Description
This logic path provides recommendations on colorectal surveillance intervals for individuals with a personal history of CRC, as recommended by the U.S. Multi-Society Task Force of Colorectal Cancer (USMSTF).
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients with a personal history of colorectal cancer in remission | |
'Personal history of colorectal cancer' is TRUE | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Personal history of colorectal cancer resection? | |
`Colorectal cancer resection` PROCEDURE exists | |
Actions
Recommendation: Colonoscopy surveillance starting 1 year after surgery or post-operative clearing colonoscopy Description Initiate surveillance colonoscopy: 1 year after cancer resection or post-operative clearing colonoscopy. For patients with certain localized rectal cancers, additional local surveillance every 2-3 months for the first 2-3 after surgery/post-operative clearing colonoscopy should be considered. Routine surveillance intervals: * After the 1-year colonoscopy, the interval to the next colonoscopy should be 3 years (4 years after surgery or postoperative clearing colonoscopy). * After the 3-year colonoscopy, the interval to the next colonoscopy should be 5 years (9 years after surgery or postoperative clearing colonoscopy). * Subsequent colonoscopies should occur at 5-year intervals, until the benefit of continued surveillance is outweighed by diminishing life expectancy. For patients with certain localized rectal cancers (e.g. partial, local or endoscopic excision or who did not receive neoadjuvant therapy), consider additional local surveillance with (flexible sigmoidoscopy or EUS) every 3-6 months for the first 2-3 years after surgery/perioperative colonoscopy. Intervals for polyp surveillance: If potentially precancerous polyps are detected in surveillance, the subsequent surveillance interval should be provided by the endoscopist, consistent with the shorter interval of: * Recommendations for post-polypectomy surveillance * Recommendations for surveillance after colorectal cancer resection (routine surveillance intervals above). Source: USMSTF, 2016; USMSTF, 2020 Pseudocode |
References
- USMSTF (2016): Kahi, C. J., et al. (2016). Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 150(3), 758-768.e11. https://doi.org/10.1053/j.gastro.2016.01.001
- USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 158(4), 1131–1153.e5. https://doi.org/10.1053/j.gastro.2019.10.026