Follow up after surgery colorectal cancer

Following surgery for colorectal cancer it is important to undergo regular check ups. This is to identify any return of the cancer early and allow further treatment to be started as soon as possible. The majority of cancer recurrences occur within the first 2 years and depend on the stage of the tumour at presentation, the earlier the cancer at the first operation the less likely it is to return. The standard follow up protocol would be;

     1 - A colonoscopy 6 months after surgery of this had not been performed before hand

     2 - Further colonoscopy at 5 years depending on the findings of the previous colonoscopy

     3 - CT scan of chest, abdomen and pelvis 1, 2 and 5 years after surgery

     4 - Carcinoembryonic antigen (CEA) blood tests every 6 months

     5 - Unlimited access to colorectal specialist nurses for any concerns

Although an intensive follow up programme has been shown to improve outcomes, some patients will develop recurrent cancer between visits to the surgeon or oncologist and any new symptoms or worries should be discussed with them or one of the specialist nurses as soon as they occur.

Follow up after liver resection surgery

Some patients require surgery to remove an area of colorectal cancer that has spread to their liver. Patients generally do very well after this procedure but require a slightly different follow up which would be;

     1 - CT scan 4 weeks after surgery

     2 - CT scan of chest, abdomen and pelvis and blood test measuring liver function, blood count and CEA every 6 months for the first 3 years after surgery and annually for the next 2 years
 

National Bowel Screening

Around 1 in 20 people will develop colorectal cancer. Since these cancers tend to grow slowly, arising from polyps it is possible to identify a great many patients when their tumour is at an early stage. The government is expanding a programme of screening for colorectal cancer to the general population. People between the age of 60 and 69 will be invited to submit a stool sample for testing every 2 years. This is known as faecal occult blood testing (FOB) and looks at the tiny quantities of blood that these growths produce. Those over the age of 70 will be able to undergo the test if they wish but will have to contact their local doctor.

Around 98 people in every 100 screened will have a normal result, of these 4 will be unclear and people will have to repeat the test. Two in every 100 will have an abnormal test and will be advised to undergo a colonoscopy evaluation of the colon (bowel). Half will have nothing serious wrong but may have a simple condition such as haemorrhoids, 4 in ever 10 will have polyps which may be removed and 1 will have a cancerous growth. Of those with cancer studies have shown that 2/3^rd of are at a very early stage amenable to cure. For ore information visit the national screening web site;

 www.cancerscreening.nhs.uk/bowel/^.

Polyp follow up

Inflammatory bowel disease

Patients from a family thought to have a genetic condition that pre-disposes to the formation of colorectal cancer such as familial adenomatous polyposis (FAP) or hereditary non polyposis colon cancer (HNPCC) should be evaluated by a genetics specialist and offered surgery or entered into a screening programme if appropriate. The majority of patients do not have these conditions but the risk of developing a bowel cancer increases with the number of family members who have developed these cancers. These people benefit from colonoscopic surveillance but should see their local doctor for further evaluations who will refer them to a specialist clinic if there is any doubt.