Colon Cancer Follow-Up Sheet
To begin the chart, fill in the date of diagnosis. Add the years/months in the first column to the date of diagnosis to obtain target dates. Record visits, test dates, and CEA values in the rows corresponding to each target date as they are completed. Darkened rows indicate that a particular procedure is not required at that time. Programmable follow-up sheet available at www.asco.org/guidelines.
Table u1.
| Patient Name: | Date of Birth: | MR#: | Date of Diagnosis (DOD): |
Table u2.
| Estimated Target Dates | Dates Completed | ||||
|---|---|---|---|---|---|
| DOD plus: | Target Dates | CEA1 (Date/Value) | Counseling Visit2 | CT Scan3 | Colonoscopy4 |
| + 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.
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.