Colorectal cancer surveillance: What's new and what's next?

Table 1 Five-year surveillance regimens tested in reviewed randomized controlled trials

	Enrollment period	Setting	Stages included	Type of regimen	Surveillance regimen
Ohlsson et al[15]	1983-1986	2 Swedish centers	Dukes A, B, C	Intensive	History and physical exam, rigid proctosigmoidoscopy, CEA, Alk Phos, liver function tests, fecal hemoglobin, and chest X-ray at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48 and 60 mo; endoscopic visualization of the anastomosis at 9, 21, and 42 mo; complete colonoscopy at 3, 15, 30 and 60 mo; pelvic CT (rectal cancer only) at 3, 6, 12, 18 and 24 mo
				Minimal	No structured follow-up. Advised to obtain fecal hemoglobin tests every 3 mo for 2 years, then annually. Instructed to seek care if a series of warning signs/symptoms were experienced
Mäkelä et al[16]	1988-1990	1 Finnish center	Dukes A, B, C	Intensive	History and physical exam CEA, CBC fecal hemoglobin at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 48, 54 and 60 mo; Flexible sigmoidoscopy (if rectal/sigmoid tumors) every 3 mo; Liver ultrasound every 6 mo; Colonoscopy and liver CT annually
				Minimal	History and physical exam CEA, CBC fecal hemoglobin, CXR (and rigid sigmoidoscopy if rectal cancer) at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, 60 mo; Barium enema at 12, 24, 36 48 and 60 mo
Kjeldsen et al[17]	1983-1994	A single Danish county	Dukes A, B, C	Intensive	History and physical exam including digital rectal exam and gynecologic exam, hemoglobin, erythrocyte sedimentation rate, liver enzymes, fecal hemoglobin, colonoscopy, and chest X-ray at 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 120, 150 and 180 mo
				Minimal	The same investigations as above, but only at 60, 120, and 180 mo
Pietra et al[18]	1987-1990	1 Italian center	Dukes B, C	Intensive	History and physical exam, liver ultrasound, and CEA at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, 60 mo; CT, Chest X-ray and colonoscopy annually
				Minimal	History and physical exam, liver ultrasound, and CEA at 6, 12, 24, 36, 48, and 60 mo; Chest X-ray and colonoscopy annually
Schoemaker et al[19]	1984-1990	Multiple Australian centers	Dukes A, B, C	Intensive	History and physical exam, CEA, CBC, liver function tests, and fecal hemoglobin at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, 60 mo; Chest X-ray, liver CT, and colonoscopy annually
				Minimal	History and physical exam, CEA, CBC, liver function tests, and fecal hemoglobin at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, 60 mo; Chest X-ray, liver CT, and colonoscopy at 60 mo
Secco et al[20]	1988-1996	1 Italian center	Low-risk	Intensive risk-adapted	History and physical, CEA, abdominal/pelvic ultrasound at 6, 12, 18, 24, 36, 48, and 60 mo; Chest X-ray annually; Rectal cancer only: Rigid proctosigmoidoscpy at 12, 24 and 48 mo
				Minimal	Telephone follow-up every 6 mo; History and physical exam annually
			High-risk	Intensive risk-adapted	History and physical and CEA at 3, 6, 9, 12, 15, 18, 21, 24, 28, 32, 36, 42, 48, 54, and 60 mo; Abdominal/pelvic ultrasound at 6, 12, 18, 24, 30, 36, 48 and 60 mo; Rigid proctosigmoidoscopy (rectal cancer only) and chest X-ray annually
				Minimal	Telephone follow-up every 6 mo; History and physical exam annually
Rodríguez-Moranta et al[21]	1997-2001	3 Spanish centers	TNM II and III	Intensive	History and physical, CEA, CBC, and liver function tests at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54 and 60 mo; Abdominal/pelvic CT (rectal cancer only) or Abdominal ultrasound (colon cancer only) at 6, 12, 18, 24, 36, 48, 60 mo; Chest X-ray and colonoscopy annually
				Minimal	History and physical, CEA, CBC, and liver function tests at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54 and 60 mo; Colonoscopy at 12 and 36 mo

CEA: Carcinoembryonic antigen assay; CBC: Complete blood count; Alk phos: Alkalilne phosphatase; CT: Computed tomography.