PET to detect recurrence of colon cancer with serially rising CEA levels – pro

PET is being more frequenlty used to detect and identify recurrence. More recently NCCN has been more supportive of PET in this setting. It used to support PET only in the situation of rising CEA and no identified recurrence for localization of disease recurrence in patients with rising CEA level and non-diagnostic imaging studies, such as CT scans.However,  PET scan can potentially identify occult disease in this setting that CT misses. Therefore,  PET scans can led to greater potentially curative resection in patients with elevated CEA and patients who are candidates for resection of isolated colorectal cancer liver metastases. PET scan prior to attempted resection reduces the number of unnecessary laparotomies.

On p. Col-9,  2012 NCCN recommends the use of CT scans of chest and abdomen in the situation of serial CEA elevations but also says “Consider PET/CT scan”.

CMS guidelines state that PET would rarely be used in the diagnosis of colorectal cancer. However, starting July 1, 2001, HCFA, now called the Centers for Medicare and Medicaid Services (CMS), is covering FDG-PET imaging for diagnosis, staging, and restaging of colorectal cancer.
Abdel-Nabi H, Doerr RJ, Lamonica DM, et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology, 1998;206:755-760.

Podoloff DA, Advani RH, Allred C, Benson AB 3rd, Brown E, Burstein HJ, Carlson RW, Coleman RE, Czuczman MS, Delbeke D, Edge SB, Ettinger DS, Grannis FW Jr, Hillner BE, Hoffman JM, Kiel K, Komaki R, Larson SM, Mankoff DA, Rosenzweig KE, Skibber JM, Yahalom J, Yu JM, Zelenetz AD.
NCCN task force report: positron emission tomography (PET)/computed tomography (CT) scanning in cancer.
J Natl Compr Canc Netw. 2007 May;5 Suppl 1:S1-S22; quiz S23-2.

Erratum in:
J Natl Compr Canc Netw. 2007 Aug;5(7)

Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, Vaylet C, Rougier P, AndréT, Gornet JM,
Cherqui D, Delbaldo C, Panis Y, Talbot JN, Meignan M, Le Guludec D, Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer.
 Br J Cancer. 2008;98(5): 875.

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