Rectal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Rectal Cancer
The primary goals of postoperative surveillance programs for rectal cancer are the following:
- To assess the efficacy of initial therapy.
- To detect new or metachronous malignancies.
- To detect potentially curable recurrent or metastatic cancers.
Routine, periodic studies following patients treated for rectal cancer may lead to earlier identification and management of recurrent disease.[66,67,68,69,70] A statistically significant survival benefit has been demonstrated for more intensive follow-up protocols in two clinical trials. A meta-analysis that combined these two trials with four others was reported to show a statistically significant improvement in survival for patients who were intensively followed.[66,71,72] Guidelines for surveillance after initial treatment with curative intent for colorectal cancer vary between leading U.S. and European societies, and optimal surveillance strategies remain uncertain.[73,74] Large, well-designed, prospective, multi-institutional, randomized studies may be required to establish an evidence-based consensus for follow-up evaluation.
Measurement of CEA, a serum glycoprotein, is frequently used in the management and follow-up of patients with rectal cancer. A review of the use of this tumor marker for rectal cancer suggests the following:
- Serum CEA testing is not a valuable screening tool for rectal cancer because of its low sensitivity and low specificity.
- Postoperative CEA testing should be restricted to patients who are potential candidates for further intervention, as follows:
- Patients with stage II or III rectal cancer (every 2 to 3 months for at least 2 years after diagnosis).
- Patients with rectal cancer who would be candidates for resection of liver metastases.
In one retrospective study of the Dutch TME trial for the treatment of rectal cancer, investigators found that the preoperative serum CEA level was normal in the majority of patients with rectal cancer, and yet, serum CEA levels rose by at least 50% in patients with recurrence; the authors concluded that serial, postoperative CEA testing cannot be discarded based on a normal preoperative serum CEA level in patients with rectal cancer.[75,76]
Other PDQ summaries containing information related to rectal cancer include the following:
- Unusual Cancers of Childhood Treatment (colorectal cancer in children).
- Genetics of Colorectal Cancer.
- Colorectal Cancer Prevention.
- Colorectal Cancer Screening.
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