FOLLOW-UP OF COLORECTAL-CANCER

Surveillance for a second primary colon or rectal cancer, detection an d treatment of recurrent disease, and health maintenance are the essen tial components of follow-up of a patient population with potentially curative resection of a primary large bowel cancer. The value of follo w-up programs have been extensively studied with colorectal cancer. Of 100 colorectal cancer patients in a follow-up program, approximately 20 patients should have prolongation of life as a result of surveillan ce, detection and treatment, and health maintenance. Detection of recu rrent cancer and its treatment may be the most expensive and least eff ective part of the follow-up program. Lead time is minimal with intens ive follow-up (including serial CEA blood tests) when compared to the time of diagnosis derived from symptoms of recurrent malignancy in an informed patient. Aggressive reoperative surgery in selected patients with recurrent disease with use of adjunctive radiation therapy and ch emotherapy when appropriate, will salvage long term the greatest numbe r of people and yield some palliative benefits. It is crucial that reo perative surgery be pursued by an experienced team familiar with this type of intervention. Comprehensive follow-up of colorectal cancer pat ients has a high value in its medical economic cost and should continu e to be pursued, studied, to become more cost effective, and integrate d into a complete management plan.