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	Patients who underwent routine follow up with the tumor marker and CT scan enjoyed a longer survival.
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Follow up of stage II and stage III colorectal cancer patients with tumor marker and CAT scan is beneficial, according to a new study.

In a study published in this week's Journal of Clinical Oncology, researchers from the  Royal Marsden Hospital in the UK concluded that patients who underwent routine follow up with the tumor marker, CEA and CT scan of the thorax, abdomen and pelvis enjoyed a longer survival.

Patients with stage II and stage III colorectal cancer are treated surgically. Once their tumor is removed some of these patients receive additional protective chemotherapy in order to improve their survival.

These patients are then followed up for the next 5 years usually every 3 to 4 months. Follow up includes careful history taking and examination in addition to requesting a tumor marker called CEA (carcinoembryonic antigen), a serum glycoprotein, which is elevated in some patients with recurrent or progressing colon cancer. A CT scan or even a colonoscopy may be requested if the physician feels suspicious of any symptoms or signs the patient may have.

Until now the rationale for performing these investigations routinely was not based on sound evidence. Some even argued that cost of performing these investigations routinely was not warranted.

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Study details

The study which was performed between 1993 and 1999, included 530 patients with resected stage II and III colorectal cancer. Patients were randomly assigned to bolus fluorouracil/leucovorin or protracted venous infusion fluorouracil. The median follow-up was 5.6 years.

Patients were divided into groups and disease relapse was detected either by symptoms, CEA, CT, and others. Fourteen patients, whose relapses were detected by CT, had a concomitant elevation of CEA and were included in both groups. The CT-detected group had a better survival compared with the symptomatic group from the time of relapse. 20% of these patients proceeded to potentially curative surgery for relapse and enjoyed a better survival than those who did not. CEA was measured at each clinic visit, and CT of thorax, abdomen, and pelvis was performed at 12 and 24 months after commencement of chemotherapy.

The presence of elevated levels of CEA in colorectal cancer patients prior to surgery has been established in previous studies as a sign of poor prognosis. In detecting colon cancer CEA has a sensitivity of 47% and a specificity of 90%.

References:

Ian Chau, Mark J. Allen, David Cunningham, Andrew R. Norman, Gina Brown, Hugo E.R. Ford, Niall Tebbutt, Diana Tait, Mark Hill, Paul J. Ross, Jacqui Oates. The Value of Routine Serum Carcino-Embryonic Antigen Measurement and Computed Tomography in the Surveillance of Patients After Adjuvant Chemotherapy for Colorectal Cancer. Journal of Clinical Oncology, Vol 22, No 8 (April 15), 2004: pp. 1420-1429.

Article reviewed by:	Dr. Tamer Fouad, M.D.
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