Updated Guidelines Recommend That Patients With Colorectal Cancer Undergo Colonoscopy After Cancer Resection
According to new recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer published by Kahi et al in Gastroenterology, postoperative colonoscopy is associated with improved overall survival for colorectal cancer patients. Therefore, it is critically important that colorectal cancer patients undergo colonoscopy after surgery to ensure that they do not have a second colon cancer and to find and remove any additional polyps. Between 0.7% and 7% of patients with colorectal cancer have a second, concurrent cancer.
These recommendations update the 2006 U.S. Multi-Society Task Force consensus guideline, which addressed the use of endoscopy for patients after colorectal cancer resection. The updated document focuses on the role of colonoscopy in these patients, as well as reviews possible adjunctive roles of fecal testing and computed tomographic (CT) colonography in postresection patients.
Patients who have surgery to remove colorectal cancer should receive colonoscopy on the following schedule:
- Before cancer resection surgery, if possible. If not, colonoscopy should be performed within 3 to 6 months after surgery.
- At 1 year after surgery or 1 year after the perioperative colonoscopy.
- At 4 years after surgery or the perioperative colonoscopy.
- At 9 years after the perioperative colonoscopy.
Subsequent colonoscopies should occur at 5-year intervals until diminishing life expectancy outweighs the benefit of continuing surveillance. If precancerous polyps are found, the intervals for surveillance should follow published guidelines for polyp surveillance.
These recommendations do not apply to patients with Lynch syndrome. Review the “Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the U.S. Multi-Society Task Force on Colorectal Cancer” for more information.
Additional Considerations in Surveillance of Rectal Cancer
Patients with rectal cancer have a higher risk of local recurrence compared to those with colon cancer. This is particularly true of patients with locally advanced rectal cancer who are not treated preoperatively with radiation and chemotherapy and, in general, rectal cancer patients who are operated on using surgical techniques not considered a total mesorectal excision. Patients at high risk of local recurrence of rectal cancer should be considered for additional surveillance:
- Local surveillance with flexible sigmoidoscopy or endoscopic ultrasound should occur every 3 to 6 months for the first 2 to 3 years after surgery.
- These surveillance measures are in addition to recommended colonoscopic surveillance for second cancers.
Alternatives and Adjuncts to Colonoscopy
Patients who have an obstructive colorectal cancer and therefore cannot undergo a complete colonoscopy should receive CT colonography as the best alternative to exclude synchronous neoplasms. Patients can also undergo double-contrast barium enema, if CT colonography is not available.
There is little evidence to support the routine use of fecal immunohistochemical tests or fecal DNA tests for surveillance after colorectal cancer resection.
Colorectal cancer is the second leading cause of cancer death for both men and women combined in the United States. More than 132,000 new cases of colorectal cancer were estimated to be diagnosed in 2015, and of those, 70% to 80% were expected to undergo surgical resection with intent to cure the disease. Up to 40% of patients with locoregional disease will develop recurrent cancer, 90% of which will occur within 5 years.
The U.S. Multi-Society Task Force is composed of gastroenterology specialists with a special interest in colorectal cancer, representing the American Gastroenterological Association, the American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
