| Patient Name: | Date of Birth: | MR#: | Date of Diagnosis (DOD): |
| Estimated Target Dates | Dates Completed | |||||||
|---|---|---|---|---|---|---|---|---|
| DOD plus: | Target Dates | CEA1 (Date/Value) | Counseling Visit2 | CT Scan (chest/abdomen)3 | Colonoscopy4 | CT Scan (pelvic)5 | Flex Proctsig6 | |
| + 0y/3m → | / | (opt) | ||||||
| + 0y/6m → | / | |||||||
| + 0y/9m → | / | (opt) | ||||||
| + 1y/0m → | / | |||||||
| + 1y/3m → | / | (opt) | ||||||
| + 1y/6m → | / | |||||||
| + 1y/9m → | / | (opt) | ||||||
| + 2y/0m → | / | |||||||
| + 2y/3m → | / | (opt) | ||||||
| + 2y/6m → | / | |||||||
| + 2y/9m → | / | (opt) | ||||||
| + 3y/0m → | / | |||||||
| + 3y/6m → | ||||||||
| + 4y/0m → | ||||||||
| + 4y/6m → | ||||||||
| + 5y/0m → | ||||||||
Carcinoembryonic antigen (CEA) testing is not recommended during the administration of adjuvant chemotherapy.
As guidelines suggest 3 to 6 months for counseling visits, optional dates are marked with (opt).
Recommended for high-risk patients.
Acceptable to wait 3 years for follow-up if the pre- or perioperative colonoscopy examined the entire colon.
Consider especially for patients who were not treated with radiotherapy.
Recommended for patients who were not treated with pelvic radiation.
This flow sheet is a practice tool based on ASCO practice guidelines and is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients. This tool does not purport to suggest any particular course of medical treatment. Use of the practice guidelines and this flow sheet are voluntary. The practice guidelines and additional information are available at http://www.asco.org/guidelines.Copyright © 2005 by American Society of Clinical Oncology. All rights reserved.