CEA (Carcinoembryonic antigen) tumour marker blood testing

Ideally check CEA every 3 months for 3 years and then annually after that until the patient is not fit enough or unwilling to undergo any further cancer treatment.

CT scanning

Ideally request CT chest and abdomen (and pelvis in rectal cancer patients) 6 months after completion of definitive treatment (e.g. surgery or chemotherapy) and then annually for 3 years.

Colonoscopy

Ideally request a full colonoscopy within 12 months of definitive treatment (e.g. surgery or chemotherapy) to ensure that the entire colon has been inspected and that there are no further colorectal polyps or tumours.  This colonoscopy can be conducted before or after the colorectal cancer definitive treatment.

Then a further colonoscopy in 3 years and 5 yearly afterwards until the patient is not fit enough or unwilling to undergo any further cancer treatment.

Out-Patient Clinic Appointments

Clinic doctors or specialist colorectal nurses should ensure that the above guidelines for follow up CEA, CT and colonoscopy checks are undertaken for appropriate patients with a previous histological diagnosis of colorectal carcinoma within the limits of the healthcare service that they are in.  Patients should be made aware of these guidelines in the clinic and how to access them on the internet.  Patients with no internet access can be directed to their local library where internet access can be gained or they can be given a print-out of this web page.  Out-patient clinic visits can be tailored to individual patient circumstances and wishes.  Clinic doctors should note that NHS GPs do not currently have permission to directly request CTs or colonoscopies so these must be arranged by a specialist hospital doctor.  Patients may prefer to have their regular CEA blood tests checked by their GP (in which case a formal request and instructions will need to be sent to the GP concerned) or they may prefer to attend the surgical clinic.  If you are in any doubt about the appropriate timing of a future out-patient clinic visit for a patient then please ask Mr Moore at the next available opportunity.

The above guidelines do not apply to patients undergoing palliative care.  The follow up of palliative patients should be discussed with Mr Moore at the next opportunity because they often do not require regular invasive investigations or follow up in the surgical clinic.  Discuss any palliative clinic patient with a colorectal Macmillan nurse and if they are not available then copy the colorectal Macmillan nurses in to your GP letter.

If a patient has decided that they would not consent to any further cancer treatment such as surgery, chemotherapy or radiotherapy then do not arrange any further colonoscopies, CTs or CEAs and discuss further management with Mr Moore at the next opportunity.

Frail patients should be discussed with Mr Moore before arranging any further investigations because they may be contraindicated.

The majority of patients given 'curative-intent' bowel resection operations remain colorectal cancer free for the rest of their lives.  Patients who subsequently develop further colorectal cancer or metastases are given hope in that techniques such as salvage surgery, aggressive combination chemotherapy and liver surgery are now delivering improved patient outcomes.  Therefore the above follow up program is quite intensive to try to make sure that patients requiring further cancer treatment are identified at the earliest opportunity.