Colorectal Cancer: Follow-Up Care

Approved by the Cancer.Net Editorial Board, 01/2021

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Follow-up care is especially important in the first 5 years after treatment for colorectal cancer because this is when the risk of recurrence is highest.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Recommended follow-up care

The tests your doctor recommends and how often you need to have them will be based on your risk of recurrence and your overall health. In general, you will visit your doctor and receive follow-up screening every 3 to 6 months for 5 years after diagnosis. It is important to remember that different people have different risks of recurrence, so it is important to talk with your doctor about the possibility of the cancer coming back.

ASCO has recommendations for follow-up care for people who had stage II or stage III colorectal cancer. It is less certain what testing should be done for people who had stage I colorectal cancer because this stage is less likely to come back. If you have had treatment for metastatic colorectal cancer, it is important to talk with your doctor about creating a survivorship care plan specifically for you, since there is currently no standardized follow-up care schedule for this stage of colorectal cancer. It is also important to remember that these follow-up care recommendations are for people who had colorectal cancer that was not inherited (see Risk Factors).

First year after treatment

  • Physical examination and CEA testing every 3 to 6 months

  • Abdominal and chest CT scan each year (every 6 to 12 months for people with a high risk of recurrence)

  • For people with rectal cancer, pelvic CT scan every 6 to 12 months

  • Colonoscopy 1 year after surgery

  • Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis.

Second year after treatment

  • Physical examination and CEA testing every 3 to 6 months

  • CT scan each year (every 6 to 12 months for people with a high risk of recurrence)

  • For people with rectal cancer, pelvic CT scan every 6 to 12 months

  • Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Third year after treatment

  • Physical examination and CEA testing every 3 to 6 months

  • CT scan each year (every 6 to 12 months for people with a high risk of recurrence)

  • For people with rectal cancer, pelvic CT scan every 6 to 12 months

  • Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Fourth year after treatment

  • Physical examination and CEA testing every 3 to 6 months

  • For people with rectal cancer, pelvic CT scan each year

  • Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Fifth year after treatment

  • Physical examination and CEA testing every 3 to 6 months

  • For people with rectal cancer, pelvic CT scan each year

  • Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

This information is based on the ASCO endorsement of the Cancer Care Ontario guideline, "Follow-Up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer Endorsement." Note that this link takes you to a different ASCO website.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.