Colorectal Cancer :: Follow-up endoscopic surveillance in colorectal cancer patients improves survival

Colorectal cancer patients who undergo colonoscopic surveillance during follow-up after surgery experience improved survival, according to a study to be published in the April issue of Clinical Gastroenterology and Hepatology but currently available online.

Results of the study suggest that colorectal cancer patients should undergo routine colonoscopic surveillance at one year after their surgery and that more intensive surveillance may be needed in patients found to have advanced neoplasia as well as those with a prior history of adenomatous colon polyps.

“The results of our study provide additional evidence that colorectal cancer survivors benefit from surveillance with colonoscopy, and it appears that the initial surveillance colonoscopy should be performed at one year after colon resection because of the significant risk of additional cancers and polyps in these patients,” according to Stephen J. Rulyak, MD, MPH, lead author of the study and Acting Assistant Professor in the Division of Gastroenterology at the University of Washington in Seattle.

The study included a total of 1,002 patients identified from the Group Health Cooperative, a large health system in Washington State, and consisted of equal proportions of men and women, the majority of whom were aged 60 years or older. More than 700 (70 percent) were alive at the end of the study period and the cumulative survival for the study group was 96 percent at one year and 68 percent at five years.

Patients who underwent one or more colon examinations during follow-up had improved survival compared with patients who did not undergo examination (652 patients versus 350 patients). Patients? estimated five-year survival was similar regardless of whether the initial follow-up colon exam was performed within 18 months of diagnosis (78.0 percent), between 18 and 35 months of diagnosis (75.5 percent) or between 36 and 60 months of diagnosis (77.3 percent). However, among patients who did not undergo a colon examination during follow-up, the five-year survival was at least 45 percent lower (52.5 percent).

Twenty patients in the study (3.1 percent) were diagnosed with a second colorectal cancer, including nine cancers detected within 18 months of initial cancer diagnosis. Advanced neoplastic polyps were also more common (15.5 percent) when the initial colonoscopy was delayed until 36 to 60 months after diagnosis compared with patients who had an initial colonoscopy within 18 months (6.9 percent). Patients with a prior history of adenomas were more likely to have advanced neoplastic polyps on follow-up. In addition, patients with advanced neoplastic polyps on the initial surveillance colonoscopy were frequently found to have advanced neoplasia on subsequent colonsocopies (81 percent).

“The best prevention we have against colorectal cancer is screening. All individuals over the age of 50 or those with a family history of the disease should be screened for this deadly disease,” according to Charles Mel Wilcox, MD, Editor-in-Chief, Clinical Gastroenterology and Hepatology, and professor of medicine, University of Alabama, Birmingham. “This study provides further proof of the value of screenings and the lives that can be extended and saved.”

Colorectal cancer is the third leading cause of cancer-related deaths and affects men and women equally. An estimated 112,340 new cases of colon cancer and an estimated 41,420 cases of rectal cancer will be diagnosed this year, according to the National Cancer Institute. More than 52,000 Americans will die from colorectal cancer in 2007. Colorectal cancer rates have been decreasing steadily over the past several decades due to an increase in awareness and screening.

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