This is the current release of the guideline.

This guideline updates a previous version: Benson AB, Desch CE, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Petrelli NJ, Pfister DG, Smith TJ, Somerfield MR. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 2000 Oct 15;18(20):3586-8.

1. History and Physical Examination and Risk Assessment

   Current recommendation. Coordinating physician visits should occur every 3 to 6 months for the first 3 years, every 6 months during years 4 and 5, and subsequently at the discretion of the physician. Physician visits should focus on the initial risk assessment, followed by the implementation of a surveillance strategy and periodic counseling based on estimated risk and feasibility of surgical interventions like hepatic resection.

2. Laboratory Tests

   Carcinoembryonic antigen (CEA): Current recommendation. Postoperative serum CEA testing should be performed every 3 months in patients with stage II or III disease for at least 3 years after diagnosis, if the patient is a candidate for surgery or systemic therapy. (Note: Adapted from the 2005 American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines for the Use of Tumor Markers in Gastrointestinal Cancer). Since fluorouracil-based therapy may falsely elevate CEA values (Moertel et al., 1993), waiting until adjuvant treatment is finished to initiate surveillance is advised.

   Blood tests: Current recommendation. No change from the last update of the guideline. Routine blood tests (i.e., complete blood counts or liver function tests) are not recommended.

   Fecal occult blood test: Current recommendation. No change from the last update of the guideline. Periodic fecal occult blood testing is not recommended.

3. Imaging Procedures

   Computed tomography (CT) in colon and rectal cancer surveillance: Current recommendation. Patients who are at higher risk of recurrence, and who could be candidates for curative-intent surgery, should undergo annual CT of the chest and abdomen for 3 years after primary therapy for colon and rectal cancer. A pelvic CT scan should be considered for rectal cancer surveillance, especially for patients who have not been treated with radiotherapy.

   Chest x-ray: Current recommendation. No change from the last update of the guideline. Yearly chest x-rays are not recommended.

4. Endoscopic Surveillance Techniques

   Colonoscopy: Current recommendation. All patients with colon and rectal cancer should have a colonoscopy for the pre- or perioperative documentation of a cancer- and polyp-free colon. Following the surgical treatment of colorectal cancer, the Panel recommends the surveillance guideline presented by the American Gastroenterology Association (AGA): a colonoscopy at 3 years and then, if normal, once every 5 years thereafter (Winawer et al., 2003). For colorectal cancer patients with high-risk genetic syndromes, the physician should consider the guideline published by the AGA (see Table below):

   Table: Colon Cancer Screening Recommendations for People With Familial or Inherited Risk

   Familial Risk Category	Screening Recommendations
   First-degree relative affected with colorectal cancer or an adenomatous polyp at age >60 years, or two second-degree relatives affected with colorectal cancer	Same as average risk but starting at age 40 years
   Two or more first-degree relatives with colon cancer, or a single first-degree relative with colon cancer or adenomatous polyps diagnosed at an age <60 years a	Colonoscopy every 5 years, beginning at age 40 years or 10 years younger than the earliest diagnosis in the family, whichever comes first
   One second-degree or any third-degree relative with colorectal cancer b c	Same as average risk
   Gene carrier or at risk for familial adenomatous polyposis d	Sigmoidoscopy annually, beginning at age 10 to 12 years e
   Gene carrier or at risk for hereditary non-polyposis colorectal cancer	Colonoscopy, every 1 to 2 years, beginning at age 20 to 25 years or 10 years younger than the earliest diagnosis in the family, whichever comes first
   NOTE. Reprinted from Colorectal cancer screening and surveillance: Clinical guidelines and rationale--Update based on new evidence. Gastroenterology 124:544-60, 2003; with permission from the American Gastroenterological Association. a First-degree relatives include patients, siblings, and children. b Second-degree relatives include grandparents, aunts, and uncles. c Third-degree relatives include great-grandparents and cousins. d Includes the subcategories of familial adenomatous polyposis, Gardner syndrome, some Turcot syndrome families, and attenuated adenomatous polyposis coli (AAPC). e In AAPC, colonoscopy should be used instead of sigmoidoscopy because of the preponderance of proximal colonic adenomas. Colonoscopy screening in AAPC should probably begin in the late teens or early 20s.

   Flexible proctosigmoidoscopy (rectal cancer): Current recommendation. For patients who have not received pelvic radiation, flexible sigmoidoscopy of the rectum every 6 months for 5 years is recommended.

5. Laboratory-Derived Prognostic and Predictive Factors (Note: This topic is new to the guideline.)

   Current recommendation. Until prospective data are available, use of molecular or cellular markers should not influence the surveillance strategy.

None provided

The recommendations are based on evidence derived from randomized clinical trials and meta-analyses of data from randomized clinical trials.

Not applicable: The guideline was not adapted from another source.

1999 Apr (revised 2005 Nov 20)

American Society of Clinical Oncology - Medical Specialty Society

American Society of Clinical Oncology (ASCO)

American Society of Clinical Oncology (ASCO) Expert Panel

Panel Members: Al B. Benson, MD, (Co-Chair); Christopher Desch, MD, (Co-Chair); Patrick J. Flynn, MD; Carol Krause; Charles L. Loprinzi, MD; Bruce D. Minsky, MD; Nicholas J. Petrelli, MD; David Pfister, MD; Katherine S. Virgo, PhD

Although all authors completed the disclosure declaration, the following author or immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation.

This is the current release of the guideline.

This guideline updates a previous version: Benson AB, Desch CE, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Petrelli NJ, Pfister DG, Smith TJ, Somerfield MR. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 2000 Oct 15;18(20):3586-8.

This summary was completed by ECRI on June 29, 1999. The information was verified by the guideline developer on July 27, 1999. The summary was updated by ECRI in December 2000; the updated summary was verified by the guideline developer as of December 20, 2000. This NGC summary was updated by ECRI on May 11, 2006. The updated information was verified by the guideline developer on June 15, 2006.

This summary is based on the original guideline, which is subject to the American Society of Clinical Oncology's copyright restrictions.