GASTROENTEROLOGY ARTICLE OF THE WEEK
August 26, 2004
Pfister DG, Bensol AB, Somerfield MR. Survillance strategies after curative treatment of colorectal cancer. N Engl J Med 2004;350:2375-82.
1. Surveillance after colon cancer resection
a. Annual chest X-ray has been found to be effective in decreasing mortality
b. CEA determination is commonly the first test to identify relapse, it should not
be measured in patients who had a normal CEA level prior to resection
c. A complete colonoscopy should be performed 3 to 6 months after cancer
resection if the patient did not undergo a full colonoscopy exam prior to resection.
d. Most guidelines recommend yearly CEA level for monitoring for recurrent
disease, it has been proven to be an effective strategy.
e. Additional testing is best guided by the onset of symptoms or abnormal physican findings, rather than a routine battery of tests.
True or False
2. During surveillance after colon cancer rejection, the majority of recurrences represent metastatic or recurrent disease rather than new primary cancers
3. Resection of localized lung metastasis from colon cancer results in a survival similar to that of resection of isolated liver metastasis
4. After resection of colorectal carcinoma, the patient has a 1.5 to 3 fold increased risk of developing additional primary colon cancers
5. Patients who are not medically fit for additional surgery or chemotherapy should not undergo surveillance to detect recurrent cancer.
6. Recurrence of colon cancer 6 or more years after resection is rare, only periodic colonoscopy to detect new polyps is recommended as a surveillance strategy in this group.
7. Local recurrence of cancer is more common after resection of rectal rather than colon cancers.
8. Most guidelines recommend yearly colonoscopy after resection of colon cancer.
9. We have no clue as to what is the best strategy to follow patients after resection of colon cancer.
10. After colon cancer resection, once it is established that there are no polyps, repeat colonoscopy should be every 3 to 5 years.