Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Obstruction, perforation or acute treatment-related deterioration during follow-up
New vomiting with distension and obstipation, peritonism, uncontrolled bleeding, jaundice with sepsis or rapid physiological decline may represent recurrent disease or a late treatment complication and needs same-day assessment.
Action: Begin ABCDE care, keep nil by mouth when obstruction or perforation is possible, obtain intravenous access, full blood count, renal and liver tests, lactate and blood-bank samples, and arrange urgent contrast imaging with colorectal, oncology, hepatobiliary or anaesthetic input according to the presentation.
Synopsis
Coordinate surveillance after colorectal or anal cancer to detect treatable recurrence, complete scheduled colon evaluation, manage stoma and functional late effects, and avoid using tumour markers without imaging or clinical context.
Surveillance intensity depends on tumour site, stage, treatment, resection status, fitness for salvage and national or local protocol.
CEA can support recurrence detection after colorectal resection but smoking, inflammation and non-secreting tumours limit interpretation.
CT surveillance looks for resectable liver, lung, nodal or local recurrence; symptoms still require assessment between planned scans.
Key red flags
New vomiting with distension and obstipation, peritonism, uncontrolled bleeding, jaundice with sepsis or rapid physiological decline may represent recurrent disease or a late treatment complication and needs same-day assessment.
Reasoning priorities
01
Serial serum CEA
Support detection of colorectal recurrence after potentially curative treatment.
Measure at least every six months in the first three years under the NICE quality standard; confirm and image an unexplained rise, but do not use a normal result to dismiss symptoms.
Worked reasoning
Worked case: rising CEA with a treatable liver recurrenceTurn surveillance abnormality into a verified salvage decision
Eighteen months after R0 stage III colon-cancer resection and adjuvant treatment, an asymptomatic 63-year-old has CEA rising from 3 to 11 then 18 micrograms/L on repeat testing.
Review the original tumour’s CEA secretion, pathology and surveillance record and assess weight, abdomen, respiratory symptoms and performance status rather than treating the marker in isolation.
Repeat CEA to confirm the trend and obtain contrast CT chest, abdomen and pelvis, which identifies a new solitary segment VI liver lesion without other recurrence.
Dedicated liver MRI confirms one technically resectable metastasis; refer promptly to the hepatobiliary MDT instead of waiting for the next routine CT.
The patient undergoes parenchymal-sparing liver resection and pathology confirms a colorectal metastasis removed with a clear margin.
Verify the actual histology, postoperative oncology decision and revised cross-sectional, CEA and colonoscopy schedule and continue functional and late-effect review.
Key medicines
Loperamide for watery high-frequency LARSAfter excluding recurrence, anastomotic narrowing, infection and active inflammation, start 2 mg orally 30 minutes before breakfast and 2 mg before the evening meal; review within one week and titrate by 2 mg daily toward one to two formed stools, not exceeding 16 mg daily.Do not use with ileus, abdominal distension, acute dysentery, severe active colitis or suspected bacterial enterocolitis; stop for constipation or increasing distension, use caution in hepatic impairment and avoid doses above the licensed maximum because serious cardiac toxicity occurs with overdose.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.