The evidence-based recommendations described below outline the standard follow-up procedures for rectal 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.
Patients who have had rectal cancer are at risk of developing metastatic disease. Metastatic disease from rectal cancer that develops in the liver or lung may be amenable to surgical resection, which has the potential for cure and long-term survival. It is for this reason that the primary care provider is asked to organize the patient's 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** | (optional) | - | - | ||
| 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.
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.
Please be aware of these potential symptoms of colorectal cancer 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.
Note: The information on this page was adapted from the AHS Guideline Resource Unit's Rectal Cancer Guideline and the accompanying AHS GURU Rectal Cancer Transfer of Care Physician Letter. Also available is the Rectal Cancer Transfer of Care Patient Letter.
