What Is the Appropriate Timetable and Exams Density for Tailored Follow-Up?

  • L. Påhlman
  • T. Wiggers


After completion of treatment for colorectal cancer, patients are offered a control program. This program can be split into aftercare and follow-up. Aftercare is meant to treat and to support the patient in the somatic and psychologic sequelae of the intensive treatment. In most cases, the patient has adopted to these consequences after 1 year. In this period, follow-up has already been started to detect recurrent disease in curatively treated patients. The rationale behind this scheduled follow-up is to detect asymptomatic recurrent disease as early as possible and by that increase the rate of curable recurrences followed by a better survival in a cost-effective way. Traditionally it consists of anamnesis, physical examination, blood tests, and imaging. Timing and duration has been debated for many years with endless discussions about the definition of minimal or intensive schedule, but guidelines all over the world have incorporated a kind of follow-up schedule in their national or institutional guidelines. However, evidence for a certain schedule of follow-up is based on old, often poor, designed studies with inclusion of the patients in the 1970s and 1980s of the last century, when surgery was suboptimal and the preoperative staging more or less missing. The subsequent meta-analyses have included all these old series and are the rationale of today’s practice. In general, the conclusion is that a kind of follow-up results in an improved survival, but it is not possible to determine the best combination of tests and the frequency.


  1. 1.
    Grossmann I, Doornbos PM, Klaase JM, de Bock GH, Wiggers T (2014) Changing patterns of recurrent disease in colorectal cancer. Eur J Surg Oncol 40(2):234–239CrossRefPubMedGoogle Scholar
  2. 2.
    Grossmann EM, Johnson FE, Virgo KS, Longo WE, Fossati R (2004) Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial. Surg Oncol 13(2–3):119–124CrossRefPubMedGoogle Scholar
  3. 3.
    Wille-Jorgensen P, Laurberg S, Pahlman L, Carriquiry L, Lundqvist N, Smedh K et al (2009) An interim analysis of recruitment to the COLOFOL trial. Color Dis 11(7):756–758CrossRefGoogle Scholar
  4. 4.
    Primrose JN, Perera R, Gray A, Rose P, Fuller A, Corkhill A et al (2014) Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA 311(3):263–270CrossRefPubMedGoogle Scholar
  5. 5.
    Verberne CJ, Zhan Z, van den Heuvel E, Grossmann I, Doornbos PM et al (2015) Carcino-embryonic antigen (CEA) measurements and CEA-triggered imaging: results of the randomized “CEAwatch” trial. Eur J Surg Oncol 41(9):1188–1196CrossRefPubMedGoogle Scholar
  6. 6.
    Jeffery M, Hickey BE, Hider PN. (2007). Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database of Systematic Reviews 1. Art. No.: CD002200Google Scholar
  7. 7.
    Treasure T, Monson K, Fiorentino F, Russell C (2014) The CEA second-look trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer. BMJ Open 4(5):e004385-2013-004385CrossRefGoogle Scholar
  8. 8.
    Steele SR, Chang GJ, Hendren S, Weiser M, Irani J, Buie D, Rafferty JF (2015) Practice guideline for the surveillance of patients after curative treatment of Colon and Rectal cancer. Dis Colon Rectum 58:713–725CrossRefPubMedGoogle Scholar
  9. 9.
    Colorectal cancer: the diagnosis and management of colorectal cancer. (
  10. 10.
    Glimelius B, Tiret E, Cervantes A, Arnold D (2013) on behalf of the ESMO guidelines working group. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Supplement 6):vi81–vi88PubMedGoogle Scholar
  11. 11.
    Verberne CJ, Nijboer CH, de Bock GH, Grossmann I, Wiggers T, Havenga K (2012) Evaluation of the use of decision-support software in carcino-embryonic antigen (CEA)-based follow-up of patients with colorectal cancer. BMC Med Inform Decis Mak 12:14-6947-12-14CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  1. 1.Department Surgical ScienceUppsala UniversityUppsalaSweden
  2. 2.Department of Surgical OncologyUniversity Medical Center GroningenGroningenThe Netherlands

Personalised recommendations