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ASCO Patient Guide: Follow-Up Care for Colorectal Cancer
Introduction
2005
To help doctors give their patients the best possible care, ASCO asks its medical experts to review the latest research on issues in cancer care and develop recommendations called clinical practice guidelines. ASCO recently updated a clinical practice guideline about follow-up care for patients with stage II or III colorectal cancer. To help people living with cancer understand their cancer care, ASCO created this patient guide, which is based on ASCO's recommendations for follow-up care for colorectal cancer.
As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.
Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product or company.
Last Updated: October 31, 2005
Background
In 2000, ASCO issued clinical practice guidelines for follow-up care for people with colorectal cancer to help reduce the risk of recurrence (return of the cancer). These guidelines were updated in 2005 to reflect changes in the treatment and monitoring of colorectal cancer.
Last Updated: October 31, 2005
Recommendations
The primary goal of follow-up examinations is to find a recurrence that can be removed. ASCO's recommendations for follow-up care for people with stage II or III colorectal cancer, including a table summarizing the recommendations, are listed below.
Regular visits with your doctor. Most colorectal cancer recurrences develop within five years after surgery. Doctor visits are recommended every three to six months for the first three years, every six months during years four and five, and as often as you and your doctor decide after five years. Regularly scheduled visits have several purposes. They help increase the likelihood of finding a treatable recurrence or may provide you some reassurance about your situation. These visits also permit you and your doctor to discuss any new findings related to follow up or risk of other cancers in you and your family.
Discussing your risk of recurrence is an important part of your post-treatment appointments. Web-based prediction tools are now available to help your doctor better estimate the risk of recurrence. Knowing this information helps the doctor develop an appropriate follow-up care plan. Using these guidelines as a starting point, talk with your doctor about what tests you need and how often you need them so that you have the best chance of detecting recurrence at an early, treatable stage.
Carcinoembryonic antigen (CEA) test. The CEA test is a blood test. High levels of CEA may indicate that a cancer has spread to other parts of the body. The CEA test should be done every three months in patients with stage II or III colorectal cancer for at least three years after diagnosis once adjuvant therapy (chemotherapy given after surgery) is finished.
Computerized tomography (CT) scan. A CT scan creates an image of the inside of the body. For patients who have a higher risk of recurrence and may be good candidates for surgical removal of a secondary tumor, a CT scan of the chest and abdomen for the first three years is recommended. A CT scan of the pelvis is recommended for patients who are at high risk for rectal cancer recurrence, especially those who have not had radiation therapy. Talk with your doctor to develop a plan based on your risk of recurrence.
Colonoscopy. This test allows the doctor to look for polyps or second cancers in the entire rectum and colon with a colonoscope (lighted tube). Following surgery, a colonoscopy is recommended at three years and then, if normal, every five years thereafter. Some patients, however, such as those with high-risk hereditary colorectal cancer syndromes, may require more frequent colonoscopy screening. Talk with your doctor about an appropriate schedule for colonoscopy testing, based on your medical history and risk of recurrence.
Flexible proctosigmoidoscopy. This test is used to check for polyps, second cancers, and other abnormalities. During a flexible proctosigmoidoscopy, a sigmoidoscope (lighted tube) is inserted into the rectum and lower colon. Patients with stage II or III rectal cancer who did not have radiation treatment of the pelvic area should have a proctosigmoidoscopy every six months for five years.
The following tests are not currently recommended by ASCO for regular follow-up care because there is not enough scientific evidence to support a recommendation:
- A complete blood count (CBC) test or liver function tests
- A fecal occult blood test, which is a test that looks for blood in the stool
In previous versions of the guideline, the value of chest x-rays was unclear. However, now that annual CT scans of the chest and abdomen are recommended (as described above), routine chest x-rays are probably not relevant.
Follow-Up Care Recommendations for Colorectal Cancer by Years After Treatment
Follow-Up Care Recommendation
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Year 1
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Year 2
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Year 3
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Years 4 and 5*
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Doctor's Visit
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Every three to six months
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Every three to six months
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Every three to six months
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Every six months
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CEA test
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Every three months
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Every three months
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Every three months
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As determined by your doctor
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CT scan (chest and abdomen)
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Every year, if recommended by your doctor
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Every year, if recommended by your doctor
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Every year, if recommended by your doctor
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As determined by your doctor
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CT scan (pelvis) (rectal cancer only)
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Every year, if recommended by your doctor
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Every year, if recommended by your doctor
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Every year, if recommended by your doctor
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As determined by your doctor
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Colonoscopy
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Once†
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At three years
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Proctosigmoidoscopy (rectal cancer only)
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Every six months (for patients who did not have pelvic radiation treatment) for five years
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* After five years, the need for future tests and visits are decided by the patient and doctor.
† A colonoscopy should be done around the time of surgery. If the examination shows no signs of a recurrent tumor or polyps, a colonoscopy should be done at three years, and if normal, every five years thereafter.
What this means for patients
These guidelines are designed to help patients and their doctors develop a plan for reducing the risk of colorectal cancer recurrence. Because each patient's risk of recurrence is different, you and your doctor are the best people to determine how to apply these guidelines to your situation. For example, one patient at higher risk may require CT scans, whereas another patient at lower risk may not. Or, a person with a hereditary colorectal cancer syndrome may require additional colonoscopies compared with someone without a hereditary cancer syndrome. Use these guidelines to start a discussion with your doctor about an appropriate follow-up care plan that is right for you.
Last Updated: October 31, 2005
Questions to Ask the Doctor
To learn more about follow-up care for colorectal cancer, consider asking your doctor the following questions: - Can you recommend a follow-up care plan for me?
- What is my risk of recurrence?
- How often do you recommend office visits?
- Do you recommend CT scans? If so, how often?
- How often do I need a colonoscopy?
- How often do I need a proctosigmoidoscopy (rectal cancer only)
- Can we discuss ways to monitor any long-term effects of cancer treatment?
- Where can I find more information about follow-up care?
Last Updated: October 31, 2005
Helpful Links and Resources
Helpful links
Read the entire clinical practice guideline published in the Journal of Clinical Oncology (JCO)
Cancer.Net Guide to Colorectal Cancer
Resources
Cancer.Net (www.cancer.net) is the comprehensive, oncologist-approved cancer information website from ASCO. Visit Cancer.Net to find guides on more than 85 types of cancer, clinical trials information, coping resources, information on managing side effects, a live online chat series, medical illustrations, cancer information in Spanish, the latest cancer news, and much more. For more information about ASCO's patient information resources, call toll free 888-651-3038.
American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA 30329
Toll Free: 800-ACS-2345 (800-227-2345)
www.cancer.org
American Gastroenterological Association
National Office
4930 Del Ray Ave.
Bethesda, MD 20814
Phone: 301-654-2055
Fax: 301-654-5920
www.gastro.org
CancerCare
275 Seventh Ave.
New York, NY 10001
Toll Free: 800-813-HOPE (800-813-4673)
www.cancercare.org
Colon Cancer Alliance
175 Ninth Ave.
New York, NY 10011
Toll Free: 877-422-2030
www.ccalliance.org
Colorectal Cancer Coalition (C-three)
4301 Connecticut Ave. NW, Ste. 404
Washington, DC 20008
Phone: 202-244-2906
www.c-three.org
Colorectal Cancer Network
P.O. Box 182
Kensington, MD 20895-0182
Phone: 301-879-1500
www.colorectal-cancer.net
Hereditary Colon Cancer Association
H/516 (5124) CSC
600 Highland Ave.
Madison, WI 53792-5124
Phone: 608-263-1017
Fax: 608-280-7292
www.hereditarycc.org
National Cancer Institute
NCI Public Inquiries Office, Ste. 3036A
6116 Executive Blvd., MSC8322
Bethesda, MD 20892-8322
Toll Free: 800-4-CANCER (800-422-6237)
www.cancer.gov
© Copyright 2005 American Society of Clinical Oncology. For permissions information, contact permissions@asco.org.
Last Updated: October 31, 2005
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