Surveillance for Local Recurrence of Colon Cancer

A comparison of different surveillance strategies for locally recurrent colorectal cancer:

Modality	Sensitivity	Specificity	PPV	NPV	Accuracy
CEA	44.4%	92.5%	66.7%	83.1%	80.3%
PET-CT	94.4%	73.6%	54.8%	97.5%	78.9%
MRI	88.9%	73.6%	53.3%	95.1%	77.5%

The National Comprehensive Cancer Network (NCCN) also has new surveillance guidelines (2012) for colon and rectal cancer patients. For colon cancer patients, these guidelines include:

• History and physical examination every 3-6 months for the first 2 years, then every 6 months for a total of 5 years.
• CEA every 3-6 months for the first 2 years. If the original tumor was T2 or greater or N1-N2, CEA every 6 months for a total of 5 years after that.
• CT Chest, abdomen, pelvis every year for node positive patients and node negative patients at high risk for recurrence (e.g., vascular invasion and poorly differentiated tumors).
• Colonoscopy in 1 year (if the patient did not have a pre-operative colonoscopy due to an obstructive lesion, colonoscopy in 3-6 months). Repeat colonoscopy in 1 year if advanced adenoma. If no advanced adenoma was present, repeat in 3 years then every 5 years.
• PET-CT is not routinely recommended.

References

• Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ; American Society of Clinical Oncology. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005 Nov 20;23(33):8512-9.
• Fiocchi F, Iotti V, Ligabue G, Malavasi N, Luppi G, Bagni B, Torricelli P. Role of carcinoembryonic antigen, magnetic resonance imaging, and positron emission tomography-computed tomography in the evaluation of patients with suspected local recurrence of colorectal cancer. Clin Imaging. 2011 Jul-Aug;35(4):266-73.