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Follow-up and Surveillance of Colon Cancer Patients Treated with Curative Intent

Revised May 2018

Following completion of definitive surgery and chemotherapy, patients are typically advised to undergo a surveillance program for a period of up to 5 years, except colonoscopy, which should continue while the patient is a candidate for treatment should a metachronous or recurrent cancer be found. This is typically managed under the direction of their primary care provider.

Stage 0-I:

  • If complete colonoscopy was not performed at time of initial cancer diagnosis, it should be completed within 6 months to rule out metachronous lesions. Otherwise, repeat colonoscopy is recommended in one year, and if normal, in three years, and if normal every five years thereafter.
  • For patients with specific genetic syndromes, the American Gastroenterological Association guidelines should be followed.
  • No evidence of improved survival with routine imaging or blood work.

Stage II-III:

  • History and physical examination every three to six months for the first three years and then every six months for two additional years. Rectal examination at least annually. 
  • If the patient is a potential candidate for hepatic or pulmonary metastatectomy:

  1. Carcinoembryonic antigen (CEA) tumour marker level should be checked at each follow-up visit 
  2. If CEA is elevated, repeat test within 28 days 
  3. Chest, abdominal and pelvic imaging (CT preferred, or chest xray and ultrasound if CT contraindicated or not available) should be done be done a minimum of two times over the first three years of follow-up (suggested at 12 months and 36 months)
  • If complete colonoscopy was not performed at time of initial cancer diagnosis, it should be completed within 6 months to rule out metachronous lesions. Otherwise, repeat colonoscopy is recommended in one year, and if normal, in three years, and if normal every five years thereafter. 
  • If the patient is not a candidate for metastatectomy, CEA and routine imaging studies are not recommended as there is little to no utility in diagnosing an early metastatic recurrence in an asymptomatic patient. 
  • If the patient is found to have an elevated CEA and/or signs and symptoms of recurrent colon cancer, imaging of the thorax, abdomen and pelvis should be done and a re-referral to the primary oncologist is indicated. 
  • Other imaging and routine blood work are not recommended in follow-up, but may be appropriate in a patient with symptoms suggestive of recurrence.

Stage IV treated with curative-intent metastatectomy (Stage IV NED)

  • No standard guidelines currently exist for surveillance in Stage IV NED and are as determined by the treating oncologist
  • May follow the recommendations as per Stage II-III.

SOURCE: Follow-up and Surveillance of Colon Cancer Patients Treated with Curative Intent ( )
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