The guidelines, published in the April issue of the Journal of Clinical Oncology, recommend against using liver function tests, fecal occult blood tests, CT-scans of the liver and pelvis, routine chest x-rays and complete blood counts.
In a press release, ASCO said the new recommendations differ from current clinical practice in which colonoscopies are conducted semi-annually or yearly, as are other diagnostic tests.
"The guidelines are not intended to overrule individual physician's judgment, but rather to make suggestions for post-surgery monitoring based on the weight of decades of medical research. The panel was also guided by the principle of cost minimization--the least expensive test was recommended when two strategies of different cost were believed to be equally effective," the ASCO statement explained.
The new guidelines also state, "If resection of liver metastases would be clinically indicated, it is recommended that postoperative serum CEA testing be performed every 2 to 3 months in patients with stage II or III disease for 2 or more years after diagnosis. An elevated CEA level, if confirmed by retesting, warrants further evaluation for metastatic disease but does not justify the institution of systemic therapy for presumed metastatic disease." That recommendation parallels the ASCO guideline for CEA testing in breast and colon cancer.
Flexible proctosigmoidoscopy is recommended only for rectal cancer patients who have not had pelvic radiation.
J Clin Oncology 1999; 17: 1312-1321
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