After your treatment is completed, monitoring is designed to find any signs of cancer coming back or spreading when it is still small and easiest to treat. Disease monitoring can also help with assessing long-term side effects and improving survival rates.
Your monitoring plan is unique to you. It’s based on factors like your cancer stage and risk level.
Your doctor will use these guidelines to create a personalized schedule for you, but they may adjust it based on your specific needs.
Your doctor will likely recommend colonoscopies approximately one year after surgery to look for new tumor growths inside your colon.
• If an advanced adenoma is found, repeat a colonoscopy in one year.
• If no advanced adenoma, repeat in three years, then every five years.
Your plan will be more frequent in the first few years. It will likely include a mix of colonoscopies, CEA blood tests, and imaging scans (like CT or MRI). The CEA test looks at a protein in your blood that can be related to cancer. After the first two years, these tests may become less frequent.
Your care team will use frequent imaging and blood tests to track how your treatment is working. This monitoring will continue throughout your treatment and beyond, as needed.
The colonoscopy will monitor for cancer recurrence and new polyps. Any new polyps can be removed and tested, just like during a traditional screening colonoscopy.
Frequency: one year post-diagnosis and 3-5 years after that
Benefits: Direct visualization of the colon, allows removal of new polyps during the procedure, highly effective for detecting local recurrence.
Drawbacks: Invasive, requires bowel prep and sedation, carries small risks of bleeding or perforation, may be uncomfortable for patients.
MRD testing can also be labeled as “liquid biopsy” or “circulating tumor DNA (ctDNA).” This type of testing monitors for the small number of cancer cells that remain in the body after treatment, cells that are not detectable through standard imaging or other conventional tests but may indicate a recurrence.
MRD detection via liquid biopsy can often identify relapse before it becomes visible on scans.
Frequency: Often performed every 3–6 months (may vary depending on stage and risk).
Benefits: Non-invasive, detects recurrence earlier than conventional methods, may guide treatment adjustments.
Drawbacks: Newer approach (not yet standard across all practices), cost may be higher, occasional false positives/negatives.
CEA testing measures for proteins in the blood that is elevated in colorectal and other cancer patients.
Frequency: Every 3–6 months for the first 2 years, then less frequently thereafter (especially in stages II–III monitoring)
Benefits: Simple blood draw, inexpensive, widely available, can signal recurrence.
Drawbacks: Not specific—CEA can be elevated due to non-cancer causes (e.g., smoking, inflammation), limited sensitivity, is less reliable as a sole monitoring tool.
Visual surveillance looks for signs of cancer within the body, assesses cancer spread (metastasis), and monitors treatment progress.
Frequency: Often every 3–6 months for the first few years in higher-stage disease, less often after 2–5 years if stable
Benefits: Provides a comprehensive view of cancer spread, and helps guide treatment decisions.
Drawbacks: Radiation exposure (CT, PET), high cost (PET, MRI), potential false positives leading to unnecessary follow-up tests.
