1 / 16

Follow-up of GI Cancers

Follow-up of GI Cancers. Dr. Marianne Taylor BC Cancer Agency – CSI November 29, 2003. Introduction. Purposes of follow-up Colorectal cancer Gastric cancer Esophageal cancer Pancreas cancer. Colorectal Cancer - Surveillance.

treva
Télécharger la présentation

Follow-up of GI Cancers

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Follow-up of GI Cancers Dr. Marianne Taylor BC Cancer Agency – CSI November 29, 2003

  2. Introduction • Purposes of follow-up • Colorectal cancer • Gastric cancer • Esophageal cancer • Pancreas cancer

  3. Colorectal Cancer - Surveillance • Primary goal is to discover isolated recurrence in lung, liver or bowel that is potentially curable with surgery • ?Secondary goals – • Prevent second primary • Support patient • Start metastatic therapy earlier?? • Look for side effects of therapy

  4. Colorectal Cancer – Surveillance • Resectable liver metastases – 5yr survival 25-30% • Resectable lung metastases – 5 yr survival 25-30% • Isolated rectal recurrence – 20% 5 yr. Survival (Tepper et al. J Clin Oncol. 2003)

  5. Colorectal Cancer – Surveillance • Risk of a second primary • Cancer risk 5.3% in five years (Togashi et al. Dis Colon Rectum 2000) • Risk of polyps is higher • Polypectomy can prevent development of cancer (National Polyp Study)

  6. Levels of Evidence • Meta-analysis and good RCT (high power) • At least one well designed trial or RCT with low power • Well designed but quasi-experimental trials cohort, case-control studies • Comparative and case studies • From case reports and clinical examples

  7. ASCO & BCCA Guidelines • History and physical exam every 3-6 months x 3yrs then annually • BCCA- every 3mos x 3yrs then annually • Level V • CEA – only if surgery will be considered • Q2-3 months for  2yrs • BCCA guideline –q3mos. X 3 yrs • Level II J. Clin Oncol – 20:3586 2000

  8. ASCO & BCCA Guidelines • Colonoscopy – pre or post-op then q3-5 yrs (level I) • Ba enema & sigmoidoscopy • Liver function testing – NR (level IV) • FOBT – NR (level II) • CT scan – NR (level II) • CXR – NR (level II) J. Clin Oncol – 20:3586 2000

  9. ASCO & BCCA Guidelines • Proctosigmoidoscopy – only if no XRT • No interval suggested (level IV) • If XRT colonoscopy as usual • Pelvic imaging – NR (level IV) • CBC – NR (level IV) J. Clin Oncol – 20:3586 2000

  10. ASCO & BCCA Guidelines Summary: • Do: • History and physical • CEA • Colonoscopy • Investigate symptoms/signs as appropriate

  11. ASCO & BCCA Guidelines Summary • Don’t do: • CBC, liver tests, FOBT • Proctosigmoidoscopy unless no prior XRT • Pelvic imaging/ CT scan • CXR

  12. Gastric Cancer • Very early cancers (musosa or submucosa +/- nodes) might benefit from follow-up gastroscopy ( 6 &18 mos then 2-3 yr. Intervals) • No evidence to support any follow-up in those with more advanced disease • Clinical follow-up only with investigations directed by symptoms/signs

  13. Esophageal Cancer • No evidence to support imaging/gastroscopy/BW • Symptomatic follow-up only • High propensity in XRT patients for benign strictures – so consider early referral for dilatation

  14. Pancreas Cancer • After curative surgery – clinical follow-up only • Keep in mind that surgery only cures 10-20% • Have low index of suspicion for symptoms/signs – good palliative therapy is available

  15. Summary - GI Follow-up More intensive follow-up helpful: • Colorectal • Anal canal carcinoma

  16. Summary - GI Follow-up Clinical follow-up only: • Stomach • Esophagus • Pancreas

More Related