eMedicine Specialties > Oncology > Carcinomas of the Gastrointestinal Tract

Colon Cancer, Adenocarcinoma: Follow-up

Author: Tomislav Dragovich, MD, PhD, Associate Professor of Medicine and Director of Clinical Gastroenterology Oncology Program, Arizona Cancer Center, University of Arizona College of Medicine
Coauthor(s): Vassiliki L Tsikitis, MD, Assistant Professor of Surgery, Section of Surgical Oncology, University of Arizona Medical Center
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

Further Outpatient Care

Pooled analysis form several large adjuvant trials reported that 85% of colon cancer recurrences occur within 3 years from after resection of primary tumor. Therefore, patients with resected colon cancer (stage II and III) should undergo regular surveillance for at least 5 years following resection. An update of American Society of Clinical Oncology (2005) recommends physical examinations every 3-6 months for the first 3 years, every 6 months during years 4 and 5, and subsequently at the discretion of physician and based on individual risk assessment.

Serum CEA level should be checked every 3 months in patients with stage II or III disease for at least 3 years and every 6 months in years 4 and 5. Computerized tomography (CT) of the chest and abdomen should be performed annually for at least 3 years after resection of primary tumor. All patients with colon cancer should have preoperative or postoperative colonoscopy to document absence of additional primary colon tumors or polyps. In the absence of high-risk pathology on the first colonoscopy or increased susceptibility for colon cancer, follow-up colonoscopy should be performed at 3 years after surgery and then, if normal, once every 5 years thereafter.

Deterrence/Prevention

Colorectal cancer prevention strategies are based on our understanding of colorectal carcinogenesis and availability of pharmacologic agents that are effective yet minimally toxic. The efficacy of these agents is usually first tested in high-risk populations.

Celecoxib (Celebrex), a selective cyclooxygenase-2 inhibitor was first tested in patients with familial adenomatous polyposis (FAP). Celecoxib was effective in decreasing the number and size of polyps on serial colonoscopies, which was the primary surrogate endpoint for this trial. The drug was approved for FAP patients, although it remains to be seen if this intervention translates to reduced cancer incidence and prolonged survival.

Other NSAIDs, such as sulindac and nonselective cyclooxygenase inhibitors were tested in lower risk populations.  Enthusiasm for cyclooxygenase-2 inhibitors as chemopreventive agents has dampened because of a high incidence of cardiovascular toxicity (rofecoxib) in trial patients. An aspirin prevention trial suggested a benefit in terms of polyp prevention with low-dose (81 mg) aspirin. Some recent trials focused on combined inhibition of polyamine production and cyclooxygenase inhibition. A recent report from a large randomized trial of a combination of sulindac and dimethylformamine (DMFO), an inhibitor of ornithine decarboxylase (ODC), described a dramatic effect of this combination in reducing polyp recurrence in patients with prior history of colon polyps. Confirmatory trials are ongoing.34

Screening

 The goal of colorectal cancer screening is to decrease mortality through  diagnosis and treatment of precancerous lesions (adenomatous colon polyps) and early curable cancerous lesions. The evidence for the importance of early detection and removal of colorectal polyps in preventing development of invasive cancer is mostly indirect but has been corroborated by data from many trials.

In the United States, a Joint Guideline was developed by the American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. The Guideline lists appropriate screening procedures and their indications and frequency based on projected individual risks of developing colorectal cancer.

Their testing options for the early detection of colorectal cancer and adenomatous
polyps for asymptomatic adults aged 50 years and older can be summarized as follows:

  • Tests that detect adenomatous polyps and cancer
    • Flexible sigmoidoscopy every 5 years, or
    • Colonoscopy every 10 years, or
    • Double-contrast barium enema every 5 years, or
    • computed tomographic colonography every 5 years
  • Tests that primarily detect cancer
    • Annual guaiac-based fecal occult blood test with high test sensitivity for cancer, or
    • Annual fecal immunochemical test with high test sensitivity for cancer, or
    • Stool DNA test with high sensitivity for cancer, interval uncertain

For individuals who carry an increased or high risk of developing colorectal cancer such as persons with prior history of polyps, prior history of colorectal cancer, family history of colon cancer, or history of inflammatory bowel diseases screening should start at an earlier age and be more frequent and more stringent. Those genetically diagnosed or suspected of having hereditary familial syndromes such as HNPCC or FAP should be treated as having high risk of developing colon and rectal cancer and should adhere to a more intense surveillance protocol.35

Prognosis

The approximate 5-year survival rate for colorectal cancer patients in the United States (all stages included) is 65%. Survival is inversely related to stage; patients with stage I have a 95% 5-year survival rate, and those with stage III have only a 60% survival rate. For patients with metastatic, stage IV disease, the 5-year survival rate is estimated at approximately 10% (see Staging).

 


More on Colon Cancer, Adenocarcinoma

Overview: Colon Cancer, Adenocarcinoma
Differential Diagnoses & Workup: Colon Cancer, Adenocarcinoma
Treatment & Medication: Colon Cancer, Adenocarcinoma
Follow-up: Colon Cancer, Adenocarcinoma
Multimedia: Colon Cancer, Adenocarcinoma
References
Further Reading
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Keywords

colon cancer, colorectal cancer, adenocarcinoma, gastrointestinal cancer, colorectal malignancy, colon cancer prevention, colon cancer treatment, colon cancer medications, colon cancer detection, colon cancer screening, colon cancer diagnosis, colorectal adenoma, adenomatous polyp, colon polyp, colorectal polyp, adenomatous polyposis, hereditary nonpolyposis colon cancer syndrome, HNPCC, Lynch syndrome, familial adenomatous polyposis, FAP, inflammatory bowel disease, IBD, colitis, Crohn’s disease, Crohn disease

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Contributor Information and Disclosures

Author

Tomislav Dragovich, MD, PhD, Associate Professor of Medicine and Director of Clinical Gastroenterology Oncology Program, Arizona Cancer Center, University of Arizona College of Medicine
Tomislav Dragovich, MD, PhD is a member of the following medical societies: American Association for Cancer Research and American Society of Clinical Oncology
Disclosure: Genentech Oncology Honoraria Speaking and teaching; Sanofi-Aventis Honoraria Speaking and teaching

Coauthor(s)

Vassiliki L Tsikitis, MD, Assistant Professor of Surgery, Section of Surgical Oncology, University of Arizona Medical Center
Vassiliki L Tsikitis, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, and Association of Women Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Philip Schulman, MD, Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Clinical Professor, Department of Medicine, New York University School of Medicine
Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York
Disclosure: celgene Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; genetech/idec Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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