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20-12-2016 | Colorectal cancer | Article

Surveillance after curative treatment for colorectal cancer

Authors:
Eric P. van der Stok, Manon C. W. Spaander, Dirk J. Grünhagen, Cornelis Verhoef, Ernst J. Kuipers

Abstract

Treatments for colorectal cancer (CRC) of all stages have evolved considerably over the past two decades, resulting in improved long-term outcomes. After curative treatment, however, 30% of patients with stage I–III and up to 65% of patients with stage IV CRC develop recurrent disease. Thus, patients are routinely offered surveillance in order to detect disease recurrence at an early, asymptomatic stage, with the intention of improving survival. Nevertheless, controversy continues to surround the optimal surveillance protocols. For patients with stage I–III CRC, more-intensive surveillance improves overall survival compared with less-intensive or no surveillance, probably owing to improved outcomes after cancer recurrence, as well as proactive treatment of other conditions detected opportunistically. The benefit of surveillance after curative treatment of stage IV CRC is more controversial, but might be justified because repeat resection can improve overall survival and 20% of these patients are eligible for such treatment with curative intent. No trials have assessed the optimal follow-up approach after curative resection of metastatic CRC, and similarly to surveillance of patients with stage I–III disease, most programmes are more intensive during the first 3 years than at later time points. Herein, we provide a comprehensive overview of surveillance strategies for patients with CRC, and discuss the future development of patient-centred programmes.

Nat Rev Clin Oncol 2017; 14: 297–315. doi:10.1038/nrclinonc.2016.199

Subject terms: Cancer imaging • Cancer screening • Colorectal cancer • Medical imaging • Metastasis

Colorectal cancer (CRC) is a major cause of cancer-related deaths1: CRC is the third most commonly diagnosed cancer worldwide, with an estimated 614,000 women (9.2% of all new cancer cases) and 746,000 men (10% of all new cancer cases) affected, and an estimated 693,900 CRC-related deaths in 2012 (Ref. 2). Around 50% of patients with CRC present with localized disease (stage I–II), about 25% with locoregional advanced-stage disease (stage III), and the remainder with metastases in distant organs (stage IV)3, 4, 5. National screening programmes for CRC have been introduced in more than 50 countries, and this number is increasing6. Of note, screening increases the proportion of patients with CRCs who are diagnosed at an early disease stage7, thereby increasing the potential for treatment with curative intent and improving patients outcomes. After treatment with curative intent, patients with CRC enter a surveillance programme that generally lasts for 5 years. Approximately 30% of patients with stage I–III disease develop recurrent disease after initial treatment8, 9; among patients with stage IV CRC, up to 65% have relapsed disease after treatment with curative intent10, 11, 12, 13, 14, 15, 16.

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