Is There Still a Role for Physical Consultation in Colorectal Cancer Surveillance?
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RESEARCH COMMUNICATION
Is There Still a Role for Physical Consultation in Colorectal Cancer Surveillance? Hui-Yu Tham 1 & Jerrald Lau 2 & Sean Kien-Fatt Lee 1 & Stephen Hwang 1 & Dedrick Kok-Hong Chan 1,2 & Ker-Kan Tan 1,2 Received: 5 June 2020 / Accepted: 8 August 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Colorectal cancer . Cancer surveillance . Cancer recurrence . Physical examination
This study was conducted to evaluate how cancer recurrence was initially suspected/diagnosed for all colorectal cancer (CRC) patients from the National University Hospital, Singapore over a 5-year period, with the aim of exploring the role of community-based CRC surveillance. After obtaining ethical approval, a review of all CRC patients without metastatic disease who underwent curative surgery from January 2012 to December 2014 was performed. All patients were followed up in the outpatient clinics in accordance to protocols adapted from the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines over 5 years.1,2 Typically, patients are reviewed 3monthly for the first 2 years and then 6-monthly for the remaining 3 years. Apart from history taking and appropriate physical examination, the surgeons or medical oncologists will go through the results of the serum carcinoembryonic antigen (CEA) levels, radiological and endoscopic investigations with the patients. Patients with early cancers are typically discharged after 5 years, while those with more advanced cancers can opt to continue surveillance in the hospital. From a total of 507 CRC patients, 437 underwent surgery with curative intent after staging scans (Table 1). Over a median follow-up of 50 months, 81 patients (18.54%) developed disease recurrence (Table 2). In the
* Ker-Kan Tan [email protected] 1
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore Singapore
2
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Singapore
remaining 356 patients, 38 (8.70%) were lost to followup, 49 (11.21%) died with no documentation of disease recurrence, and 268 (61.33%) remained disease-free. In these 81 patients, the index modality of suspicion was a raised CEA (n = 24, 29.63%), surveillance CT scans with normal CEA levels (n = 29, 35.80%), both elevated serum CEA levels and abnormal CT scans concurrently (n = 13, 16.05%). Twelve (14.81%) other patients presented with non-specific symptoms. Only two (2.47%) patients had asymptomatic recurrence diagnosed on physical examination, one of them at 7 years from the index operation. Within the 5-year period, 436 (99.77%) patients were physically assessed with no clear benefit in oncological outcomes. CRC recurrences were primarily asymptomatic and/or detected objectively via CEA and radiological scans. This echoed studies demonstrating poor sensitivity of physical examination in detection of recurrence.3,4 These findings question the advocacy of routine ph
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