“I think it’s really important that people keep signing up to these type of trials to push research forward.”
A trial looking at follow up after bowel surgery (FACS)
The aim of this study was to find the best way to follow up patients after treatment for bowel cancer.
More about this trial
Bowel (colorectal) cancer can be treated with
Often these treatments can cure the cancer but sometimes it can come back (recur). Some specialists see their patients regularly after treatment has finished, but some do not. Follow up varies a lot between different hospitals, and doctors are not sure what is best.
More regular follow up may mean that bowel cancer that has come back is picked up sooner. But having regular tests can be stressful for patients. And there is limited evidence that earlier diagnosis of bowel cancer that has come back helps you to live longer.
Summary of results
The trial team found that regular 3 to 6 monthly CT scans or CEA blood tests (as follow up in people who had previously had surgery aiming to cure their bowel cancer) increased 3 times the number of cancer recurrences that were detected at an early stage which could be treated with further surgery but there was no short term benefit in how long people lived.
This was a randomised trial. It recruited 1,202 people who had surgery to remove their bowel cancer. They were put into 1 of 4 groups.
- 300 people had regular
CEA blood testsfor 5 years after surgery
- 299 people had regular
CT scansfor 5 years after surgery
- 302 people had regular CT scans and CEA blood tests for 5 years after surgery
- 301 people had a CT scan 12 to 18 months after surgery (the team called this minimum follow up)
After an average follow up of 4½ years, cancer had come back in 199 of the 1,202 people in the trial. Of these, 130 recurrences were found as a result of scheduled follow up tests. The remaining 69 recurrences were found when people presented with symptoms or when they had tests for another illness.
Of these 199 people, 71 people had further surgery aiming to cure the cancer that had come back.
- 20 people were from the CEA group
- 24 people were from the CT scan group
- 20 people were from the CEA and CT scan group
- 7 people were from the minimum follow up group
Sadly of the 1,202 people who joined the trial, a number had died. But there wasn’t a significant difference in the number of deaths between the 4 groups.
The trial team concluded that regular CT scans and CEA blood tests increased the number of people who could have further surgery aiming to cure bowel cancer that had come back. Doing these extra follow up tests does not make much of a difference to how long they lived in the short term and it’s too soon to know the impact on how long people will live in the longer term.
We have based this summary on information from the team who ran the trial. The information they sent us has been reviewed by independent specialists (
How to join a clinical trial
Professor David Mant
Professor John Primrose
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
NIHR Health Technology Assessment (HTA) programme
Southampton Clinical Trials Unit
University of Oxford
University of Southampton