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61

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

5

Metastatic disease

Metastases at diagnosis

Guide 11. Nonsurgical treatment

Symptom status

What are the options?

The cancer isn’t causing symptoms

• Systemic treatment listed in Part 6

The cancer is causing symptoms

• Systemic treatment listed in Part 6

• Infusional 5-FU + radiation

• Bolus 5-FU + radiation

• Capecitabine + radiation

• Rectal surgery

• Diverting ostomy

• Stent

• Short-course radiation for T1–T3 tumors

Guide 12. Follow-up care

Type of care

How often is this care needed?

Medical history and physical exam

• Every 3–6 months for 2 years

◦◦ If normal, then repeat every 6 months for 3 years

CEA blood test

• Every 3–6 months for 2 years

◦◦ If normal, then repeat every 6 months for 3 years

CT of chest, abdomen, pelvis

• Every 3–6 months for 2 years

◦◦ If normal, then repeat every 6–12 months for 3 years

Colonoscopy

• If no prior total colonoscopy, 3–6 months after treatment

• If prior total colonoscopy,

1 year after treatment

◦◦ If no advanced adenoma, repeat in 3 years

▪ If results are normal, then repeat every 5 years

◦◦ If advanced adenoma, repeat in 1 year

Side effect care

• As needed

Prevent and screen for other diseases • Follow guidelines

Help for healthy lifestyle

• As needed