HOW SHOULD PATIENTS BE FOLLOWED AFTER SUCCESSFUL TREATMENT FOR RECTAL CANCER?

More than 40,000 people are diagnosed with rectal cancer annually in the United States. Fortunately, survival rates for those with rectal cancer have improved dramatically with new advances in imaging, surgical techniques, and chemotherapeutic regimens. Although 75% of rectal cancer patients present with localized disease that may be amenable to surgical resection, up to 40% of these patients will develop local recurrent or metastatic cancer. 1 There are a number of diagnostic modalities used in postoperative surveillance of rectal cancer with the primary objective of these tests being to detect disease recurrence early in its course. As most recurrence occurs within 2 years of therapy, clinical outcomes may be improved if disease is detected at an early (local) stage. Thus, most accepted protocols for surveillance emphasize aggressive early surveillance with physician visits, imaging, and laboratory analysis. Surveillance recommendations will be impacted somewhat by the initial surgical intervention (eg, transanal excision, radical resection with sphincter preservation, radical resection with permanent colostomy, etc) and use of neoadjuvant or adjuvant therapies (eg, chemoradiation therapy, etc). 2 In this chapter we discuss the basic tenets of rectal cancer surveillance after resection.