Stage III Surveillance

Vigilant surveillance must continue for several years after colorectal cancer therapy.  Early detection of recurrent or metastasized cancer yields the best possibility for cure or containment of the cancer.  For these reasons, patients at Johns Hopkins come for follow-up every three to size months for the first three years and then every six to 12 months for two years afterwards. 

Your doctors at Johns Hopkins will design a follow-up care program for your individual situation.  It is crucially important to keep these appointments and maintain the follow-up care plan that your doctor recommends.  Your doctors will monitor your recovery progress to look for signs of cancer recurrence and check on any after effects of treatment.  As you meet with your doctors for follow-up surveillance this presents a great opportunity to discuss your condition and prognosis with your medical team and to consider lifestyle and other changes to optimize recovery and good health.

The usual program for follow-up begins a few weeks after treatment ends.  Your specific follow-up schedule and recommended tests depend on your individual situation. Your medical team at Hopkins works together to customize your surveillance schedule for your specific needs. 


A typical surveillance program for Stage III colorectal cancer includes:

  • A few weeks after completion of chemotherapy, your doctor will order a CT scan of the chest, abdomen and pelvis along with the blood tumor marker, CEA, and standard labs. These results will serve as a baseline as you recover.

  • Blood test, including tests for cancer markers, such as CEA, every three months for the first two years and then every six months for the next three years.

  • Colonoscopy after one year, then every one to three years thereafter depending on the findings.

  • Patients treated for rectal cancer may also have digital rectal examinations, proctoscopies, or sigmoidoscopies in addition to the colonoscopy.  The frequency of these tests depends on the findings and the individual details of the patient. 


 Symptoms of Recurrence

While it is not necessarily productive to worry about your cancer recurring, it is very important to be able to begin treating it as soon as possible.  In order to engage your medical team at the slightest hint of a recurrence, it is important to pay attention to your body and how you are feeling day to day.  This is sometimes difficult since signs and symptoms of a cancer recurrence or metastases can be vague, especially when you are recovering from major treatment.  It may be difficult to sort out new sensations from the ones you had before surgery. 

The following are symptoms that you we advise you take to seriously and share with your medical team as soon as possible.

  • Fatigue, weight loss, loss of appetite, and anorexia.  The could be connected to therapy but can also be signs of cancer recurrence.

  • Abdominal pain and bowel blockage.  Cancer can recur in the area of the bowel where it was treated or elsewhere in the colon.  This may block normal bowel movements, so do report pain and constipation.

  • Nausea, vomiting, or yellow discoloration of eyes and skin may be signs of metastases to the liver.

  • Shortness of breath might indicate lung tumors.

  • Infrequent urination accompanied by hip or back pain can indicate that the cancer has spread to the urinary system or skeleton.