Watching for recurrence in colorectal cancer survivors

This review explored the most appropriate surveillance methods for detecting and reducing mortality associated with recurrences (return of the cancer) of colorectal cancer.

Due to treatment advances and lowering death rates, there are increasing numbers of colorectal cancer survivors. Therefore, appropriate surveillance methods are essential to monitor for a recurrence, although it is also important that these methods do not interfere greatly with the patient’s life. Current guidelines set by the National Comprehensive Cancer Network include clinical examinations every 3–6 months for the 2 years following surgical resection (removal of the tumor), annual colonoscopies (visual examination of the inner lining of the large intestine using a thin tube with a camera inserted through the anus), and, depending on the type and stage of the cancer, blood tests or imaging tests such as computed tomography (CT scans). The current review focused on the effectiveness of this surveillance schedule in the early detection of recurrences and metastases (spread of the cancer to distant organs and tissues of the body), and whether they lead to a decrease in colorectal cancer mortality.

Eight studies were reviewed which examined whether early detection of recurrences led to more positive outcomes, by comparing patients undergoing intensive versus less intensive surveillance programs. While the programs varied by study, intensive surveillance included more tests occurring more often than in the less intensive programs. When the results of the eight studies were combined, recurrences were detected in 29% of the intensively followed patients and 29% of the less intensively followed patients. However, intensive surveillance was more likely to discover asymptomatic (the patient shows no symptoms related to the cancer) recurrences than was a less intensive surveillance (19% versus 6%). One study found that in patients with lung metastases, 66% of the intensively followed patients were still alive after 5 years, versus 0% of the less intensively followed patients. Another study noted that recurrences found through colonoscopy had the highest resectability rates, as did those found through liver-focused imaging, such as CT scans or ultrasound (the use of sound waves to make pictures of the body).

The recommendations based on this review include surveillance that is based on the risk of recurrence. Therefore, surveillance should focus on recurrences that could be resected, in patients that would be able to undergo surgery. Surveillance procedures should include colonoscopies, liver imaging, and measures of carcinoembryonic antigen or CEA (a protein which is elevated in some cancers such as colorectal cancer).

This review concluded that intensive surveillance can be effective in detecting recurrences, particularly in patients that are asymptomatic, and in increasing long-term survival rates in patients with colorectal cancer. The intensity of surveillance used should ideally be tailored to an individual patient.

Discuss with your physician the appropriate surveillance methods and schedule for your situation.