The primary goal of follow-up examinations is to find a recurrence that can be removed. ASCO's recommendations for follow-up care for people with stage II or III colorectal cancer, including a table summarizing the recommendations, are on page two.
Regular visits with your doctor. Most colorectal cancer recurrences develop within five years after surgery. Doctor visits are recommended every three to six months for the first three years, every six months during years four and five, and as often as you and your doctor decide after five years. Regularly scheduled visits help increase the likelihood of finding a treatable recurrence and/or may provide you some reassurance about your situation. Regular visits with your doctor also allow you the time to discuss the risk of other cancers for you and your family. Discussing your risk of recurrence is an important part of your post-treatment appointments. Web-based prediction tools are now available to help your doctor better estimate the risk of recurrence. Knowing this information helps the doctor develop an appropriate follow-up care plan. Using these guidelines as a starting point, talk with your doctor about what tests you need and how often you need them so that you have the best chance of detecting recurrence at an early, treatable stage.
Carcinoembryonic antigen (CEA) test. The CEA test is a blood test. High levels of CEA may indicate that a cancer has spread to other parts of the body. The CEA test should be done every three months for patients with stage II or III colorectal cancer for at least three years after diagnosis once adjuvant therapy (chemotherapy given after surgery) is finished.
Computerized tomography (CT) scan. A CT scan creates an image of the inside of the body. For patients who have a higher risk of recurrence and may be good candidates for surgical removal of a secondary tumor, a CT scan of the chest and abdomen for the first three years is recommended. A CT scan of the pelvis is recommended for patients who are at high risk for rectal cancer recurrence, especially those who have not had radiation therapy. Talk with your doctor to develop a plan based on your risk of recurrence.
Colonoscopy. This test allows the doctor to look for polyps or second cancers in the entire rectum and colon with a colonoscope (lighted tube). After surgery, a colonoscopy is recommended at three years and then, if normal, every five years thereafter. Some patients, however, such as those with high-risk hereditary colorectal cancer syndromes, may require more frequent colonoscopy screening. Talk with your doctor about an appropriate schedule for colonoscopy testing, based on your medical history and risk of recurrence. Learn more about what to expect with a colonoscopy 
Flexible proctosigmoidoscopy. This test is used to check for polyps, second cancers, and other abnormalities. During a flexible proctosigmoidoscopy, a sigmoidoscope (lighted tube) is inserted into the rectum and lower colon. Patients with stage II or III rectal cancer who did not have radiation treatment of the pelvic area should have a proctosigmoidoscopy every six months for five years. Learn more about what to expect during a sigmoidoscopy. 
The following tests are not currently recommended by ASCO for regular follow-up care because there is not enough scientific evidence to support a recommendation:
- A complete blood count (CBC) test or liver function tests
- A fecal occult blood test, which is a test that looks for blood in the stool
In previous versions of the guideline, the value of chest x-rays was unclear. However, now that annual CT scans of the chest and abdomen are recommended (as described on the previous page), routine chest x-rays are probably not relevant.
Follow-Up Care Recommendations for Colorectal Cancer by Years After Treatment
|Follow-Up Care Recommendation||Year 1||Year 2||Year 3||Years 4 and 5*|
|Doctor's Visit||Every three to six months||Every three to six months||Every three to six months||Every six months|
|CEA test||Every three months||Every three months||Every three months||As determined by your doctor|
|CT scan (chest and abdomen)||Every year, if recommended by your doctor||Every year, if recommended by your doctor||Every year, if recommended by your doctor||As determined by your doctor|
|CT scan (pelvis) (rectal cancer only)||Every year, if recommended by your doctor||Every year, if recommended by your doctor||Every year, if recommended by your doctor||As determined by your doctor|
|Colonoscopy||Onceâ||At three years|
|Proctosigmoidoscopy (rectal cancer only)||Every six months (for patients who did not have pelvic radiation treatment) for five years|
* After five years, the need for future tests and visits are decided by the patient and doctor.
â A colonoscopy should be done around the time of surgery. If the examination shows no signs of a recurrent tumor or polyps, a colonoscopy should be done at three years, and if normal, every five years thereafter.
What this means for patients
These guidelines are designed to help patients and their doctors develop a plan for reducing the risk of colorectal cancer recurrence. Because each patient's risk of recurrence is different, you and your doctor are the best people to determine how to apply these guidelines to your situation. For example, one patient at higher risk may require CT scans, whereas another patient at lower risk may not. Or, a person with a hereditary colorectal cancer syndrome may require additional colonoscopies compared with someone without a hereditary cancer syndrome. Use these guidelines to start a discussion with your doctor about an appropriate follow-up care plan that is right for you.