Updated June 2007

Standardized BC Cancer Agency Follow-up Letter for Stage II or III Colorectal Cancer patients following resection of their primary, with or without adjuvant chemo/radiotherapy

Dear Doctor,

Your patient has now completed their adjuvant therapy at the BC Cancer Agency. We would like to turn further follow-up over to you. We recommend the following procedures for your patient:

• History and physical exam every three months for first three years and then every six months for two additional years. Rectal exam at least yearly
• Colonoscopy: should have a polyp clearing colonoscopy either prior to the bowel resection or within one year following. The colonoscopy should then be repeated at intervals of every three to five years or as suggested by the GI specialist. Patients with rectal tumours who have not received radiation therapy may benefit from more frequent endoscopic follow up
• If your patient is a potential candidate for hepatic or pulmonary resection:
  • a carcinoembryonic antigen (CEA) tumour marker level should be checked at each follow up visit
  • confirmation of an elevated test is usually recommended within 28 days
  • liver imaging should be done every six months for three years then annually for two more years
  • patients with rectal cancer should have a chest x-ray every 6-12 months for five years
• If patient is not a surgical candidate, there is little to no utility in diagnosing a recurrence in an asymptomatic patient, so CEA and imaging studies are not required
• If the patient is found to have an elevated CEA, the patient should be evaluated for recurrence with history/physical examination followed by thoracic and abdominal +/- pelvic imaging. Consider contacting the primary oncologist for advice on the findings
• Other imaging and routine blood testing are not recommended in follow-up, but may be appropriate in a patient with symptoms suggestive of recurrence