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Colorectal Cancer

Cancer Care Alberta

The evidence-based recommendations described below outline the standard follow-up procedures for colorectal cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.

Topics

Surveillance Activities & Timelines|Red Flags|Referrals for Recurrence|General Support for Healthy Living

Quick Reference

Surveillance Activities & Timelines

Patients who have had colorectal cancer are at risk of developing metastatic disease. Once they are discharged from Cancer Care Alberta, their primary care provider is asked to organize their follow-up according to the schedule below:

 

Schedule of Tests

Test Year 1 Year 2 Year 3 Year 4 Year 5
CEA blood test* Every 3-6 months Every 3-6 months Every 3-6 months Every 6 months Every 6 months
CT scan**       - -
Colonoscopy**   Every 3 to 5 years as recommended by the patient's endoscopist

* CEA = carcinoembryonic antigen tumour marker
**CT scans (chest, abdomen, pelvis) and colonoscopies are performed around the anniversary date of the patient's surgery

 

Colonoscopy should be performed within 1 year after surgery, and every 3-5 years thereafter, based on findings.

  • Those with high-risk hereditary genetic features (i.e. HNPCC, FAP) may require more frequent colonoscopy at the discretion of their surgeon or oncologist
  • In the event of an abnormal colonoscopy (i.e. polyps present), the intervals may be decreased at the discretion of the investigating physician
  • Fecal occult blood testing (FOBT) and/or fecal immunochemical test (FIT) should not be used for surveillance for new primary lesions or polyps

If the CEA is elevated but less than 10, repeat in a month. If repeat CEA has increased further, evaluate for recurrence with physical exam and CT scan (chest, abdomen and pelvis). Elevation of CEA levels to above 10 are concerning for recurrence and require CT of the chest, abdomen and pelvis. If the CEA is elevated and continuing to increase, and the CT is negative, performing a PET/CT or referring back to the cancer center would be advisable.

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Red Flags

Please be aware of these potential symptoms of colorectal cancer recurrence:

  • Abdominal pain, especially in right upper quadrant or flank
  • Worsening fatigue
  • Nausea or unexplained weight loss
  • Dry cough
  • For rectal cancer: pelvic pain, change in urinary/bowel habits, sciatica

Referrals for Recurrence

Contact the treating oncologist to determine how to refer the patient back to the cancer centre. If the oncologist's contact information is not available, search "cancer" in the Alberta Referral Directory for the most up-to-date information and instructions for referral.

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Note: The information on this page was adapted from the AHS Guideline Resource Unit's Colorectal Cancer Surveillance (Stages I, II, and III) Guideline and the accompanying Colorectal Cancer Transfer of Care Physician Letter.