NCCN - Colorectal Cancer Surveillance

Question 1

% of CRC recurrence that occurs in the first 3 years post-tx?
5 years post tx?

Answer 1

80% first 3 years post tx

95% first 5 years post tx

Question 2

Surveillance for stage 1 CRC after definitive treatment?

Answer 2

Colonoscopy at year 1 and year 3 – then repeat every 5 years

Question 3

Surveillance for stage 2 or 3 CRC after definitive treatment?

Answer 3

Colonoscopy at year 1 and year 3 – then repeat every 5 years
H&P w/ CEA lab Q3-6mos for 2 years, then Q6mos until 5 year mark
CT CAP Q6-12mos – for up to 5 years
Remember - NO CT or CEA after 5 years

Question 4

What is the surveillance for metastatic CRC after definitive treatment with curative intent once there is no evidence of residual disease?

Answer 4

Colonscopy at year 1 and year 3 – then repeat every 5 years
H&P w/ CEA lab Q3-6mos for 2 years, then Q6mos until 5 year mark
CT CAP Q3-6mos for 2 years, then 6-12 mos until 5 year mark

Question 5

How to manage uptrending CEA level found during surveillance that does not yield new lesion on imaging?

Answer 5

• If work-up does not reveal malignancy then continue scans every 3 months until lab resolves or lesion is identified

Question 6

How common are false positive CEA’s during surveillance? When are levels most concerning?

Answer 6

Sloan Kettering study showed that ~50% of CEA elevations at level 5-15 were false positives
If >15 unlikely to be false positive
If >35 NEVER a false positive