Why should there be a postoperative follow-up program?
Surgery is the most effective treatment for colorectal cancer. Even when all visible cancer has been removed, it is possible for cancer cells to be present in other areas of the body.
Microscopic cancer deposits are undetectable at the time of surgery, but they can begin to grow at a later time. The chance of recurrence depends on the stage and other characteristics of the original cancer. Recurrence may also be affected by the effectiveness of other treatments such as chemotherapy and radiation. Patients with recurrent cancers, if diagnosed early, may benefit or be cured by further surgery or other treatments.
In addition to recurrent cancers, at least one in five patients with a history of colon or rectal cancer will develop a new polyp at a later time in life. It is important to detect and remove these polyps before they become cancerous.
The goals of a postoperative follow-up program are to identify recurrent cancer and prevent new cancers by removing any polyps that may develop.
How long will my follow-up program last?
Most recurrent cancers are detected within the first 2 years after surgery. Therefore, follow-up is most frequent during this period of time. After 5 years, nearly all cancers that are going to recur will have done so. Follow-up after 5 years is primarily to detect new polyps.
Does the state of my initial cancer affect my follow-up?
Early stage disease (Stage 1, no lymph node involvement) may involve little postoperative intervention, and some cancer specialists minimize the number of tests and visits. Stage 3 and 4 of the disease (spread to lymph nodes or beyond) usually involves postoperative chemotherapy and, as a result of the higher risk recurrence, requires much more intensive follow-up. Patients with Stage 2 disease typically receive similar surveillance to patients with Stages 3 and 4. Your doctor will determine the extent of your follow-up visits.
What might I expect at my follow-up visit?
Your doctor will examine you approximately every 3 to 4 months for the first 2 years and discuss your progress. Your doctor may ask questions about any symptoms you are experiencing or changes in your bowel habits. A physical examination is a routine part of the followup visit. A carcinoembryonic antigen (CEA) blood test is usually obtained to assist in the detection of cancer recurrence. CEA is a protein that is often elevated in the blood of individuals with metastatic colorectal cancer. Additional follow-up examinations may include other blood tests, flexible sigmoidoscopy (an examination of the rectum and lower colon with a flexible, lighted instrument), colonoscopy (examination of the entire colon with a long flexible instrument), CT scans, PET scans, MRls or ultrasound tests.
What happens if a recurrence is found?
If a recurrence is found during regular follow-up, your cancer specialist and your colorectal surgeon will work together to determine how extensive it is. Most likely, imaging tests, such as a CT or PET scan, will be performed to determine whether there has been additional distant spread. If the recurrence is distant from the original tumor, or in more than one area, this is usually treated initially with chemotherapy. If the recurrence is local, it may be possible to treat it with another surgery. If your original cancer was in the colon (not the rectum), it is more likely that this local recurrence will be able to be removed.
What about my family?
Close relatives of patients with colon and rectal cancer (parents, brothers, sisters, and children) are at increased risk for the disease. Therefore, periodic colonoscopies are usually advised. If polyps ‘are promptly detected and removed, cancers are less likely to develop. Other factors that may increase the risk of developing polyps or colorectal cancer include cancer occurring at an early age and a personal history of breast or female gynecological cancer.