Following patients after treatment for colon cancer serves several functions. First, surveillance attempts to identify recurrent disease at a stage potentially resectable for cure. Secondly, following patients with colonoscopy can identify metachronous polyps or cancers at an early stage. Finally, surveillance serves to reassure the patient. A balance must be struck between accomplishing the above goals and providing care that has minimal morbidity and is cost effective. Based on available data, guidelines for follow-up have been developed, including by the National Comprehensive Cancer Network (NCCN) (Engstrom et al, 2003). Patients with T2 or greater tumors should be followed with history and physical examination and a CEA level every 3 months for the first 2 years after treatment and then every 6 months for the next 3 years. If a rising CEA is identified, further testing should be performed, including imaging studies and colonoscopy. CT scan is the most frequently used imaging modality. If negative with a continuing rise of the CEA, PET imaging should be considered. In addition, PET can be useful in cases where resection of metastatic disease is being considered to rule out more extensive disease. In cases where the primary tumor is of early stage (Tis, T1) or where the patient may not be a candidate for aggressive treatment of recurrent disease, follow-up testing can be more limited. There is a separate chapter on metastatic cancer of the liver (see Chapter 129, "Metastatic Cancer of the Liver").

Colonoscopy should be performed at 1 year postop-eratively, or within 6 months, if a complete colonoscopy was not possible preoperatively due to obstruction or perforation. If the postoperative colonoscopy is free of polyps, repeat surveillance every 3 years is generally recommended. In patients where adenomas are found or if a hereditary syndrome is present, annual colonoscopy should be considered.

Chemo prevention of colorectal adenomas is discussed in the February 3, 2004 issue of the Annals of Internal

Medicine, Chan, et al. 140:157-66, in an editoral by Sandler, and in the chapter on colonic polyps (see Chapter 95, "Colorectal Polyps and Polyposis Syndromes").

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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