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Follow-up of colorectal cancer patient at health centres
Julkaistu 15.06.2012 00.01
Routine follow-up after colorectal cancer treatment has been proven efficient. In approximately half of the patients the cancer recurs and recurrences appear early, more than 90% within three years of surgery. Early detection of recurrence in the bowel, new primaries or metastases is important, as they are treatable. New tumours, adenomas and some recurrences in the bowel, liver or lung are even curatively resectable with a 5-year survival of 25-50%.
Follow-up schedules include psychological support, laboratory tests, endoscopy and physical check up (with radiology in selected centres). Recurrences cause characteristic symptoms and signs, thus the importance of the history and physical examination cannot be overestimated. Long term toxicity after colorectal cancer treatment is not negligible and small measures may improve patients’ quality of life significantly. Determination of carcinoembryonic antigen (CEA) is recommended at 3-12-month intervals for five years. CEA increases in 60-80% of recurrences, with a lead of months. Colonoscopy at one year and at 3-5-year intervals thereafter, combined with sigmoidoscopy after anterior resection, reveals local recurrences (15%), new colorectal primaries (10%) and adenomas (50%). Radiology is routinely used in selected high risk patients. Body CT and colonoscopy is indicated as work up if CEA is increasing or symptoms or signs of recurrence are present.
Follow-up provides an opportunity to discuss prevention, diet, new treatments, and other health concerns. Support is needed as patients change from cancer patients to survivors and their health care use increases in the process.
Pia Österlund
Department of Oncology
Helsinki University Central Hospital and Helsinki University
Tapio Salminen, Heikki J. Järvinen
Finnish Medical JOurnal 2012;67:1913–8.
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