Follow-up investigations in colorectal cancer

Background: In view of improved surgical techniques and other local treatment modalities, i.e. radiofrequency ablation, cryosurgery, and the availability of new active cytotoxic agents, which in the neoadjuvant treatment setting may allow curative resection of liver or lung metastases and locoregional recurrences in up to 30% of cases, the ASCO and ESMO recommendations 2002 should be up-dated. Current Recommendations: According to the ASCO, history, clinical examination and CEA assessments should be performed every 3 months for greater than or equal to2 years after initial diagnosis and annually thereafter, whereas the ESMO discourages any routine laboratory examinations. Furthermore, rather in contrast to the ASCO guidelines, which do not recommend proctosigmoidoscopy in patients with rectal cancer (unless postoperative radiochemotherapy has not been effected) the ESMO suggests endoscopic +/- endosonographic evaluations of the rectosigmoid every 6 months for 2 years and colonoscopy only every 5 years. Chest x-ray and abdominal ultrasound are not suggested, except in symptomatic patients and in case of elevated CEA levels. Possible New Surveillance Recommendations: History, clinical examination and CEA testing should be performed every 3 months for 2 years after diagnosis and annually thereafter. Similarly, liver sonography or CT-scan +/- chest x-ray should be performed every 6 months for 2 years and annually thereafter. Because of significantly improved local control in patients with rectal cancer undergoing total mesorectal excision preoperative radiotherapy, the frequency of rectosigmoidoscopy should be reduced .