Colorectal cancer secondary prevention

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To view the secondary prevention of familial adenomatous polyposis (FAP), click here
To view the secondary prevention of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.


Secondary prevention of colorectal cancer, as opposed to primary prevention, indicates that a person has already had the disease and there are steps being taken to prevent cancer recurrence, usually as metachronous tumors. This involves annual surveillance with colonoscopy after surgical removal and possibly an adjunct after the initial operation. The timing for secondary prevention is critical to prevent recurrent advanced disease.

Colorectal Cancer Secondary Prevention

Familial Colorectal Cancer Syndromes

  • The presence of multiple polyps in the colon
  • Young age at onset of colorectal cancer, particularly age less than 50 years
  • A strong family history suggesting a familial syndrome
  • Evidence for a syndrome based on genetic testing

Sporadic Colorectal Cancer Syndromes

  • An individual may develop sporadic colorectal cancer for the following reasons[1]:
  • The patient has an unrecognized familial syndrome
  • The residual tumor may be present after resection
  • The patient has strong risk factors
  • The patient has genetic risk factors that do not fit into a familial syndrome
  • After the diagnosis, a colonoscopy should be performed to rule out synchronous tumors and polyps along with a primary tumor resection[1]

The table below displays the guidelines for colonoscopy surveillance after the primary tumor resection[3].

Colonoscopy Findings Recommeded Surveillance Interval (years)
No polyps 10
Small (< 10 mm) hyperplastic polyps in rectum or sigmoid 10
1-2 small (< 10 mm) tubular adenomas 5-10
3-10 tubular adenomas 3
>10 adenomas < 3
One or more tubular adenomas ≥ 10 mm 3
One or more villous adenomas 3
Adenoma with high grade dysplasia (HGD) 3
Sessile serrated polyp(s) < 10 mm with no dysplasia 5
Sessile serrated polyp(s) ≥ 10 mm 3
Sessile serrated polyp with dysplasia 3
Traditional serrated adenoma 3
Serrated polyposis syndrome (one of the following criteria according to WHO: (1) at least 5 serrated polyps proximal to sigmoid, with 2 or more ≥ 10 mm (2) any serrated polyps proximal to sigmoid with family history of serrated polyposis syndrome (3) > 20 serrated polyps of any size throughout the colon) 1


  1. 1.0 1.1 1.2 1.3 Carethers, John M. (2010). "Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?". Current Colorectal Cancer Reports. 6 (1): 24–29. doi:10.1007/s11888-009-0038-1. ISSN 1556-3790.
  2. Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW (2011). "Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials". Lancet. 377 (9759): 31–41. doi:10.1016/S0140-6736(10)62110-1. PMID 21144578. Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-2 Review in: Evid Based Nurs. 2011 Jul;14(3):71
  3. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; et al. (2012). "Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer". Gastroenterology. 143 (3): 844–57. doi:10.1053/j.gastro.2012.06.001. PMID 22763141.

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