Choosing Wisely:

Don’t obtain routine blood work (e.g., complete blood count, liver function tests) other than a carcinoembryonic antigen level during surveillance for colorectal cancer.

Rationale and Comments: Due to lack of sensitivity and accuracy in detecting early recurrences, current evidence does not support measurement of complete blood count or liver function tests for surveillance following colorectal cancer treatment. Although evidence is not unequivocal, surveillance regimens that include serial carcinoembryonic antigen testing have been associated with improved survival. Depending on the stage of nonmetastatic disease, accepted components for colorectal cancer surveillance include a combination of history and physical examination; carcinoembryonic antigen; CT of the chest, abdomen, and pelvis; and colonoscopy at variable intervals depending on stage and risk of recurrent disease.
Sponsoring Organizations:
  • Society of Surgical Oncology
  • Sources:
  • National Comprehensive Cancer Network/ACS/ASCO guidelines
  • Disciplines:
  • Gastroenterologic
  • Oncologic
  • References: • Benson AB 3rd, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, Engstrom PF, Enzinger PC, Fakih MG, Fenton MJ, Fuchs CS, Grem JL, Hunt S, Kamel A, Leong LA, Lin E, May KS, Mulcahy MF, Murphy K, Rohren E, Ryan DP, Saltz L, Sharma S, Shibata D, Skibber JM, Small W Jr, Sofocleous CT, Venook AP, Willett CG, Gregory KM, Freedman-Cass DA; National Comprehensive Cancer Network. Localized colon cancer, version 3.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2013 May 1;11(5):519-28.
    • El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, Cannady RS, Wong SL, Rose J, Barbour AL, Stein KD, Sharpe KB, Brooks DD, Cowens-Alvarado RL. American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin. 2015;65(6):428-55.
    • Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, Petrelli NJ, Ryan K, Schrag DH, Wong SL, Benson AB 3rd; American Society of Clinical Oncology. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013 Dec 10;31(35):4465-70.

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