Authors' objectives:

This report focusses on follow-up of both benign tumours and cancers of the large bowel (colon and rectum).

This report examines two areas, firstly follow-up after surgical resection of colorectal cancer, and secondly interventions and follow-up after the discovery of the benign tumours of the bowel known as adenomas, which present as polyps within the bowel. It is believed that colorectal cancer usually arises from an adenoma which has turned malignant.

Authors' recommendations: Follow-up after cancer: - intensive follow-up in hospital clinics is not worthwhile. Most patients could be informed about symptoms to watch for, and could then contact their general practitioner to be referred back. - assuming that the bowel has been cleared of tumour and polyps after resection of the original cancer, either at the time of operation or at 6 month follow-up, there seems to be no benefit in routine screening by colonoscopy before 5 years. Hence one option for follow-up is a screening colonoscopy at 6 months, followed by discharge to GP care, until the next screening colonoscopy at 5 years. Further research is necessary, if we are to find ways of detecting recurrence in time for cure. - the use of tumour markers such as CEA does not help detect curable recurrences, and should not be funded. - faecal occult blood testing is ineffective for detecting recurrences. - newer methods of imaging with monoclonal antibody markers show promise, but should be regarded as a research area meantime. Follow-up and interventions after detection of adenomas: a) Diet If the theories about diet and colorectal cancer are true, the recommended diet would be similar to that already recommended for prevention of heart disease and stroke, and so no special recommendations are required. b) Dietary supplements There is no evidence for these at present, but a trial of folic acid would be worthwhile. c) Aspirin and the other NSAIDS No recommendation can be made at present. Several trials of aspirin in the recurrence of adenomas are underway. d) Exercise No recommendation can be made in terms of colorectal tumours, but the recommendation would probably be similar to the advice given for reducing heart disease risk, though trials of the amount of exercise needed to reduce adenoma recurrence would be useful.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.nhsconfed.net/shpic/doc16.htm

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Purchasing Information Centre

Copyright: Scottish Health Purchasing Information Centre