Care of the Colorectal Cancer Survivor

Kristina Burgers; Clint Moore; Lori Bednash

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Mar 1, 2018 Issue

Care of the Colorectal Cancer Survivor

KRISTINA BURGERS, MD, Womack Army Medical Center Family Medicine Residency, Fort Bragg, North Carolina

CLINT MOORE, DO, 82nd General Support Aviation Battalion, Fort Bragg, North Carolina

LORI BEDNASH, DO, Joel Health Clinic, Fort Bragg, North Carolina

Am Fam Physician. 2018 Mar 1;97(5):331-336.

Author disclosure: No relevant financial affiliations.

Article Sections

Abstract
Disease Surveillance
Health Promotion and Screening for Other Primary Malignancies
Management of Long-Term Treatment Effects
Care Coordination
References

Colorectal cancer is the fourth most common cancer in the United States and has a five-year survival rate of 65%. The American Cancer Society and other experts have released guidelines on surveillance, health promotion, screening for other malignancies, and management of treatment effects. Surveillance for disease recurrence should occur every three to six months for the first two to three years, then every six months for a total of five years. Each visit should include a history and physical examination, routine care for chronic medical conditions, and screening for other primary cancers according to guidelines for the general population. Topics addressed depend on the treatment utilized but generally include gastrointestinal issues, neuropathy, pain, urinary symptoms, fatigue, psychological issues, cognitive problems, sexual symptoms, and stoma care. Carcinoembryonic antigen testing should be performed at each visit in patients who are candidates for further intervention. Chest, abdomen, and pelvic computed tomography should be performed annually for five years after treatment. Colonoscopy should be repeated one year after treatment, then three years later if no advanced adenoma is identified.

Colorectal cancer is the fourth most commonly diagnosed cancer in the United States.1 In 2014, the prevalence was estimated at 0.3%, representing nearly 1.2 million Americans.1 Because successful treatment of colorectal cancer has increased the five-year survival rate to 65%,1 family physicians are likely to encounter survivors in their practice. This article reviews the 2015 American Cancer Society guidelines for the care of the colorectal cancer survivor.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Follow-up visits with colorectal cancer survivors should occur every three to six months for the first two to three years after curative treatment, then every six months for a total of five years.	C	2, 3, 5–7
CEA testing should be performed every three to six months for five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
CT and CEA testing are not recommended beyond five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
Routine positron emission tomography is not recommended in colorectal cancer survivors.	C	2, 3, 5–7
Patients with stage I or II disease who are at higher risk of recurrence and all patients with stage III disease should be offered annual CT of the chest, abdomen, and pelvis for five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
Colonoscopy should be performed one year and three years after initial treatment for colorectal cancer, then every five years until there is no longer a benefit to the patient.	C	2, 3, 5–7
Physicians should screen for other malignancies in colorectal cancer survivors based on guidelines for average-risk patients.	C	2

CEA = carcinoembryonic antigen; CT = computed tomography.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Follow-up visits with colorectal cancer survivors should occur every three to six months for the first two to three years after curative treatment, then every six months for a total of five years.	C	2, 3, 5–7
CEA testing should be performed every three to six months for five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
CT and CEA testing are not recommended beyond five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
Routine positron emission tomography is not recommended in colorectal cancer survivors.	C	2, 3, 5–7
Patients with stage I or II disease who are at higher risk of recurrence and all patients with stage III disease should be offered annual CT of the chest, abdomen, and pelvis for five years after curative treatment for colorectal cancer.	C	2, 3, 5–7
Colonoscopy should be performed one year and three years after initial treatment for colorectal cancer, then every five years until there is no longer a benefit to the patient.	C	2, 3, 5–7
Physicians should screen for other malignancies in colorectal cancer survivors based on guidelines for average-risk patients.	C	2

CEA = carcinoembryonic antigen; CT = computed tomography.

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The Authors

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KRISTINA BURGERS, MD, is a faculty family physician at Womack Army Medical Center Family Medicine Residency, Fort Bragg, N.C....

CLINT MOORE, DO, is a flight surgeon for the 82nd General Support Aviation Battalion, Fort Bragg.

LORI BEDNASH, DO, is a family physician at Joel Health Clinic, Fort Bragg.

Address correspondence to Kristina Burgers, MD, Womack Army Medical Center, 2817 Reilly Rd., Fort Bragg, NC 28310 (e-mail: kristina.g.burgers.mil@mail.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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