May 6, 2013
After a patient successfully completes his or her treatment for cancer, elation is often followed by the fear of recurrence. That is why we encourage all physicians involved in those patients’ care to speak with them about the need for consistent follow-up exams as well as healthy life choices either to reduce the probability that a cancer will return or to catch a recurrence early so further interventions can be undertaken. That includes continuing with an appropriate schedule of colonoscopies and other routine cancer surveillance needs.
Colorectal cancer patients should see their oncologists:
- Every three months for the first year after receiving a clean bill of health for physical exam and routine blood work
- Every four to six months in the second and third years
- Every six months during the fourth and fifth years
- CT scans may be performed yearly up until five years after diagnosis
- It is also important to review additional cancer screenings such as Pap smears, mammograms and PSAs in the appropriate patient populations
People who benefited from an early cancer diagnosis may require less frequent follow-up exams.
As part of routine follow-up, patients should also receive a colonoscopy six to 12 months after they were diagnosed. Depending upon the findings, future colonoscopies can become less frequent. That decision is determined by the gastroenterologist and is based upon the number of polyps in subsequent colonoscopies.
It is also critically important to determine if the patient carries a familial cancer syndrome gene. A genetic predisposition to cancer requires a more rigorous exam schedule, has implications for possibly developing additional cancers, and carries the probability of other family members developing cancer. If the patient is diagnosed earlier than age 50 or if two or more close relatives had the same type of cancer, the cancer could be the result of an inherited genetic mutation.
Endometrial cancer is also related to Lynch Syndrome, so a thorough family history of cancer needs to be undertaken. The evaluation of a possible genetic component of the cancer is initially evaluated by molecular testing of the patient’s tumor. Subsequent testing will ensue if the testing of the tumor is abnormal.
This additional testing requires a multidisciplinary approach that involves genetic counselors to help educate the patient and family about the implications of having a genetic cancer syndrome. The post-treatment stage for a familial cancer syndrome patient requires yearly colonoscopies and encouragement that family members be tested. Some patients even elect to undergo total colectomies rather than risk the development of a future colon cancer.
There can be many residual side effects of chemotherapy, surgery or radiation. Some of these may take over a year to resolve or may not resolve completely:
- Memory loss
- Difficulty concentrating
- Irregular bowel movements
- Taste alteration
We recognize the importance of continuing to address these issues as part of our follow-up. There are some medications and additional therapies that can be useful to help with these symptoms.
Not only can there be physical effects of cancer treatment, but there can be psychological issues as well. Patients can be depressed about having undergone cancer treatment, or they can have anxiety about the risk of recurrence. These symptoms can be addressed through counseling, support groups, and sometimes through a psychiatrist and/or medication.
At OHC, our belief in treating the whole patient ensures that the patient continues to enjoy the best quality of life possible.Comments (2)