A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results.
Reports of prolonged survival in patients with recurrent colon or rectal cancer following a reoperative surgery suggest that early diagnosis of locally persistent or limited metastatic disease may save some patients. To determine which laboratory and radiologic tests were useful, a prospective comparison of all currently available modalities was begun in 1978. Sixty-six patients at high risk for recurrent large-bowel cancer were studied. At present, mean follow-up is at 4 1/2 years. Protocol studies included monthly carcinoembryonic antigen (CEA) assays for 3 years and then at 3-month intervals for 2 more years. A review of symptoms and a physical examination were performed every 4 months for 3 years and then every 6 months for 2 more years. Computerized tomograms of the abdomen, full lung tomograms, and liver/spleen scintigrams were obtained every 4 months for 3 years and then annually for 2 more years. Intravenous pyelography, barium enema, and bone scintigraphy were performed yearly for 5 years. Thirty-three recurrences were observed in 31 patients. A progressive rise in serial CEA values was the first indication of recurrence in 22 of 33 patients (67%), review of symptoms and physical examination in seven of 33 (21%), CT scan in two of 33, and bone scintigraphy and full lung tomography each in one of 33 patients. Serial CEA assays and routine visits to a physician's office were the most useful tests in this study population. Use of a simplified follow-up plan will result in the earliest detection of recurrent colon cancer.
D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003110:Colonic Neoplasms; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011860:Radiography, Abdominal; D011877:Radionuclide Imaging; D012004:Rectal Neoplasms; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D002272:Carcinoembryonic Antigen