Surveillance schedule

The follow-up programme after rectal cancer treatment

Once treatment ends, five years of check-ups follow. There are many of them, they stretch over years and it is easy to lose track — especially because the intervals differ for the clinical review, the blood tests, the CT scan and the colonoscopy. This page generates your own concrete schedule, with real calendar dates, which you can print or import into the calendar on your phone.

The schedule is indicative. The real programme is set by the team looking after you, according to your situation and to what is available locally. Use it so you know what to expect and so you do not miss a check-up, not to contradict your doctor.

1 What treatment did you have? Resection surgery (low anterior resection, abdominoperineal excision, total mesorectal excision) Local excision (TEM, TAMIS, transanal excision — the tumour is removed through the anus, without resecting the rectum) Watch and wait (no surgery, after a complete response to chemoradiotherapy)

2 Date of the operation

All the check-ups are calculated from this date.

3 Stage after the operation Stage I (tumour confined to the rectal wall, no lymph nodes involved) Stage II or III (locally advanced tumour and/or involved lymph nodes) Stage IV, after complete removal of metastases

If you had chemoradiotherapy before the operation, use the stage from the histopathology report issued after surgery (ypTNM).

4 Did you have a complete colonoscopy before the operation? Yes, the whole colon was examined No, or it was not possible to reach the end (usually because of a tumour narrowing the lumen)

What the studies actually say about follow-up

It is worth knowing the limits of this follow-up as well, because they are well documented and nobody usually tells patients about them.

Follow-up does work for what it sets out to do: it roughly doubles the chance that a recurrence can be operated on with curative intent (Cochrane review, 19 randomised trials, more than 13,000 patients).
On the other hand, more intensive follow-up has not been shown to make people live longer than less frequent follow-up. The COLOFOL trial compared 5 CT scans over 3 years with only 2 and found no difference in mortality at 5 years. The FACS trial and the GILDA trial reached the same conclusion.
Follow-up does, however, reduce the risk that a recurrence is discovered only when symptoms appear.
CEA on its own is not sensitive enough. A normal value does not rule out a recurrence, and a raised one is often a false alarm.
Follow-up is not only about cancer. It is also about bowel, urinary and sexual function, stoma care and mental health — things it is worth asking for help with at every check-up.

The reasonable conclusion: go to your check-ups, but do not be alarmed if your doctor orders fewer CT scans than a calculator on the internet. The difference between schedules has not translated into a difference in survival, and repeated exposure to radiation and contrast is a legitimate reason why the guidelines differ.

Get ready for your check-ups

Take your personal case card to every appointment and, if you are tracking symptoms, the charts from your post-operative journal.

Personal case card → Post-operative journal → Questions for your doctor →

Scientific references

Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv22-iv40. PubMed

Localised rectal cancer: ESMO Clinical Practice Guideline. Ann Oncol. 2025. ESMO Living Guideline, version 1.0, July 2025.

Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: ASCO clinical practice guideline endorsement. J Clin Oncol. 2013;31(35):4465-4470. PubMed

Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2019;9:CD002200. PubMed

Methodological note: the guidelines differ significantly from one another, and this schedule does not mix them. For stage II–III it follows the NCCN scheme for clinical reviews, CEA and colonoscopy, but uses annual CT as the default option — NCCN itself grades a frequency below 12 months at a weaker level of recommendation, and ESMO and ASCO recommend annually. For stage I it follows NCCN (colonoscopy only), with European follow-up available as an option. For watch and wait it uses MRI every 6 months, as in the OPRA trial and in NCCN, not every 3 months as in ESMO 2025. Every divergence is flagged in the result.