Colorectal Cancer: Surveillance After Curative-Intent Therapy
There are more than 1.2 million people in the United States in survivorship care after curative resection of colorectal cancer. They face a lifetime of risk for cancer recurrence or metachronous colorectal cancer, yet there is little consensus on optimal
- PDF / 316,583 Bytes
- 16 Pages / 595.28 x 790.87 pts Page_size
- 51 Downloads / 265 Views
Key Concepts
Introduction
• Liver metastases and locoregional recurrence are more likely to be amenable to curative-intent salvage resection when detected in asymptomatic patients. Therefore, active surveillance is indicated for patients who are candidates for liver and/or intestinal resection. • Use of carcinoembryonic antigen testing and computed tomography (CT) scans is associated with increased detection of asymptomatic recurrence after curative resection for colorectal cancer. There is no evidence to support the use of any other laboratory testing or positron emission tomography (PET) scans in routine surveillance. • Patients with advanced age and comorbidity, who would not be fit to undergo therapy for recurrence, should not be subjected to active surveillance. They should, however, receive evaluation and treatment for symptoms suggestive of recurrence. • Patients with resected rectal cancers are at greater risk for locoregional recurrence. This risk is increased by omission of chemoradiotherapy for locally advanced tumors, close or positive margins, T4 and N2 histology. Consideration should therefore be given to local pelvic surveillance both endoluminally and extraluminally in these patients at highest risk. • Surveillance after resection of Stage I colorectal cancer remains controversial. While the recurrence rates are low, in general, there are markers of relatively greater risk, including margin positivity, unknown lymph node status (e.g., local excision), inadequate lymph node sampling, lymphovascular invasion, poorly differentiated histology, and/or T2 disease. Active surveillance may be considered for patients with one or more of these risk factors.
With improvements in screening, diagnosis, surgical technique, and adjuvant therapy for colon and rectal cancers, nearly two-thirds of patients who undergo surgical resection survive 5 years or more [1]. As a result, there is a rapidly growing population of colorectal cancer survivors, exceeding 1.2 million in the United States alone [2]. These individuals face varying risk for subsequent colorectal cancer throughout their lifetime, yet there is little consensus on optimal regimens for surveillance and survivorship care [3, 4]. The primary goal of colorectal cancer surveillance is to detect treatable recurrent, metastatic or metachronous colorectal malignancy and optimize the opportunities for potentially curative intervention. Thus, surveillance strategies must include not only evaluation for local recurrence and distant metastasis from the treated cancer, but also the increased personal risk for subsequent primary colorectal cancers. For patients with suspected or known genetic colorectal cancer syndromes, these strategies must also take into account the risk of other associated cancers, and the screening needs of potentially affected family members [5]. Ultimately, the success of colorectal cancer surveillance may be measured by improvements in overall survival, cancerspecific survival, disability or quality of life. Some studies have evaluated proxy
Data Loading...
