According to an article published in the Journal of Clinical Oncology, more intensive screening up to the fifth year following treatment for patients diagnosed with stage II colon cancer yields improved survival compared with simpler screening strategy.
Colorectal cancer remains the second-leading cause of cancer-related deaths in the U.S.
After surgical removal of colon cancer, the cancer is referred to as stage II (B) if the final pathology report shows that the cancer has penetrated the wall of the colon into the abdominal cavity; cancer at this stage has not invaded local lymph nodes and cannot be detected in other locations in the body.
Stage III (C) colon cancer is diagnosed if the final pathology report following surgery shows that the cancer has penetrated the wall of the colon into the abdominal cavity and invaded local lymph nodes; cancer at this stage cannot be detected in other locations in the body.
Patients with stages II-III colon cancer are often treated with surgery to remove as much cancer as possible, followed by chemotherapy with or without radiation. Unfortunately, cancer recurs following treatment in a substantial number of patients. Patients diagnosed with colon cancer are monitored following treatment to detect recurrence at its earliest stage so that it may be treated as soon as possible. However, the optimal scheduling and testing for a recurrence is under debate.
Researchers from Spain recently conducted a trial to compare different screening schedules among patients who had been diagnosed and treated for either stage II or III colon cancer.
This trial included 259 patients: 132 patients underwent a simple surveillance strategy including a clinical evaluation and carcinoembryonic antigen (CEA) levels (protein levels that can be measured in the blood which are often elevated with the presence of cancer); 127 patients underwent an intensive surveillance strategy including abdominal computed tomography (CT) or ultrasound, chest X-rays, and colonoscopy in addition to a clinical evaluation and CEA levels.
Patients with stage II colon cancer had improved outcomes with an intensive surveillance strategy:
- After a median follow-up of 4 years, there was no difference in survival among patients with stage III colon cancer.
- There were no differences in time before cancer recurred and type of recurrence between the two groups screening groups.
- Patients with stage II colon cancer had improved survival when undergoing intensive screening compared to simple screening (81.6 months versus 70.9 months, respectively).
- Patients with cancers in the rectum had improved survival with intensive screening compared to simple screening.
- 51% of patients who underwent intensive screening were able to have their cancer recurrence completely removed, compared with only 29% of patients who underwent simple screening.
- Although intensive screening was more expensive than simple screening, surgery for recurrences was more expensive for those who underwent simple screening.
The researchers concluded that a more intensive screening strategy improves overall survival among patients diagnosed with stage II colon cancer more than a simpler strategy. A consensus on the exact routine of screening for patients with this disease has not yet been confirmed, these results may provide important information on establishing follow-up screening guidelines for stage II colon cancer. Patients diagnosed with stage II colon cancer may wish to speak with their physician regarding their individual follow-up screening recommendations.
Reference: Rodriguez-Moranta F, Salo J, Arcusa A, et al. Postoperative Surveillance in Patients With Colorectal Cancer Who Have Undergone Curative Resection: A Prospective, Multicenter, Randomized, Controlled Trial. Journal of Clinical Oncology. 2006; 24: 386-393.
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