FORT LAUDERDALE, Fla--The frequency of surveillance after colectomy,
particularly CEA testing, was a major topic of discussion after
the presentation of the National Comprehensive Cancer Network's
(NCCN) preliminary guidelines on colorectal cancer, one of eight
such guidelines introduced at the coalition's first annual conference.
Paul F. Engstrom, MD, of Fox Chase Cancer Center, who headed the
colorectal cancer guidelines panel, said that monitoring after
colectomy encompasses more than just CEA testing, and he cited
several reasons for doing surveillance:
To monitor for complications. "The types of
therapy we're giving are often combined modality with surgery,
radiotherapy, and chemotherapy, and a specialist needs to see
these patients often to monitor for complications, at least in
the first 2 years," he said.
To detect curable recurrence. "These are rare,
maybe 5% of patients who recur have a curable recurrence,"
Dr. Engstrom said, "but we don't want to overlook those patients."
To look for a synchronous or new colon cancer. "The
best way to prevent these is to remove the premalignant lesions,
and that's why colonoscopy is recommended [annually for 2 years,
then every 3 years if negative]."
He added two other possible reasons for surveillance: to provide
assurance to the patient and to look for other, non-colon cancer
In the guidelines, which are still in a preliminary form, CEA
testing is recommended for patients whose CEA level is elevated
at diagnosis or within 1 week of colectomy, at a frequency of
every 6 months for 2 years, than annually for 5 years.