How Can We Identify Local Relapse?

Abstract

After curative resection of rectal cancer, nowadays around 3% of patients develop a local relapse. The main challenge is to detect these local recurrences when they are still curable. There is no strong evidence at which frequency follow-up visits should be done and with which tools. According to current guidelines, routine surveillance in patients with colorectal cancer should at least include regular clinical examination and CEA testing. Most international guidelines also advice annual CT of the chest and abdomen (including the pelvis in patients with rectal cancer). Particularly in patients with an increased risk for local recurrence (based on prognostic factors, elevated CEA levels or clinical symptoms), routine imaging is justified. In case of equivocal CT findings, PET is more beneficial in identifying a local relapse. Currently the main role of MRI is to establish the resectability of a local tumour recurrence once it has been diagnosed. A new dilemma in rectal tumours is the follow-up of patients undergoing organ-preserving treatments. In these patients one may assume that a more intensive follow-up is justified to detect any potential tumour regrowth as early as possible in order to offer patients salvage surgery without compromising the oncological outcome. However, intensification of the follow-up in this specific group is mainly in study settings, and there is no proof yet whether the patients benefit from an intensified follow-up and – if so – at which frequency.