Colorectal Cancer: Surveillance

  • Nadav Dujovny
  • Jon S. Hourigan


The majority of patients with colon and rectal cancer undergo curative resection and become candidates for continuing surveillance. It is well understood that the risk of colorectal cancer recurrence is largely dependent on the stage of disease at initial presentation and the appropriate level of postoperative surveillance should reflect this degree of risk stratification. Therefore, considerable effort has been devoted to the follow-up and surveillance of patients who have undergone curative-intent surgery. Continued surveillance is imperative to detect both metachronous neoplasms and prevent the development of subsequent cancers. In theory, proper surveillance allows subsequent polyps to be removed before malignant transformation occurs and improve survival by early identification of treatable recurrent cancer. Furthermore, surveillance directs family members of patients with hereditary cancers to receive proper screening and genetic counseling.



This chapter was authored by Brett T. Gemlo and David A. Rothenberger in the previous version of this textbook.


  1. 1.
    Giordano P, Efron J, Vernava 3rd AM, Weiss EG, Nogueras JJ, Wexner SD. Strategies of follow-up for colorectal cancer: a survey of the American Society of Colon and Rectal Surgeons. Tech Coloproctol. 2006;10(3):199–207.CrossRefGoogle Scholar
  2. 2.
    Vernava 3rd AM, Longo WE, Virgo KS, Coplin MA, Wade TP, Johnson FE. Current follow-up strategies after resection of colon cancer. Results of a survey of members of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 1994;37(6):573–83.CrossRefGoogle Scholar
  3. 3.
    Meyerhardt JA, Mayer RJ. Follow-up strategies after curative resection of colorectal cancer. Semin Oncol. 2003;30(3):349–60.CrossRefGoogle Scholar
  4. 4.
    Guyot F, Faivre J, Manfredi S, Meny B, Bonithon-Kopp C, Bouvier AM. Time trends in the treatment and survival of recurrences from colorectal cancer. Ann Oncol. 2005;16(5):756–61.CrossRefGoogle Scholar
  5. 5.
    Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27(22):3677–83.CrossRefGoogle Scholar
  6. 6.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.CrossRefGoogle Scholar
  7. 7.
    Böhm B, Schwenk W, Hucke HP, Stock W. Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma? Dis Colon Rectum. 1993;36(3):280–6.CrossRefGoogle Scholar
  8. 8.
    Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer. 1981;48(6):1492–5.CrossRefGoogle Scholar
  9. 9.
    Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons Jr RJ, Pemberton JH, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet. 1992;174(1):27–32.PubMedGoogle Scholar
  10. 10.
    Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141(1):67–75.CrossRefGoogle Scholar
  11. 11.
    Griffin MR, Bergstralh EJ, Coffey RJ, Beart Jr RW, Melton 3rd LJ. Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer. 1987;60(9):2318–24.CrossRefGoogle Scholar
  12. 12.
    Cho YB, Chun HK, Yun HR, Lee WS, Yun SH, Lee WY. Clinical and pathologic evaluation of patients with recurrence of colorectal cancer five or more years after curative resection. Dis Colon Rectum. 2007;50(8):1204–10.CrossRefGoogle Scholar
  13. 13.
    Ohlsson B, Breland U, Ekberg H, Graffner H, Tranberg KG. Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum. 1995;38(6):619–26.CrossRefGoogle Scholar
  14. 14.
    Secco GB, Fardelli R, Gianquinto D, Bonfante P, Baldi E, Ravera G, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol. 2002;28(4):418–23.CrossRefGoogle Scholar
  15. 15.
    Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;(1):CD002200.Google Scholar
  16. 16.
    Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg. 1997;84(5):666–9.CrossRefGoogle Scholar
  17. 17.
    Mäkelä JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg. 1995;130(10):1062–7.CrossRefGoogle Scholar
  18. 18.
    Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum. 1998;41(9):1127–33.CrossRefGoogle Scholar
  19. 19.
    Rodríguez-Moranta F, Saló J, Arcusa A, Boadas J, Piñol V, Bessa X, et al. Postoperative surveillance in patients with ­colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol. 2006;24(3):386–93.CrossRefGoogle Scholar
  20. 20.
    Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology. 1998;114(1):7–14.CrossRefGoogle Scholar
  21. 21.
    Wattchow DA, Weller DP, Esterman A, Pilotto LS, McGorm K, Hammett Z, et al. General practice vs. surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer. 2006;94(8):1116–21.CrossRefGoogle Scholar
  22. 22.
    Desch CE, Benson 3rd AB, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;23(33):8512–9.CrossRefGoogle Scholar
  23. 23.
    Anthony T, Simmang C, Hyman N, Buie D, Kim D, Cataldo P, et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum. 2004;47(6):807–17.CrossRefGoogle Scholar
  24. 24.
    Engstrom PF, Arnoletti JP, Benson AB 3rd, Chen YJ, Choti MA, Cooper HS, et al. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. J Natl Compr Canc Netw. 2009;7(8):778–831.
  25. 25.
    Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O’Connell MJ, et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006;98(22):1647–54.CrossRefGoogle Scholar
  26. 26.
    Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, et al. Impact of physical activity on cancer recurrence and survival in patients with Stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22): 3535–41.CrossRefGoogle Scholar
  27. 27.
    Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, et al. Association of dietary patterns with cancer recurrence and survival in patients with Stage III colon cancer. JAMA. 2007;298(7):754–64.CrossRefGoogle Scholar
  28. 28.
    Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest. 2005;23(4):338–51.CrossRefGoogle Scholar
  29. 29.
    Wiratkapun S, Kraemer M, Seow-Choen F, Ho YK, Euk W. High preoperative serum CEA predicts metastatic recurrence in potentially curable colon cancer. Dis Colon Rectum. 2001;44(2):231–5.CrossRefGoogle Scholar
  30. 30.
    Slentz K, Senagore AJ, Hibbert J, Mazier WP, Talbott TM. Can preoperative and postoperative CEA predict survival after colon cancer resection? Am Surg. 1994;60(7):528–32.PubMedGoogle Scholar
  31. 31.
    Martin EW, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg. 1983;202:310–7.CrossRefGoogle Scholar
  32. 32.
    Allen-Mersh TG. Aspects of treatment. Serum CEA in the follow-up of colorectal carcinoma. Experience in a district general hospital. Ann R Coll Surg Eng. 1984;66:751–5.Google Scholar
  33. 33.
    McCall JL, Black RB, Rich CA, et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum. 1994;37:875–81.CrossRefGoogle Scholar
  34. 34.
    Moertel CG, Fleming TR, Macdonald JS, Haller DG, Lauri JA, Tangen CM. An evaluation of the carcinoembryonic antigen test for monitoring patients with resected colon cancer. JAMA. 1993;270:943–7.CrossRefGoogle Scholar
  35. 35.
    Carriquiry L, Pineyro A. Should CEA be used in the management of patients with colorectal cancer? Dis Colon Rectum. 1999;42(7):921–9.CrossRefGoogle Scholar
  36. 36.
    Figuerado A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R, et al. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer. 2003;3:26.CrossRefGoogle Scholar
  37. 37.
    Fazio VW, Church JM, Delaney CP. Current therapy in colon and rectal surgery. 2nd ed. Philadelphia: Elsevier Mosby Publishing; 2005. Chapter 67, Page 405.Google Scholar
  38. 38.
    Tsikitis VL, Malireddy K, Green EA, Christensen B, Whelan R, Hyder J, et al. Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial. J Clin Oncol. 2009;27(22):3671–6.CrossRefGoogle Scholar
  39. 39.
    Abir F, Alva S, Longo WE, Audiso R, Virgo KS, Johnson FE. The postoperative surveillance of patients with colon cancer and rectal cancer. Am J Surg. 2006;192(1):100–8.CrossRefGoogle Scholar
  40. 40.
    Graham RA, Wang S, Catalano PJ, Haller DG. Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy. Ann Surg. 1998;228(1):59–63.CrossRefGoogle Scholar
  41. 41.
    Chau I, Allen MJ, Cunningham D, Norman AR, Brown G, Ford HE, et al. The value of routine serum carcino-embryonic antigen measurement and computed tomography in the ­surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol. 2004;22(8):1420–9.CrossRefGoogle Scholar
  42. 42.
    Schwartz RW, McKenzie S. Update on postoperative colorectal cancer surveillance. Curr Surg. 2005;62(5):491–4.CrossRefGoogle Scholar
  43. 43.
    Yedibela S, Klein P, Feuchter K, Hoffmann M, Meyer T, Papadopoulos T, et al. Surgical management of pulmonary metastases from colorectal cancer in 153 patients. Ann Surg Oncol. 2006;13(11):1538–44.CrossRefGoogle Scholar
  44. 44.
    Rena O, Casadio C, Viano F, Cristofori R, Ruffini E, Filosso PL, et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardiothorac Surg. 2002;21(5):906–12.CrossRefGoogle Scholar
  45. 45.
    Watanabe K, Nagai K, Kobayashi A, Sugito M, Saito N. ­Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer. Br J Surg. 2009;96(9):1058–65.CrossRefGoogle Scholar
  46. 46.
    Park JS, Kim HK, Choi YS, Kim K, Shim YM, Jo J, et al. Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer. Ann Oncol. 2010;21(6): 1285–9.CrossRefGoogle Scholar
  47. 47.
    Longo WE, Johnson FE. The preoperative assessment and postoperative surveillance of patients with colon and rectal cancer. Surg Clin North Am. 2002;82(5):1091–108.CrossRefGoogle Scholar
  48. 48.
    Bleeker WA, Mulder NH, Hermans J, Otter R, Plukker JT. Value and cost of follow-up after adjuvant treatment of patients with Dukes’ C colonic cancer. Br J Surg. 2001;88(1):101–6.CrossRefGoogle Scholar
  49. 49.
    Deveney KE, Way LW. Follow-up of patients with colorectal cancer. Am J Surg. 1984;148(6):717–22.CrossRefGoogle Scholar
  50. 50.
    Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer. 2007;109(4):718–26.CrossRefGoogle Scholar
  51. 51.
    Langevin JM, Nivatvongs S. The true incidence of synchronous cancer of the large bowel. A prospective study. Am J Surg. 1984;147(3):330–3.CrossRefGoogle Scholar
  52. 52.
    Piñol V, Andreu M, Castells A, Payá A, Bessa X, Jover R, et al. Synchronous colorectal neoplasms in patients with colorectal cancer: predisposing individual and familial factors. Dis Colon Rectum. 2004;47(7):1192–200.CrossRefGoogle Scholar
  53. 53.
    Chen F, Stuart M. Colonoscopic follow-up of colorectal carcinoma. Dis Colon Rectum. 1994;37(6):568–72.CrossRefGoogle Scholar
  54. 54.
    Ballesté B, Bessa X, Piñol V, Castellví-Bel S, Castells A, Alenda C, et al. Detection of metachronous neoplasms in colorectal cancer patients: identification of risk factors. Dis Colon Rectum. 2007;50(7):971–80.CrossRefGoogle Scholar
  55. 55.
    Rex DK, Kahi CJ, Levin B, Smith RA, Bond JH, Brooks D, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2006;130(6):1865–71.CrossRefGoogle Scholar
  56. 56.
    Goldberg RM, Fleming TR, Tangen CM, Moertel CG, ­Macdonald JS, Haller DG, et al. Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and ­success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med. 1998;129(1):27–35.CrossRefGoogle Scholar
  57. 57.
    Rajaratnam SG, Dennett ER. Development of metachronous neoplasms after colorectal cancer resection: absence of synchronous neoplasms predicts a lower risk. N Z Med J. 2009;122(1294):61–6.PubMedGoogle Scholar
  58. 58.
    Hyman N, Moore J, Cataldo P, Osler T. The high yield of 1-year colonoscopy after resection: is it the handoff? Surg Endosc. 2010;24(3):648–52.CrossRefGoogle Scholar
  59. 59.
    Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, et al. Miss rate for colorectal neoplastic polyps: a ­prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008;40(4):284–90.CrossRefGoogle Scholar
  60. 60.
    Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum. 1997;40(1):15–24.CrossRefGoogle Scholar
  61. 61.
    Harris GJ, Church JM, Senagore AJ, Lavery IC, Hull TL, Strong SA, et al. Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum. 2002;45(8):1029–34.CrossRefGoogle Scholar
  62. 62.
    MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60.CrossRefGoogle Scholar
  63. 63.
    Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303–12.CrossRefGoogle Scholar
  64. 64.
    Bernstein TE, Endreseth BH, Romundstad P, Wibe A, Norwegian Colorectal Cancer Group. Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg. 2009;96(11):1348–57.CrossRefGoogle Scholar
  65. 65.
    Kim NK, Kim YW, Min BS, Lee KY, Sohn SK, Cho CH. ­Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer. World J Surg. 2009;33(8):1741–9.CrossRefGoogle Scholar
  66. 66.
    Romano G, Esercizio L, Santangelo M, Vallone G, Santangelo ML. Impact of computed tomography vs. intrarectal ultrasound on the diagnosis, resectability, and prognosis of locally recurrent rectal cancer. Dis Colon Rectum. 1993;36(3):261–5.CrossRefGoogle Scholar
  67. 67.
    de Anda EH, Lee SH, Finne CO, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery. Dis Colon Rectum. 2004;47(6):818–24.CrossRefGoogle Scholar
  68. 68.
    Shen YY, Liang JA, Chen YK, Tsai CY, Kao CH. Clinical impact of 18F-FDG-PET in the suspicion of recurrent colorectal cancer based on asymptomatically elevated serum level of carcinoembryonic antigen in Taiwan. Hepatogastroenterology. 2006;53(69):348–50.PubMedGoogle Scholar
  69. 69.
    Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps M, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med. 2000;41:1177–89.PubMedGoogle Scholar
  70. 70.
    Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer. 2008;98:875–80.CrossRefGoogle Scholar
  71. 71.
    Kjeldsen BJ, Thorsen H, Whalley D, Kronborg O. Influence of follow-up on health-related quality of life after radical surgery for colorectal cancer. Scand J Gastroenterol. 1999;34(5):509–15.CrossRefGoogle Scholar
  72. 72.
    Stiggelbout AM, de Haes JCJM, Vree R, van de Velde CJH, Bruijninckx CMA, van Groninger K, et al. Follow-up of colorectal cancer patients: quality of life and attitudes towards follow-up. Br J Cancer. 1997;75(6):914–20.CrossRefGoogle Scholar
  73. 73.
    Virgo KS, Vernava AM, Longo WE, McKirgan LW, Johnson FE. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA. 1995;273(23):1837–41.CrossRefGoogle Scholar
  74. 74.
    Renehan AG, O’Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after ­curative resection for colorectal cancer. BMJ. 2004; 328(7431):81.CrossRefGoogle Scholar
  75. 75.
    Borie F, Combescure C, Daures JP, Tretarre B, Millat B. Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a Markov model. World J Surg. 2004;28(6):563–9.CrossRefGoogle Scholar
  76. 76.
    Tjandra JJ, Chan MKY. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50: 1783–99.CrossRefGoogle Scholar
  77. 77.
    Ohlsson B, Pålsson B. Follow-up after colorectal cancer ­surgery. Acta Oncol. 2003;42(8):816–26.CrossRefGoogle Scholar
  78. 78.
    Gan S, Wilson K, Hollington P. Surveillance of patients following surgery with curative intent for colorectal cancer. World J Gastroenterol. 2007;13(28):3816–23.CrossRefGoogle Scholar
  79. 79.
    Pfister DG, Benson 3rd AB, Somerfield MR. Clinical practice. Surveillance strategies after curative treatment of colorectal cancer. N Engl J Med. 2004;350(23):2375–82.CrossRefGoogle Scholar
  80. 80.
    Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomized trials. BMJ. 2002;324(7341):813.CrossRefGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Nadav Dujovny
    • 1
  • Jon S. Hourigan
    • 2
  1. 1.Ferguson Clinic, Spectrum Health Medical GroupMichigan State UniversityGrand RapidsUSA
  2. 2.Section of Colorectal Surgery, Department of SurgeryUniversity of KentuckyLexingtonUSA

Personalised recommendations