Follow-up Tests to Fight the Return of Colorectal Cancer

Colorectal cancer recurrence successfully treated when detected with imaging or blood tests

(RxWiki News) After cancer treatment, physicians want to follow the patient to be on the lookout for the disease returning. That’s because earlier detection of any cancer usually means better outcomes.

A new study looked at the impact of follow-up tests on patients who had been treated for colorectal cancer.

The researchers found that computed tomography (CT) and a blood test looking for a specific disease marker both improved the odds of surgery successfully treating recurrent (returned) colorectal cancer.

"Discuss colorectal cancer screening with your physician."

This study was led by John N. Primrose, MD, FRCS, of the University of Southampton in England. He and his colleagues designed the research to evaluate the impact of follow-up tests following curative (designed to cure) colorectal cancer surgery.

Colorectal cancer will be diagnosed in nearly 143,000 Americans this year and result in the deaths of nearly 51,000 people in the US. As such, colorectal cancer is the third most common cancer in both men and women in the US.

If the disease is found early, colorectal cancer can often be cured, and survival rates continue to improve.

After curative treatment, patients are followed for five years. Regular testing is designed to detect if the cancer has returned.

For this study, Dr. Primrose’s team compared the effectiveness of CT and a blood test for the presence of carcinoembryonic antigen (CEA), a protein that can indicate the presence of colorectal cancer.

A total of 1,202 colorectal cancer patients from 39 hospitals in England were randomly assigned to one of four groups:

  1. CEA group had blood tests to measure for CEA every three months for two years, then every six months for three years, along with a single CT scan of the chest, abdomen and pelvis at 12 to 18 months if requested by hospital clinician.
  2. CT group had a CT scan of the chest, abdomen and pelvis every six months for two years and annually for three years.
  3. CEA and CT group underwent blood testing and CT imaging as described above.
  4. Minimum follow-up group had no scheduled follow-up tests with the exception of a single CT scan of chest, abdomen and pelvis at 12 to 18 months.

During the 4.4-year follow-up, 16.6 percent or 199 individuals had a recurrence of colorectal cancer, and 6 percent of these patients underwent curative surgery.

The research team found that compared to minimum follow-up, the difference in the number of patients who had curative surgery following recurrence was 4.4 percent in the CEA group, 5.7 percent in the CT group and 4.3 percent in the CEA and CT group.

The number of deaths from any cause and from the colorectal cancer itself was not significantly higher in the more intensive follow-up groups than in the minimum follow-up group.

Historically, the five-year survival rate is noted as 40 percent for colorectal cancer patients who have undergone curative treatment for recurrences. This study found that more than two-thirds of patients treated for recurrence were still alive at roughly 4.5 years of follow-up.

According to the researchers, “Among patients who had undergone curative surgery for primary colorectal cancer, intensive imaging or CEA screening each provided an increased rate of surgical treatment of recurrence with curative intent compared with minimal follow-up; there was no advantage in combining CEA and CT.”

This study was published January 14 in JAMA.

The project was funded by the UK National Institute for Health Research Health Technology Assessment program. No conflicts of interest were disclosed.

Review Date: 
January 14, 2014