The first aim of follow-up care is to quickly identify any relapses and tumors elsewhere. Around five percent of patients with colorectal cancer later develop another cancer. And even intestinal tumors that are considered cured can relapse. However, just like the so-called “primary tumor”, secondary tumors or metastases are often still at an early, curable stage if diagnosed early. This is why aftercare is important.
If a relapse occurs at all, it usually happens in the first two years after the end of treatment. After that, the probability of a relapse is very low: less than one percent of relapses occur more than five years after surgery.
Accordingly, the aftercare phase usually lasts five years (although a longer period may be appropriate in individual cases).
The second important reason for aftercare is that those affected continue to receive support and advice if questions or problems arise.
A structured aftercare program coordinated by a single office has proven its worth. Ideally, the doctors, psycho-oncologists and other specialists involved are kept informed and involved on an ongoing basis. It is important that the family doctor in particular is involved, as he or she is usually the first point of contact for the patient in the years after surviving cancer.
It can be stressful for those affected if they have to travel to each examination separately. However, specialized aftercare centers coordinate the examinations so that they can all be carried out on the same day if possible.
Which examinations are indicated when as part of the follow-up care depends on the stage of the tumor and the type of tumor (colon or rectal carcinoma). If a finding indicates a relapse or a second tumor, further clarification is necessary.
The follow-up examinations include
- the conversation with the doctor (medical history)
- the physical examination by the doctor
- Determination of the CEA value in the blood: If the level of the “carcinoembryonic antigen” rises, this may be an indication of a relapse. However, this is not definitive proof, as the CEA value can also be elevated in the case of intestinal inflammation or other diseases, for example.
- a complete colonoscopy, and in the case of previous rectal cancer, an additional detailed inspection of the rectum with an endoscope
- Ultrasound examination: This is mainly used to detect liver metastases.
- Computed tomography (CT) examination: This X-ray examination with the aid of contrast medium helps to detect any metastases in the lungs at an early stage as well as the growth of a tumor in the rectum.
In Switzerland, it is currently recommended that follow-up appointments should initially be held at three-monthly intervals, then at six-monthly intervals in the second and third year, and then only annually thereafter. Aftercare is usually completed 60 months after the end of treatment. However, colonoscopy is still recommended every five years.
Scientists have investigated in various studies whether these measures are beneficial to those affected. What is certain is that tumors or metastases discovered at an early stage are much more often curable than those discovered late.
However, it has not yet been conclusively proven whether the probability of survival increases if follow-up care is carried out at very short intervals and with a large number of examinations compared to a less intensive follow-up care program. As is often the case in medicine, not all studies came to the same conclusions.
The recommendations for follow-up care are therefore based both on the results of studies and on the experience of various specialist associations, which have reached a consensus. As soon as new aspects arise, the recommendations will be adapted accordingly.
What you can do
- All the factors that reduce the risk of bowel cancer also apply after surviving bowel cancer: physical activity, reasonable body weight, a healthy diet with sufficient fiber, little alcohol and no smoking. More exercise is associated with a lower risk of relapse, a higher probability of survival and a higher quality of life. On the other hand, there is no evidence that vitamins or other supplements have any benefit unless there is a deficiency.
- The CEA value can vary from laboratory to laboratory. It therefore makes sense to always have it determined in the same laboratory if possible.
- If you would like to receive complementary medical treatment, you should make sure that the therapist is well trained and up to date with the latest scientific findings. At the University Hospital Zurich, for example, the Institute for Complementary and Integrative Medicine offers an aftercare program.
- The recommendations for aftercare are not “set in stone” and can be adapted in individual cases. For example, anyone who has concerns about X-ray radiation in a CT scan should talk to their doctor about this. Compared to a computer tomogram, for example, an X-ray of the lungs is the second choice because it is less informative. However, it can still provide information at lower doses of X-rays.
- Inform your family members. This is because first and second-degree relatives have an increased risk of also developing bowel cancer. You should take early detection measures.
- If a hereditary form of bowel cancer is suspected, relatives are advised to undergo genetic testing. You should be alert if bowel cancer occurs before the age of 50, if bowel cancer occurs in a family in two consecutive generations or if other cancers (stomach, pancreas, kidney, uterus, ovaries or others) occur in the family.
Important
- If there is an increased risk of carcinoma, for example in the case of hereditary bowel cancer, special aftercare recommendations apply.
- The follow-up program only makes sense for people who – in the case of a second tumor – would be willing and able to undergo treatment.