After surgery for colorectal cancer, follow-up means regular check-ups with blood tests, CT scans and colonoscopies to catch a recurrence or a new tumor early. As a guide, our protocol includes a colonoscopy one year after surgery and then every 3 to 5 years, and a CT scan and blood test with tumor markers every 6 to 12 months. The exact schedule is adjusted to each patient's risk.
What is follow-up after colorectal cancer for?
To find a recurrence early, while it can still be treated with curative intent, and to detect polyps or a second tumor in the remaining colon. It also helps manage the after-effects of surgery and other treatments.
A recurrence in the liver or lungs, if it is found while small and localized, can sometimes be operated on. So it matters whether it is found at a scheduled check-up or only once it causes symptoms. We explain this in liver metastases.
What tests are done at check-ups?
A visit with the specialist, a blood test with tumor markers, a CT scan and follow-up colonoscopies. Each test looks for something different, which is why they are combined.
- Visit and examination, to talk about how you feel, any new symptoms and how your bowel habits are going.
- Blood test with tumor markers, mainly CEA and sometimes CA 19-9. These are substances some tumors release into the blood. If they rise steadily, the cause has to be found.
- CT scan of the chest and abdomen, to check the liver and lungs, which is where the disease most often comes back.
- Colonoscopy, to check the join in the bowel and the rest of the colon, and remove any polyps that appear.
How often are the check-ups?
In our protocol, as a guide, the colonoscopy is done one year after surgery and then every 3 to 5 years, and the CT scan and blood test with markers every 6 to 12 months. Check-ups are more frequent at first and are spaced out over time.
The schedule is not the same for everyone. It depends on the stage of the tumor, the treatments received and whether there is a hereditary risk such as Lynch syndrome, which requires more frequent colonoscopies. We adjust it with each patient.
Is follow-up different for rectal cancer?
Partly, yes. On top of the colon cancer tests, the pelvis is watched closely in rectal cancer, because that is where the tumor can come back, and MRI is used for this.
When the tumor has disappeared with chemotherapy and radiotherapy and the decision has been made not to operate, follow-up is much closer: check-ups every 3 months with examination, endoscopy, MRI, CT and blood tests. We explain this in watch and wait in rectal cancer.
What is normal after the operation?
Changes in bowel habits, especially in the first months. After rectal surgery it is common to go to the toilet more often, with fragmented stools and some urgency, and this usually improves over time.
Most patients recover well and gradually return to their normal lives over the following weeks. During treatment they are supported by a specialized nursing team that follows them closely. If a stoma was created, what is an ostomy covers its care and when it can be closed.
Which symptoms should I report without waiting for my check-up?
Blood in the stool, a change in bowel habits that does not go away, persistent abdominal pain, unexplained weight loss or tiredness with no clear cause. None of these necessarily means a recurrence, but you should not wait for the next check-up to mention them.
If you have severe abdominal pain with swelling and cannot pass stool or wind, go to the emergency room.
Can I do anything to lower the risk?
Keeping up with the check-ups helps the most. The habits that lower colorectal cancer risk in the general population, such as not smoking, limiting alcohol, keeping a healthy weight, exercising and eating more fiber, fruit and vegetables and less red and processed meat, also make sense after treatment.
If your close relatives have never had a colonoscopy, mention it at your appointment. Having a parent or sibling with colorectal cancer raises their risk, and they may need to start screening earlier than others.
Frequently asked questions
How many years does colorectal cancer follow-up last?
Usually at least five years, with more frequent check-ups at first that are spaced out over time. Follow-up colonoscopies continue after that, every 3 to 5 years, depending on the findings.
When is the first colonoscopy after surgery?
As a guide, one year after surgery. If the whole colon could not be seen before the operation, for example because the tumor was blocking it, it is brought forward to the following months.
My CEA has gone up. Does that mean the cancer is back?
Not necessarily. CEA can rise for other reasons, such as smoking or some benign conditions. A steady rise means the cause has to be looked for, usually with a CT scan.
Are check-ups the same for rectal cancer?
Pelvic MRI surveillance is added. And if watch and wait has been chosen, check-ups are every 3 months.
What happens if a check-up finds a recurrence?
Its extent is assessed and the team proposes treatment. A localized recurrence in the liver, lungs or peritoneum can sometimes be operated on, which is why it is worth finding it early.
References
- US National Cancer Institute. Colon Cancer Treatment (PDQ®), Patient Version.
- US National Cancer Institute. Rectal Cancer Treatment (PDQ®), Patient Version.
This information is for general guidance and does not replace an assessment by your doctor.