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Brief Summary

GUIDELINE TITLE

Guidelines for colonoscopy surveillance after cancer resection: A consensus update by the American Cancer Society and US Multi-Society Task Force on colorectal cancer.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Postcancer Resection Surveillance Colonoscopy Recommendations

  1. Patients with colon and rectal cancer should undergo high quality perioperative clearing. In the case of nonobstructing tumors, this can be done by preoperative colonoscopy. In the case of obstructing colon cancers, computed tomography colonography with intravenous contrast or double contrast barium enema can be used to detect neoplasms in the proximal colon. In these cases, a colonoscopy to clear the colon of synchronous disease should be considered 3 to 6 months after the resection if no unresectable metastases are found during surgery. Alternatively, colonoscopy can be performed intraoperatively.
  2. Patients undergoing curative resection for colon or rectal cancer should undergo a colonoscopy 1 year after the resection (or 1 year following the performance of the colonoscopy that was performed to clear the colon of synchronous disease). This colonoscopy at 1 year is in addition to the perioperative colonoscopy for synchronous tumors.
  3. If the examination performed at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that colonoscopy is normal, then the interval before the next subsequent examination should be 5 years.
  4. Following the examination at 1 year, the intervals before subsequent examinations may be shortened if there is evidence of hereditary nonpolyposis colorectal cancer or if adenoma findings warrant earlier colonoscopy.
  5. Periodic examination of the rectum for the purpose of identifying local recurrence, usually performed at 3- to 6-month intervals for the first 2 or 3 years, may be considered after low anterior resection of rectal cancer. The techniques utilized are typically rigid proctoscopy, flexible proctoscopy, or rectal endoscopic ultrasound. These examinations are independent of the colonoscopic examinations described above for detection of metachronous disease.

Additional Recommendations Regarding Postcancer Resection Surveillance Colonoscopy

  1. These recommendations assume that colonoscopy is complete to the cecum and that bowel preparation is adequate.
  2. There is clear evidence that the quality of examinations is highly variable. A continuous quality improvement process is critical to the effective application of colonoscopy in colorectal cancer prevention.
  3. Endoscopists should make clear recommendations to primary care physicians about when the next colonoscopy is indicated.
  4. Performance of fecal occult blood test is discouraged in patients undergoing colonoscopic surveillance.
  5. Discontinuation of surveillance colonoscopy should be considered in persons with advanced age or comorbidities (with less than 10 years of life expectancy), according to the clinician's judgment.
  6. Surveillance guidelines are intended for asymptomatic people. New symptoms may need diagnostic workup.
  7. Chromoendoscopy (dye-spraying) and magnification endoscopy are not established as essential to screening or surveillance.
  8. Computed tomography colonography (virtual colonoscopy) is not established as a surveillance modality.

CLINICAL ALGORITHM(S)

None provided

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is not specifically stated for each recommendation.

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

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

DATE RELEASED

2006 May

GUIDELINE DEVELOPER(S)

American Cancer Society - Disease Specific Society
American Gastroenterological Association Institute - Medical Specialty Society

SOURCE(S) OF FUNDING

American Cancer Society, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

GUIDELINE COMMITTEE

American Cancer Society Advisory Group on Colorectal Cancer, US Multi-Society Task Force on Colorectal Cancer

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Advisory Group and Task Force Members: Douglas K. Rex, MD; Charles J. Kahi, MD, MSc; Bernard Levin, MD; Robert A. Smith, PhD; John H. Bond, MD; Durado Brooks, MD, MPH; Randall W. Burt, MD; Tim Byers, MD, MPH; Robert H. Fletcher, MD, MSc; Neil Hyman, MD; David Johnson, MD; Lynne Kirk, MD; David A. Lieberman, MD; Theodore R. Levin, MD; Michael J. O'Brien, MD, MPH; Clifford Simmang, MD; Alan G. Thorson, MD; Sidney J. Winawer, MD

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available from the American Cancer Society Web site.

Print copies: Available from the American Cancer Society, 250 Williams St., Suite 600, Atlanta, GA 30303; Web site: www.cancer.org.

AVAILABILITY OF COMPANION DOCUMENTS

None available

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI Institute on February 4, 2008. The information was verified by the guideline developer on February 29, 2008.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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