*This article is being published jointly in CA: A Cancer Journal for Clinicians (online: May 30, 2006; print: May/June 2006) and Gastroenterology (print: May 2006) by the American Cancer Society and the American Gastroenterology Association.
Version of Record online: 24 FEB 2009
Copyright © 2006 American Cancer Society
CA: A Cancer Journal for Clinicians
Volume 56, Issue 3, pages 160–167, May/June 2006
How to Cite
Rex, D. K., Kahi, C. J., Levin, B., Smith, R. A., Bond, J. H., Brooks, D., Burt, R. W., Byers, T., Fletcher, R. H., Hyman, N., Johnson, D., Kirk, L., Lieberman, D. A., Levin, T. R., O'Brien, M. J., Simmang, C., Thorson, A. G. and Winawer, S. J. (2006), Guidelines for Colonoscopy Surveillance after Cancer Resection: A Consensus Update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer. CA: A Cancer Journal for Clinicians, 56: 160–167. doi: 10.3322/canjclin.56.3.160
† © 2006 American Cancer Society, Inc. and American Gastroenterology Association, Inc. Copying with attribution allowed for any noncommercial use of the work.
This article is available online at http://CAonline.AmCancerSoc.org
- Issue online: 24 FEB 2009
- Version of Record online: 24 FEB 2009
Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society (ACS) and US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stage II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double contrast barium enema or computed tomography colonography should be done preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination 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. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence, compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.