Guidelines for colonoscopy surveillance after removal of colorectal cancer

This review presents the recommendations of The American Cancer Society and the US Multi-Society Task Force on the use of colonoscopy for the follow up of patients with resected colorectal cancer (CRC).

Patients who undergo surgery for CRC with curative-intent (complete removal of the cancer) are candidates for surveillance (observation) colonoscopy in order to detect early recurrences. A colonoscopy is a procedure doctors use to look at the inner lining of the large intestine (colon and rectum). It uses a thin, flexible tube with a camera (colonoscope) that is guided into the large intestine, from the rectum to the small bowel. This test helps to see abnormal growths, ulcers, bleeding and inflamed areas of the large intestine and checks for early signs of cancer. Colonoscopy can serve as treatment by removing polyps or confined (stage I) CRC. It can also be used to detect early recurrences of CRC or the presence of metachronous cancers (MC) (any cancer that develops after the first cancer but did not originate from it).

The study reviewed the medical literature and included 23 studies involving CRC patients who had undergone surgery and were observed by colonoscopy. Out of the 9029 patients included, there were 137 MC discovered through colonoscopy. 56% of patients with MC did not have any symptoms before the procedure and 87% eventually had surgery to cure the MC.

These findings were considered enough to recommend that patients with resected CRC undergo a colonoscopy 1 year after removal of the cancer in order to look for MC. If this examination is normal, another colonoscopy is advised after 3 years. If it is also normal, the next colonoscopy should be performed after 5 years. If patients experience any symptoms or have personal/family history that suggests a hereditary cancer, colonoscopies should be performed more frequently following the initial examination.

Because rectal cancer recurrence is more frequent, regular rectal examinations every 3-6 months in the first 2-3 years after surgery are recommended in addition to colonoscopies.

The limitations of this review stem from the variety of parameters measured in the studies included. The definition for MC was not the same in all studies and also, not all studies separated recurrences from MC.
 

You should talk to your doctor to determine the best follow up plan for you.