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Cancer: Colon Message Board


Cancer: Colon Board Index


Ok, so I borrowed this from some research. But I'm still interested in hearing what other oncologists are recommending. Thanks.

"HOW SHOULD THE PATIENT BE MONITORED AFTER TREATMENT?

The American Society of Clinical Oncology (ASCO) sets guidelines for follow-up testing to detect recurring cancer after treatment has been completed. These ASCO guidelines may not apply to particular patients. Although they are based on the best available evidence, rigorous studies are still needed to determine which tests can best cost-effectively detect recurrence at its earliest stage.

Physical Examination and Colonoscopy
After surgery, patients should have a physical examination every three to six months for the first three years, and colonoscopy every three to four years. Studies suggest that more frequent colonoscopies may be needed, because even if colorectal cancer is cured (that is, patients remain cancer free for five years), there is still a higher risk for developing a second cancer.

CEA Levels
CEA levels [ see Carcinoembryonic Antigen (CEA) above] should be measured every two to three months after surgery for two years in Stage II or III patients. An elevated CEA level, confirmed by retesting, warrants further evaluation for return of metastatic disease. It should be noted that almost a third of all recurring cancers do not produce abnormal CEA levels.

Imaging Techniques
An advanced imaging technique called an fluorodeoxyglucose positron emission tomography (FDG-PET) scan may be used to detect recurrent or metastasized colorectal cancer in the setting of an elevated CEA. This test is proving to be very sensitive in detecting diseased areas.

Other Tests
There appears to be no additional benefit for anyone from routine follow-up liver function tests, fecal occult blood tests (FOBT), or computed tomography (CT) scans. There is some debate about whether chest x-rays should be administered annually; they appear to detect recurring cancers but not early enough to be very helpful for the great majority of patients."
Hey CDad....... looks like you are burning the midnight oil doing all that research ;)

Sorry in advance cos this has turned out to be a long post :eek: :rolleyes:

I am much like Alison in that I would like every test possible done just so we keep in control...... wishfull thinking though.

To the point. DH is now 17 months since he finished all his treatments ( a big cheer everybody please :bouncing: ). He is now having only one check up per year with each team member, ie his bowel surgeon, his liver surgeon and his oncologist. We were offered a combined once per year check up but figured the inconvenience of three appointments were outwayed by 3 sets of eyes on him throughout the year.

Bowel surgeon check up consists of sigmoidectomy during the appointment and a tick list of clinical observations. I understand that he will have a colonoscopy every 5 years for rest of life.

Liver sugeon check up consists of liver function tests and ultra-sound. This will continue for another 4 years.

Oncology check up consists of CEA tests, and a tick list of clinical observations. He did have a CT scan earlier this year but this was only to investigate the pain he had ( adhesion episode). They may do a CT scan once per year but am unsure. This will carry on for another 4 years.

I too have also been trying to find out info on the best sort of follow up. The pain that he suffers worries me a lot. Ok, so his liver was clear, his colonoscopy was clear, his CEA levels were never much of an indicator as they were never highly elevated. I do know that he had an invasive tumor which they had to scrape off his bladder but his bladder works fine. My worry is that they look at specifics but what about the rest of his body?

And now a little lecture ........

Here in the UK the purpose of follow-up for patients who have undergone surgery for colorectal cancer is to detect recurrent disease, either locally
within the field of surgery or distant recurrence particularly in the
liver or lungs (hense why I worry about the rest of his bits) . If detected early enough, in some cases (dont you just lurve that phrase) , there may be the opportunity to undergo further treatment, which aims to either
cure the cancer or slow the progression of the disease. In addition
follow-up also enables the detection of new or metachronous cancers
in the bowel.

Current mMethods of follow-up include:

Clinical Examination: the patient is seen in clinic and questioned
about any recent symptoms. A clinical examination is performed
including observing for signs of jaundice or anaemia, abdominal
examination and in the case of rectal cancers a rigid sigmoidoscopy
to check the anastomosis can also be performed.

Blood Tests: This is the current blurb from our National health Service where it describes .... Tumour markers in the blood can rise in the presence
of active tumour and two indicators Of possible recurrent cancer are CEA and CA19-9. Generally a rising CEA or CA19 –9 can be indicative of recurrent cancer and so if one or other is raised on blood testing further investigations may be requested to determine if there is recurrent disease. Question: Would there be any other reason why they would be elevated?

CT Imaging or Ultrasound: These can be done as part of the hospitals’ follow-up protocol for patients who have had surgery for bowel cancer
or may be requested in the presence of abnormal symptoms or elevated tumour markers. Scans may initially concentrate on the area of surgery
as well as common areas for metastases such as the liver and lungs. This has happened for DH. They do not like to do too many CTs in a short period of time but once a year does not sound that bad, does it?

Colonoscopy: Current guidelines recommend that all patients with
colorectal cancer undergo a complete colonoscopy at the time of
diagnosis. If this is not possible due to an obstruction then a colonoscopy should be carried out within 6 months of surgery. After that repeat colonoscopy should be performed every 5 years until the age of 75. I think it is more regular if you have a lot of polyps though.

There is a big debate surrounding the most appropriate method of follow-up because of the lack of hard evidence to support one method of surveillance over another. The harsh truth is that the additional cost of follow-up per life year gained is uncertain and therefore a case for intensive follow-up cannot be adequately argued unless you are lucky enough to find a sympathetic team of doctors. At present follow-up vary widely between our Trusts (these are different geographical bodies within our NHS) and is very often dictated by each individual consultant’s personal preference and often then for individual patients. No wonder there is not enough hard evidence if they are all doing their own thing.

There is currently running in the UK a multi-centre randomised controlled trial
looking at the cost-effectiveness of intensive versus no scheduled
follow-up in patients who have undergone resection for colorectal cancer
with curative intent (FACS Trial). I dont know much more than that but I dont think the results will be out for another couple of years.

The latest thing I read and admittedly in a national newspaper was that there is now a debate in Europe (the much faebled "EU") about safety limits of MRI tests. They are saying, without hard evidence, that there "may" be a "possible slight" risk (they didnt say what the risk was ??? ) that MRI scan may be harmful to patients and anybody administering them. They are arguing for even small children to be MRI scanned in isolation without anybody there to comfort them. I got so angry that the paper went flying across the kitchen.

Sorry to have rambled so long. Hope you make sense of all the above. Did it help in any way ?

gotta go now and cook the old man some dindins

cya
ktee





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