Colorectal Cancer Follow Up Guidelines

Here are the current follow up guidelines for patients in Mr Moore’s clinic who have had previous colorectal cancer treatment with curative intent

CEA (Carcinoembryonic antigen) tumour marker blood testing

Ideally check CEA every 6 months for 3 years and then annually after that until the patient is not fit enough or unwilling to undergo any further cancer treatment. Follow up is usually for 5 years in total.

CT and MRI scanning

Ideally request CT chest, abdomen and pelvis 12 months after date of pre-treatment diagnostic CT scan and then annually for 3 years with one final CT scan at 5 years of follow up. MRI pelvis scanning should be considered at 12 months after rectal cancer surgery.

Colonoscopy

Ideally request a full colonoscopy at about 12 months after definitive treatment (e.g. surgery or post-op chemotherapy) if the patient is fit and willing.
If life expectancy is less than 10 years or if a patient is older than 75 years then no further colonoscopy follow up is required.
Otherwise, a further one-off check colonoscopy is to be arranged 3 years later.

Out-Patient Clinic Appointments

Clinic doctors or specialist colorectal nurses should ensure that the above guidelines for follow up CEA, CT and colonoscopy checks are undertaken for appropriate patients with a previous histological diagnosis of colorectal carcinoma within the limits of the healthcare service that they are in. Patients should be made aware of these guidelines in the clinic and how to access them on the internet. Patients with no internet access can be directed to their local library where internet access can be gained or they can be given a print-out of this web page. Out-patient clinic visits can be tailored to individual patient circumstances and wishes. Clinic doctors should note that NHS GPs do not currently have permission to directly request CTs or colonoscopies so these must be arranged by a specialist hospital doctor or bowel cancer follow up administrator. Patients may prefer to have their regular CEA blood tests checked by their GP (in which case a formal request and instructions will need to be sent to the GP concerned) or they may prefer to attend the surgical clinic. If you are in any doubt about the appropriate timing of a future out-patient clinic visit for a patient then please ask Mr Moore at the next available opportunity.

Follow up after lung or liver metastasis resection. More intensive follow up for selected patients.

The cancer team may decide that certain patients may require more intensive follow up investigations. This includes patients who have undergone lung or liver metastasis resection operations. These patients undergo the follow up program described above but CEA tumour marker blood tests and CT chest, abdomen and pelvis scans are conducted every 4 months instead for the first 2 years of follow up and then 6 monthly for the next year and then annually for the last 2 years of a 5 year follow up program.
Rectal cancer patients requiring monitoring more closely are usually offered 4 monthly CEA blood tests and MRI pelvis scans for 5 years. They are usually offered CT chest, abdomen and pelvis scans at 4 months, 1 year and then annually after that till 5 years of follow up. They are usually offered flexible sigmoidoscopy at 4 months, 8 months, 16 months, 20 months, 30 months, 36 months, 42 months, 48 months, 54 months and colonoscopies at the intervening periods of 12 months, 24 months and 60 months (5 years).

Neuroendocrine tumour follow up

Many neuroendocrine tumour patients do not require any long term follow up. If the cancer team decides that follow up is required because the neuroendocrine tumour had worrying features then this usually entails fasting chromogranin A and chromogranin B blood tests every 6 months for 5 years and a CT chest, abdomen and pelvis scan at 6 months and then every 12 months till 4.5 years out from surgery.

The above guidelines do not apply to patients undergoing palliative care. The follow up of palliative patients should be discussed with Mr Moore at the next opportunity because they often do not require regular invasive investigations or follow up in the surgical clinic. Discuss any palliative clinic patient with a colorectal Macmillan nurse and if they are not available then copy the colorectal Macmillan nurses in to your GP letter.

If a patient has decided that they would not consent to any further cancer treatment such as surgery, chemotherapy or radiotherapy then do not arrange any further colonoscopies, CTs or CEAs and discuss further management with Mr Moore at the next opportunity.

Frail patients should be discussed with Mr Moore before arranging any further investigations because they may be contraindicated.

The majority of patients given ‘curative-intent’ bowel resection operations remain colorectal cancer free for the rest of their lives. Patients who subsequently develop further colorectal cancer or metastases are given hope in that techniques such as salvage surgery, aggressive combination chemotherapy and liver surgery are now delivering improved patient outcomes. Therefore the above follow up program is quite intensive to try to make sure that the small group of patients requiring further cancer treatment are identified at the earliest opportunity.