15]
These patients should have more frequent followup, as they are at increased risk for developing metachronous adenomas or colon cancer.
Colonoscopy findings and recommended scheduling of followup colonoscopy are as follows:
For serrated lesions, recommended surveillance intervals are as follows:
The European Society of Medical Oncology offers the following recommendations for surveillance of patients with familial adenomatous polyposis (FAP) [11] :
Classic FAP
Colon and rectum: Sigmoidoscopy (or colonoscopy) every 1 to 2years, starting at age 10 to 11 years and continued lifelong in mutation carriers. Once adenomas are detected, annual colonoscopy until colectomy. Surgery is indicated if there are large numbers of adenomas, including adenomas showing a high degree of dysplasia.
Gastroduodenal adenomas: Gastroduodenal endoscopy starting when colorectal polyposis is diagnosed or at age 25 to 30 years, whichever comes first. Surveillance intervals are based on the Spigelman stage.
Thyroid cancer: Consider annual cervical ultrasonography starting at age 25 to 30 years.
Desmoid tumors: Consider baseline computed tomography (CT) or magnetic resonance imaging (MRI) scan in presence of risk factors (positive family history for desmoids and site of the mutation in APC).
Attenuated FAP
Colon and rectum: Colonoscopy every 1 to 2 years, starting at age 18 to 20 years and continued lifelong in mutation carriers. Once adenomas are detected, colonoscopy should be carried out annually.
Gastroduodenal adenomas: Gastroduodenal endoscopy starting when colorectal polyposis is diagnosed or at age 25 to 30 years, whichever comes first. Surveillance intervals are based on the Spigelman stage.
Thyroid cancer: Annual cervical ultrasonography may be consideredstarting at age 25 to 30 years.
Desmoid tumors: A baseline CT scan or MRI should be considered if risk factors (positive family history for desmoids and site of the mutation in APC).
The American Society of Colon and Rectal Surgeons recommends that patients with familial adenomatous polyposis (FAP) or with personal or family risk factors for FAP be referred to center registries and genetic counselors with experience in the multidisciplinary management of these individuals. [16]
Additional recommendations include the following:
The American Society of Colon and Rectal Surgeons practice parameters for the management of colon cancer recommend colectomy as the primary treatment for localized resectable colon cancer. [17]
Additional recommendations are as follows:
National Comprehensive Cancer Network (NCCN) guidelines also recommend colectomy, with en bloc removal of regional lymph nodes, for treatment of resectable, nonobstructing colon cancer. [9] In addition, for clinical T4b disease, neoadjuvant chemotherapy may be considered. The NCCN states that laparoscopic-assisted colectomy may be considered, based upon the following criteria:
NCCN recommendations for lymphadenectomy are as follows [9] :
The American Society of Colon and Rectal Surgeons (ASCRS) defines rectal cancer as cancer located within 15 cm of the anal verge by rigid proctoscopy. ASCRS 2013 revised management guidelines and practice parameters recommend that patients with low-risk, early-stage rectal cancer be treated with primary surgical therapy. Treatment of locally advanced or high-risk disease should include neoadjuvant radiation or chemoradiation followed by surgery. [18]
Additional recommendations include the following [18] :
National Comprehensive Cancer Network (NCCN) guidelines recommend the use of as many chemotherapy drugs as possible to maximize the effect of adjuvant therapies for colon and rectal cancer. [9, 19]
The American Society of Clinical Oncology does not recommend the routine use of adjuvant chemotherapy for patients with stage II colon cancer, and instead recommends encouraging these patients to participate in clinical trials. [20]
According to the NCCN, stage I (T1-2, N0, M0) rectal cancer patients do not require adjuvant therapy due to their high cure rate with surgical resection. High-risk patients, including those with poorly differentiated tumor histology and those with lymphovascular invasion, should be considered for adjuvant chemotherapy and radiotherapy.
The NCCN guidelines recommend combination therapy with infusional fluorouracil, folinic acid, and oxaliplatin (FOLFOX) as reasonable for patients with high-risk or intermediate-risk stage II disease; however, FOLFOX is not indicated for good- or average-risk stage II rectal cancer.
Adjuvant chemotherapy is encouraged for eligible patients with stage III disease. NCCN recommendations for stage III treatment vary according to risk status. For low-risk stage III colon cancer (T1-3, N1), preferred treatments are as follows [9] :
For high-risk stage III colon cancer (T4, N1-2; T any, N2), preferred treatment recommendations include the following:
For both low-risk and high-risk colon cancer, other options include capecitabine or 5-fluorouracil (5-FU) for 6 months.
For more information on chemotherapy regimens, see Colon Cancer Treatment Protocols. For the majority of patients with stage II or stage III rectal cancer, the NCCN recommends the use of ionizing radiation to the pelvis along with adjuvant chemotherapy. Either of the two following sequences of therapy may be used:
The NCCN advises that the total duration of perioperative therapy, including chemoradiation therapy and chemotherapy, should not exceed 6 months.
Guidelines on follow-up care for survivors of stage II and stage III colorectal cancer were issued by the following organizations:
All four guidelines agree that patients with resected colon cancer (stage II and III) should undergo regular surveillance for at least 5 years following resection, and that surveillance should include regular reviews of medical history, physical examination, and carcinoembryonic antigen assays, as well as colonoscopy and abdominal and chest computed tomography (CT [21, 22, 9, 23] The frequency of the surveillance testing differs as shown in the table below.
Table.1 (Open Table in a new window)
Parameter
Organization
ESMO (2013) [22]
ASCO (2013) [24]
NCCN (2016) [9]
ASCRS (2015) [23]
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
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
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
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, and 5 y if negative
At y 1 after surgery, and every 3-5 y dictated by the findings on the first postoperative examination.
Abdominal CT*
Every 6-12 mo for first 3 y
Every 1 y for 3 y
Every 1 y for 5 y; scans to include pelvis
Every 1 y for 5 y
ESMO = European Society for Medical Oncology; ASCO = American Society of Clinical Oncology; NCCN = National Comprehensive Cancer Network; American Society of Colon and Rectal Surgeons = ASCRS 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.
In 2016, the US Multi-Society Task Force on Colorectal Cancer issued guidelines on colonoscopy after colorectal cancer resection, which included the following recommendations [24] :
Guidelines on molecular biomarker testing for the evaluation of colorectal cancer (CRC) from the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology include the following recommendations [25] :
The 2016 European Society for Medical Oncology (ESMO) guidelines for the management of patients with metastatic CRC (mCRC) include the following recommendations on biomarker testing [26] :
The ESMO guidelines do not recommend the following emerging biomarkers for routine patient management outside of a clinical trial setting:
Overview
Which organizations have issue guidelines on colorectal cancer screening?
What are tests primarily detect cancer in colorectal cancer screening?
What are the ACS colorectal screening guidelines?
What are the USPSTF colorectal screening guidelines?
What are the ACP colorectal screening guidelines?
What are the ACG colorectal screening guidelines?
What are the NCCN criteria for average risk individuals for colorectal cancer screening?
What are the NCCN criteria for increased or high-risk individuals for colorectal cancer screening?
What are NCCN criteria for the evaluation of high-risk syndromes in colorectal cancer screening?
What is hereditary nonpolyposis colorectal cancer (HNPCC) (Lynch syndrome)?
What are the ESMO guidelines for familial risk-colorectal cancer screening?
What are the ACG guidelines for postpolypectomy surveillance?
What are the ESMO guidelines for surveillance of classic familial adenomatous polyposis (FAP)?
What are the ESMO guidelines for surveillance of attenuated familial adenomatous polyposis (FAP)?
What are the American Society of Colon and Rectal Surgeon treatment guidelines for colon cancer?
What are the NCCN treatment guidelines for colon cancer?
What are the American Society of Colon and Rectal Surgeon treatment guidelines for rectal cancer?
What are the NCCN guidelines on chemotherapy for colorectal cancers?
What are the ESMO treatment guidelines for metastatic colorectal cancer?
[Guideline] Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008 May-Jun. 58 (3):130-60. [Medline].
[Guideline] Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017 Jun 6. [Medline].
[Guideline] American Cancer Society Guideline for Colorectal Cancer Screening. American Cancer Society. Available at https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html. May 30, 2018; Accessed: May 30, 2018.
[Guideline] US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation. JAMA. June 16, 2016. [Full Text].
[Guideline] Wilt TJ, Harris RP, Qaseem A, High Value Care Task Force of the American College of Physicians. Screening for cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2015 May 19. 162 (10):718-25. [Medline]. [Full Text].
[Guideline] Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009 Mar. 104 (3):739-50. [Medline].
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer Screening. NCCN. Available at http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Version 1.2018 — March 26, 2018; Accessed: May 30, 2018.
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High Risk Assessment: Colorectal. Version 2.2016. NCCN. Available at http://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf. September 26, 2016; Accessed: March 24, 2017.
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Available at http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. ersion 2.2017 — March 13, 2017; Accessed: March 24, 2017.
[Guideline] Rubenstein JH, Enns R, Heidelbaugh J, Barkun A, Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Lynch Syndrome. Gastroenterology. 2015 Sep. 149 (3):777-82. [Medline]. [Full Text].
[Guideline] Balmaña J, Balaguer F, Cervantes A, Arnold D, ESMO Guidelines Working Group. Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2013 Oct. 24 Suppl 6:vi73-80. [Medline]. [Full Text].
[Guideline] Stoffel EM, Mangu PB, Gruber SB, Hamilton SR, Kalady MF, Lau MW, 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 Jan 10. 33 (2):209-17. [Medline]. [Full Text].
[Guideline] Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015 Feb. 110 (2):223-62; quiz 263. [Medline]. [Full Text].
Umar A, Boland CR, Terdiman JP, Syngal S, de la Chapelle A, Rüschoff J, et al. Revised Bethesda Guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability. J Natl Cancer Inst. 2004 Feb 18. 96 (4):261-8. [Medline].
[Guideline] Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep. 143 (3):844-57. [Medline]. [Full Text].
Church J, Simmang C, Standards Task Force, American Society of Colon and Rectal Surgeons, Collaborative Group of the Americas on Inherited Colorectal Cancer and the Standards Committee of The American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer). Dis Colon Rectum. 2003 Aug. 46 (8):1001-12. [Medline].
Chang GJ, Kaiser AM, Mills S, Rafferty JF, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012 Aug. 55 (8):831-43. [Medline].
Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013 May. 56 (5):535-50. [Medline].
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Rectal Cancer V.1.2016. Available at http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed: March 11, 2016.
Benson AB 3rd, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004 Aug 15. 22 (16):3408-19. [Medline].
Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, 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 Dec 10. 31 (35):4465-70. [Medline].
Labianca R, Nordlinger B, Beretta GD, Mosconi S, Mandalà M, Cervantes A, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct. 24 Suppl 6:vi64-72. [Medline].
[Guideline] Steele SR, Chang GJ, Hendren S, Weiser M, Irani J, Buie WD, et al. Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer. Dis Colon Rectum. 2015 Aug. 58 (8):713-25. [Medline]. [Full Text].
[Guideline] Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016 Mar. 150 (3):758-768.e11. [Medline]. [Full Text].
[Guideline] Sepulveda AR, Hamilton SR, Allegra CJ, Grody W, Cushman-Vokoun AM, Funkhouser WK, et al. Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology. Arch Pathol Lab Med. 2017 Feb 6. 19 (2):187-225. [Medline].
[Guideline] Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016 Aug. 27 (8):1386-422. [Medline]. [Full Text].
Parameter
Organization
ESMO (2013) [22]
ASCO (2013) [24]
NCCN (2016) [9]
ASCRS (2015) [23]
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
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
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
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, and 5 y if negative
At y 1 after surgery, and every 3-5 y dictated by the findings on the first postoperative examination.
Abdominal CT*
Every 6-12 mo for first 3 y
Every 1 y for 3 y
Every 1 y for 5 y; scans to include pelvis
Every 1 y for 5 y
ESMO = European Society for Medical Oncology; ASCO = American Society of Clinical Oncology; NCCN = National Comprehensive Cancer Network; American Society of Colon and Rectal Surgeons = ASCRS 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.
Elwyn C Cabebe, MD Physician Partner, Valley Medical Oncology Consultants; Medical Director of Oncology, Clinical Liason Physician, Cancer Care Committee, Good Samaritan Hospital
Elwyn C Cabebe, MD is a member of the following medical societies: American Association for Cancer Research, American Society of Clinical Oncology, Philippine Medical Society of Northern California, Santa Clara County Medical Association, Monterey County Medical Society, Association of Northern California Oncologists
Disclosure: Nothing to disclose.
N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center
N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society
Disclosure: Nothing to disclose.
Mariclaire Cloutier Freelance editor, Medscape Drugs & Diseases
Disclosure: Nothing to disclose.
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