Revised Nov 2021
Following completion of definitive surgery and chemotherapy, patients are typically advised to undergo a surveillance program for a period of up to 5 years, except colonoscopy, which should continue while the patient is a candidate for treatment should a metachronous or recurrent cancer be found. This is typically managed under the direction of their primary care provider.
Stage 0-I:
- If complete colonoscopy was not performed at time of initial cancer diagnosis, it should be completed within 6 months to rule out metachronous lesions. Otherwise, repeat colonoscopy is recommended in one year, and if normal, in three years, and if normal every five years thereafter.
- For patients with specific genetic syndromes, the American Gastroenterological Association guidelines should be followed.
- No evidence of improved survival with routine imaging or blood work.
Stage II-III:
- History and physical examination every three to six months for the first three years and then every six months for two additional years. Rectal examination at least annually.
- If the patient is a potential candidate for hepatic or pulmonary metastasectomy:
- Carcinoembryonic antigen (CEA) tumour marker level should be checked at each follow-up visit
- If CEA is elevated, repeat test within 28 days
- Chest, abdominal and pelvic imaging (CT preferred, or chest x-ray and ultrasound if CT contraindicated or not available) should be done be done a minimum of two times over the first three years of follow-up (suggested at 12 months and 36 months)
- If complete colonoscopy was not performed at time of initial cancer diagnosis, it should be completed within 6 months to rule out metachronous lesions. Otherwise, repeat colonoscopy is recommended in one year, and if normal, in three years, and if normal every five years thereafter.
- If the patient is not a candidate for metastasectomy, CEA and routine imaging studies are not recommended as there is little to no utility in diagnosing an early metastatic recurrence in an asymptomatic patient.
- If the patient is found to have an elevated CEA and/or signs and symptoms of recurrent colon cancer, imaging of the thorax, abdomen and pelvis should be done and a re-referral to the primary oncologist is indicated.
- Other imaging and routine blood work are not recommended in follow-up, but may be appropriate in a patient with symptoms suggestive of recurrence.
Stage IV treated with curative-intent metastasectomy (Stage IV NED)
- No standard guidelines currently exist for surveillance in Stage IV NED and are as determined by the treating oncologist.
- May follow the recommendations as per Stage II-III.
