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Follow-up care after cancer treatment in the colon and rectum

Stage I (Dukes' A)

Patients with stage I (Dukes' A) treated with comprehensive resection should generally not be followed up for development of distant metastases, but if it seems relevant in relation to the patient's age and general health condition, a new colon examination may be considered after 5-10 years. Cumulative risk of metachronous colorectal cancer is about 2% after 5 years and 3-4% after 10 years.

Patients who have undergone local excision as curative or compromise operation should be followed-up at least every six months for five years to exclude local recurrence.

Stage II and III (Dukes' B and C)

All patients with stage II or III (based on the stage before any preoperative neoadjuvant therapy for rectal cancer) who are relevant for curative resection or oncological treatment if relapse/metastasis are detected, are evaluated based on age, general health- and medical condition.

In patients over 75 years at time of diagnosis, controls are usually not relevant, but may be considered individually up to 80 years. The main criteria will be whether the patient is able to undergo extensive surgical and/or oncological treatment. In this age group benefits of a possible follow-up should be carefully considered. 85% of all recurrence is occurring the first three years and the follow-up should therefore be most rigorously during this period.

After curative treatment

The first control after surgery should be performed by a surgeon. Further checks are carried out by the patient's GP or local hospital. Patients operated with low anterior resection are checked by a surgeon. Anamnesis (altered bowel habits, rectal bleeding, discomfort, stomach /pelvic pain and cough) and a targeted physical examination will be emphasized. CT of the liver, lungs and examination of the primary tumor site every four months the first year is recommended.

Follow-up for detecting recurrence

Recommended guidelines for colon cancer where curative resection or oncological treatment of relapse / metastases may become relevant.
Months postoperatively 1 6 12 18 24 30 36 48 60
CEA x x x x x x x x x
CT liver / abdomen x x
UL liver with contrast x x x x x x
Low-dose CT thorax x x x x x
Colonoscopy or CT colography x
Recommended guidelines for colorectal cancer where curative resection or oncological treatment of relapse /metastases may become relevant.
Months postoperatively 1 6 12 18 24 30 36 48 60
CEA x x x x x x x x x
CT liver / abdomen x x
UL liver with contrast x x x x x x
Low-dose CT thorax x x x x x
Colonoscopy or CT colography x
Examination of rectum /perineum.
Assessment of ailments related to function
x x x x x x x x

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