Last Modified: April 10, 2005
Dear OncoLink "Ask The Experts,"
I am vast approaching my three year surgical resection anniversary. I was Stage III colon cancer with 1 out of 23 nodes tested positive (40 years old) Colon resection with all normal margins. (1 ½ inches of rectum removed 5-FU and Radiation. My health has been very good. All Scans clear for three years.
What the normal testing protocol after three years? I am always concerned about recurrence. After three years from surgery are the statistics get better?
Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds:
After two years, the recurrence statistics start to improve dramatically, although we are fairly vigilant up to 5 years after diagnosis and treatment.
Proper follow-up is difficult to get a consensus across the board. However, it should include a colonoscopy at year 1 after surgery, and another one 3 years later. Colonoscopy 3 years after that is probably wise, and if that is negative, again 5 years later. CT scans could probably be reduced to once a year until year 5 with CEA's twice a year.
The vigilance of colonoscopic evaluation is partly based on estimated risk. If you are quite young, (less than 50) at diagnosis or have a strong family history (3 first degree relatives with colon cancer) in two successive generations, then you may have a hereditary form of cancer and may need more frequent screening. These patients or patients who feel they may benefit from genetic counseling can get a much better idea of their risk based on a detailed evaluation of family history. Anybody can take advantage of the service.