AN EVALUATION OF POSTOPERATIVE FOLLOW-UP TESTS IN COLON-CANCER PATIENTS TREATED FOR CURE

Background: Currently patients with colon cancer who are potentially c ured by surgery are followed periodically with physical examinations, blood tests and imaging studies to detect tumor recurrence early, on t he presumption that intervention can affect outcome. There is little i nformation to indicate whether frequent visits to the doctor's office or frequent testing improves survival or quality of life. Methods: Nin ety-eight patients with resected stage B2, B3 or C (modified Astler-Co ller) colon cancer who developed recurrent disease while enrolled in p rospective adjuvant trials at Mayo Clinic sponsored by the North Centr al Cancer Treatment Group were studied to evaluate the utility of foll ow-up tests to detect the first recurrence of colon cancer and the out come following various interventions for these recurrences. These pati ents had a history, physical examination, complete blood count, chemis try panel and chest x-ray approximately every 3-4 months in the 1st ye ar and then every 6-12 months thereafter for a total of 5 years. Bowel evaluation was done at 6 months, 12 months and annually thereafter. I n addition, a minority of patients had carcinoembryonic antigen (CEA) testing, and radioisotope liver scans at various intervals. Results: S ymptoms signaled the diagnosis of recurrent disease in 55 patients, ph ysical examination in 4 patients, and abnormalities in chest x-ray in 18 patients. An elevated CEA was the initial abnormal test in 5 patien ts, abnormal liver scans in 5 patients, elevated liver function tests in 6 patients and laparotomy for other reasons in 2 patients. Hemoglob in, barium enema, and fecal blood testing were useful in 1 patient eac h. Thirty-one percent of recurrences were diagnosed between scheduled visits. In our series, histories, physical examinations, and chest x-r ays led to the detection of 79% of the recurrences while liver functio n tests, liver scans and CEAs led to the detection of 16% of recurrenc es. Sixteen patients underwent resection for cure for their first recu rrence; the diagnosis of recurrence was signaled by symptoms in 6 pati ents, chest x-ray in 6 patients and abnormal liver function tests, CEA , hemoglobin, and laparotomy for colostomy closure in 1 patient each. conclusions: The majority of tumor recurrences were detected by sympto ms, physical examinations and chest x-rays. Testing for asymptomatic t umor recurrences during the ist follow-up year is likely to be much le ss fruitful for detecting resectable recurrences than testing patients in the 2nd through 4th follow-up years. Patients who had a disease re currence in the 1st postoperative year were less likely to be candidat es for curative intent surgery. Lower tumor grade al initial diagnosis correlated both with likelihood of undergoing secondary surgical rese ction and the chance of doing well following this. These data may be h elpful for defining more appropriate follow-up tests for detection of tumor recurrence in patients with resected colon cancer.