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 related malignancies.
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.