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World J Gastroenterol. Feb 28, 2014; 20(8): 1887-1897
Published online Feb 28, 2014. doi: 10.3748/wjg.v20.i8.1887
Colorectal cancer surveillance: What's new and what's next?
Johnie Rose, Knut Magne Augestad, Gregory S Cooper
Johnie Rose, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
Johnie Rose, Gregory S Cooper, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, United States
Knut Magne Augestad, Norwegian National Centre of Telemedicine and Integrated Care, University Hospitals North Norway, N-9038 Tromsǿ, Norway
Gregory S Cooper, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
Gregory S Cooper, Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
Author contributions: Rose J and Cooper GS conceived the idea for the work; Rose J and Augestad KM performed the literature review; Rose J and Augestad KM wrote the manuscript; Cooper GS provided substantive revisions; all authors approved the final version of the manuscript.
Supported by National Cancer Institute Program Grant, No. 5P30 CA043703-21; and American Cancer Society Mentored Research Scholar Grant, No. 124673-MRSG-13-315-01-CPHPS
Correspondence to: Johnie Rose, MD, PhD, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, 11000 Cedar Ave., Ste. 402, Cleveland, OH 44106-7136, United States. johnie.rose@case.edu
Telephone: +1-216-3686860 Fax: +1-216-3684348
Received: October 2, 2013
Revised: November 27, 2013
Accepted: January 3, 2014
Published online: February 28, 2014
Abstract

The accumulated evidence from two decades of randomized controlled trials has not yet resolved the question of how best to monitor colorectal cancer (CRC) survivors for early detection of recurrent and metachronous disease or even whether doing so has its intended effect. A new wave of trial data in the coming years and an evolving knowledge of relevant biomarkers may bring us closer to understanding what surveillance strategies are most effective for a given subset of patients. To best apply these insights, a number of important research questions need to be addressed, and new decision making tools must be developed. In this review, we summarize available randomized controlled trial evidence comparing alternative surveillance testing strategies, describe ongoing trials in the area, and compare professional society recommendations for surveillance. In addition, we discuss innovations relevant to CRC surveillance and outline a research agenda which will inform a more risk-stratified and personalized approach to follow-up.

Keywords: Colorectal cancer, Surveillance, Follow-up, Recurrence, Relapse, Survivorship

Core tip: We summarize the current state of knowledge and recommended practice around post-treatment surveillance of colorectal cancer survivors. In addition, we describe relevant ongoing trials and the questions which they will and will not answer regarding best surveillance practices. With that background as context, we discuss related practice innovations and propose a number of research questions whose answers could inform more effective, personalized approaches to surveillance.