Patients with resected
colorectal cancer are at risk for recurrent
cancer and
metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on
Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I
colorectal cancer, surgically resected Stages II and III
cancers, and Stage IV
cancer resected for cure (isolated hepatic or pulmonary
metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous
neoplasia in the
perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double-contrast barium enema or computed tomography colonography should be performed preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous
second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that examination is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated
adenoma findings (see "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on
Colorectal Cancer and the American Cancer Society"). Shorter intervals also are indicated if the patient's age, family history, or
tumor testing indicate definite or probable
hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of
rectal cancer generally have higher rates of local
cancer recurrence compared with those with
colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original
rectal cancer.