| CT |
Annual CT of the chest and abdomen for 3 years after primary therapy for patients who are at higher risk of recurrence and who could be candidates for surgery with curative-intent. Pelvic CT scan should be considered for rectal cancer surveillance, especially for patients who have not been treated with radiation. |
| Chest x-ray |
Yearly chest x-rays are not recommended. |
| Colonoscopy |
At 3 years after operative treatment; if results normal, every 5 years thereafter. Note. All patients with colon and rectal cancer should have a colonoscopy for the preoperative or perioperative documentation of a cancer-free and polyp-free colon. For patients with colorectal cancer who have high-risk genetic syndromes, the American Gastroenterological Association guideline should be considered. |
| Flexible proctosigmoidoscopy |
Every 6 months for 5 years for rectal cancer patients who have not been treated with pelvic radiation. |
| History and physical examination and risk assessment |
Every 3 to 6 months for the first 3 years; every 6 months during years 4 and 5; and subsequently at the discretion of the physician. Note. Physician visits should focus on the initial risk assessment, followed by the implementation of a surveillance strategy and periodic counseling based on estimated risk and feasibility of operative interventions such as hepatic resection. |
| CEA |
Every 3 months postoperatively for at least 3 years after diagnosis, if the patient is a candidate for surgery or systemic therapy. Note. Fluorouracil-based chemotherapy may falsely elevate CEA values, so surveillance should be initiated only after such adjuvant treatment has been completed. |
| Routine blood tests |
CBCs or liver function tests are not recommended. |
| Laboratory-derived prognostic and predictive factors |
Until prospective data are available, molecular or cellular markers should not influence the surveillance strategy. |
