Careful follow-up after treatment is essential for two purposes—to detect recurrences and to monitor the response to treatment. The standard procedure involves:
• Regular physical examinations and mammograms.
• Blood chemistry panel (liver, kidneys) and tumor markers (e.g., CEA, bone, CA 15-3) if they were positive
initially.
• Bone scan , especially if bone pain develops or the serum alkaline phosphatase level is elevated.
• Chest x-ray and x-rays of positive areas on bone scan.
• Special studies such as endoscopy or fine needle aspiration of recurrent masses.
Detecting Recurrence Hidden metastases can lie dormant for a long time after surgery. In unusual cases, recurrences have been noted 15, 20 or even more years after the primary cancer developed. Lifelong follow-up is therefore required to be sure that recurrences are detected and treated early.
During the first two years after initial treatment, the intervals tend to be short— every three to four months. If no evidence of recurrence is found, the intervals are lengthened during the next few years, usually to about six months to one year.
• Other studies, such as bone scans, x-rays (including CT) or blood tests, are repeated only when required.
Tumor markers such as carcinoembryonic antigen (CEA) and CA 15-3 may be sometimes included if they
