Post-treatment surveillance includes serial CEA tests, and periodic chest, abdominal and pelvic CT scans and colonoscopic evaluation.3 Current Australian guidelines outline the following rationale for follow up after curative resection for colorectal cancer:7
- Detection of second primary tumours
The incidence of metachronous primary colorectal cancers and adenomatous polyps four years after curative surgery was 7.7% and 62% respectively.
- Early detection of recurrence
About one in three people who have curative surgery for colorectal cancer will die as a result of recurrent disease. Improved outcomes may be obtained through detection of recurrence at an earlier and potentially curable stage, such as in an asymptomatic person with resectable suture-line recurrence, or resectable liver and lung metastases. An easy-to-use tool has recently been designed to predict the likelihood of colon cancer recurrence after curative surgery. The use of such a tool may aid in individual recurrence monitoring.30
Treatment options will depend on the location and extent of the recurrence and on previous management. Treatment may include surgery, radiotherapy, and/or drug therapy.24
A follow up audit provides information on clinical outcomes so clinicians can evaluate their practice against professional standards. National outcomes data can also assess the impact of new guidelines and the introduction of alternative therapies.
- Individual preference
Follow up may provide reassurance, or it may cause increased anxiety. So, it's important to consider each individual's preference.
Access the Clinical practice guidelines for management of colorectal cancer (PDF, 207KB)7 and identify the role and indications for the following follow up investigations:
- serum CEA levels
- CT scan of the liver
- chest x-ray
- PET scan
- follow up care plans.
Discuss the feasibility, strengths, and limitations of a nurse-led model of follow up care for people following treatment for colorectal cancer.