***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The value of different follow-up examinations after radical surgery for colorectal cancer has not been proven . The risk of such programmes , including invasive examinations , may invali date the possible benefit from early diagnosis of recurrent and metachronous cancer . The present trial is a r and omized study , evaluating possible benefit from a very detailed programme compared to that of virtually no follow-up . The design is presented , but so far no more than 207 of the 600 patients wanted for trial , have been included . Differences in mortality rates , survival and morbidity will be evaluated and the influence of repeated polypectomy upon risk of metachronous colorectal cancer will also be estimated Background The possible benefit for patients from follow‐up  examinations after curative surgery for colorectal cancer is unproven . The purpose of this study was to determine whether survival is improved by frequent follow‐up examinations BACKGROUND The possible benefit for patients of follow-up examinations after curative surgery for colorectal cancer is at present not proven . The purpose of this study was to evaluate the influence of follow-up examinations on health-related quality of life and to assess the attitude of the patients to check-ups . METHODS A total of 350 patients who had had curative surgery for colorectal cancer and who had been subsequently r and omized to either frequent follow-up or virtually no follow-up  completed the Nottingham Health Profile and a second question naire assessing their attitude to the follow-up visits . RESULTS The patients who were receiving more frequent follow-up had greater confidence in the check-ups , but the improvement in the health-related quality of life was only marginally better than that of those receiving few follow-up visits . CONCLUSION The relatively small benefit for health-related quality of life does not justify expensive frequent routine examinations after surgery for colorectal cancer . The Nottingham Health Profile proved to be a reliable instrument within this patient group OBJECTIVE To determine whether an intensified follow-up of patients with colorectal cancer can lead to improved reresectability and a better long-term survival . DESIGN A prospect i ve r and omized trial of 106 patients . SETTING Oulu University Hospital , a referral center in northern Finl and . PATIENTS A total of 106 consecutive patients who underwent radical resection for colorectal cancer , 54 of whom were r and omized into a conventional follow-up group and 52 into an intensified follow-up group .  MAIN OUTCOME MEASURES After a 5-year follow-up , the time of detection of recurrence , the recurrence rates , the first method showing recurrence , the mode of recurrence , reresectability , and survival were compared between the groups . RESULTS The recurrences were identified earlier in the intensified follow-up group than in the conventional follow-up group ( mean + /- SD , 10 + /- 5 months vs 15 + /- 10 months ) . The overall recurrence rate was 41 % , with 39 % in the conventional group and 42 % in the intensified group . Carcinoembryonic antigen determination was the most common method showing recurrence in both groups . Endoscopy and ultrasound were beneficial in the intensified follow-up group , but computed tomography failed to improve the diagnostics . The mode of recurrence did not differ between the groups . Radical resections were performed on 19 % ( 8/43 ) of the patients , 14 % ( 3/21 ) in the conventional group and 22 % ( 5/22 ) in the intensified group . The cumulative 5-year survival was 54 % in the conventional group and 59 % in the intensified group . CONCLUSION Earlier detection of recurrent colorectal cancer by intensified follow-up does not lead to either significantly increased reresectability or improved 5-year survival Abstract . In a prospect i ve r and omised study , 597 patients subjected to curative surgery for colorectal cancer were allocated to either a group with frequent follow-up or a control group with follow-up every 5 years . The pattern of recurrence is review ed . An equal number of recurrences was detected in the two groups , but the recurrence was diagnosed 9 months earlier in patients followed frequently , and the diagnostic characteristics of various tests dependent upon how often they were used . It is unlikely that frequent follow-up after curative surgery for colorectal cancer has a large positive influence upon survival , but a small benefit from an intensive follow-up program can not be ruled out . The present results indicate that  clinical examination , digital rectal examination , proctoscopy , colonoscopy and chest x-ray  should be included in such a programme , whereas others ( blood haemoglobin , faecal occult blood test , double contrast braium enema , serum alanine aminotransferase , and serum bilirubin ) should be avoided , having a low sensitivity for detecting recurrent colorectal cancer . Résumé . Cinq-cent-soixante-dix-sept patients ayant subi un traitement chirurgical curatif d'un cancer colo-rectal ont été inclus dans une étude prospect i ve r and omisée et ont été soumis soit à un follow-up fréquent soit à un contrôle tous les 5 ans . Les modalités de récidive sont analysés . Un nombre égal de patients ont développé des récidives dans les 2 groupes et la récidive est diagnostiquée 9 mois plus tôt dans le groupe ayant subi un follow-up à intervalles rapprochés ; les caractéristiques diagnostiques des différents tests utilisés dépendent de la fréquence de leur usage . Il est improbable qu'un follow-up à intervalles rapprochés et après chirurgie curative d'un cancer colo-rectal ait une influence très positive sur la survie des opérés mais un petit nombre de patients pourraient bénéficier d'un programme de follow-up intensif . Les résultats présents indiquent que l'examen clinique , le toucher rectal , la proctoscopie , la colonoscopie et la radio du thorax devraient être inclus dans un tel programme alors que d'autres investigations ( l'hémoglobine sanguine , la recherche de sang fécal occulte , un lavement barytéà double contraste , le dosage sérique de l'alanine aminotransférase et de la bilirubine sérique ) pourraient être évités car ces examens ne montrent qu'une faible sensitivité dans la délection des récidives de cancers colo-rectaux BACKGROUND & AIMS Guidelines on the type and frequency of follow-up of patients after curative surgery for colorectal cancer are unclear . The aim of this study was to determine the survival benefit of a planned follow-up program . METHODS Three hundred twenty-five patients who underwent curative resection of colorectal cancer were prospect ively r and omized to either intensive or st and ard follow-up . After stratification according to Dukes ' stage and site in the colon or rectum , patients were r and omized to intensive follow-up of yearly colonoscopy , computerized tomography ( CT ) of the liver , and chest radiography and clinical review and simple screening vs. structured clinical review and simple screening tests only . RESULTS On completion of 5-year follow-up , there was no significant difference in survival between the two groups . Yearly colonoscopy failed to detect any asymptomatic local recurrences . Only one asymptomatic curable metachronous colon tumor was detected . Liver CT result ed in earlier detection of hepatic metastases but did not increase the number of curative hepatectomies . Only 1 patient had an asymptomatic CT-detected liver metastasis , and another had an asymptomatic chest radiography-detected lung metastasis . Both had curative resections . CONCLUSIONS Yearly colonoscopy , liver CT , and chest radiography will not improve survival from colorectal cancer when added to symptom and simple screening review PURPOSE : The authors evaluate the effectiveness of routine colonoscopy and marker evaluation in diagnosis of intraluminal recurrent cancer . METHODS : Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990 . Clinical visits were scheduled and carcinoembryonic antigen evaluation was performed every three months , and colonoscopy was performed preoperatively , 12 to 15 months after surgical treatment , and then with intervals of 12 to 24 months or when symptoms appeared . RESULTS : About 10 percent of patients developed intraluminal recurrences . More than one-half of metachronous lesions arose within the first 24 months , and median time to diagnosis was 25 months . Patients with left-sited tumors in the advanced stage had a higher risk of developing recurrent intraluminal disease . Twenty-nine patients underwent a second surgical operation , of which 17 cases were radical . In this group , the five-year survival was 70.6 percent , although no nonradically treated or nonresected patients survived longer than 31 months . Twenty-two patients were asymptomatic at time of diagnosis of recurrence , and of these , 12 patients underwent radical operation ; on the other h and , of the 24 symptomatic patients , only 5 were treated radically . Carcinoembryonic antigen was the first sign of recurrence in eight cases . Colonoscopy must be performed within the first 12 to 15 months after operation , whereas an interval of 24 months between examinations seems sufficient to guarantee early detection of metachronous lesions . CONCLUSION :  Serial tumor marker evaluation  is of help in earlier diagnosis of local recurrences . Asymptomatic patients more frequently undergo another operation for cure and thus have a better survival rate PURPOSE : This study investigated the value of intense follow-up compared with no follow-up after curative surgery of cancer in the colon or rectum . METHODS : One hundred seven patients were r and omized to no follow-up ( control group ; n=54 ) or intense follow-up ( follow-up group ; n=53 ) after surgery and early postoperative colonoscopy .  Patients in the follow-up group were followed at frequent intervals with clinical examination , rigid proctosigmoidoscopy , colonoscopy , computed tomography of the pelvis ( in patients operated with abdominoperineal resection ) , pulmonary x-ray , liver function tests , and determinations of carcinoembryonic antigen and fecal hemoglobin .  Follow-up ranged from 5.5 to 8.8 years after primary surgery . RESULTS : Tumor recurred in 18 patients ( 33 percent ) in the control group and in 17 patients ( 32 percent ) in the follow-up group . Reresection with curative intent was performed in three patients in the control group and in five patients ( four of whom were asymptomatic ) in the follow-up group . In the follow-up group two asymptomatic patients with elevated carcinoembryonic antigen levels were disease-free three and five and one-half years after reresection and were the only patients apparently cured by reresection . No patient underwent surgery for metastatic disease in the liver or lungs . Symptomatic metachronous carcinoma was detected in one patient ( control group ) after three years . Five-year survival rate was 67 percent in the control group and 75 percent in the follow-up group ( P > 0.05 ) ; the corresponding cancer-specific survival rates were 71 percent and 78 percent , respectively . CONCLUSION : Intense follow-up after resection of colorectal cancer did not prolong survival in this study Carcinoembryonic antigen ( CEA ) estimations are used to facilitate early diagnosis of recurrent disease after treatment for colorectal cancer . PURPOSE : This study was design ed to determine the natural history of patients with normal and abnormal levels of CEA . METHODS : Patients undergoing potentially curative resection of colorectal tumors ( Dukes Stage A-C ) entered a prospect i ve , r and omized trial comparing two follow-up regimens ( to be reported separately ) had CEA levels measured every 3 months for two years ; then every 6 months for the next three years . In the study protocol , a rise in CEA was not an indication for investigation to determine recurrence unless there was also other evidence of recurrent disease . RESULTS : Three hundred eleven patients were followed for a median of 4.5 ( range , 2–5 ) years . Recurrent disease developed in 98 ( 32 percent ) patients , 57 of whom had an elevated CEA ( sensitivity 58 percent ) , with a median lead time of six ( range , 1–30 ) months from first abnormal CEA to diagnosis of recurrent disease by other means . The specificity , positive predictive value , and negative predictive value of CEA as an indicator of subsequent recurrent disease was 93 percent , 79 percent , and 83 percent , respectively . The sensitivity of CEA for predicting hepatic metastases was 80 percent , with a median lead time of eight ( range , 1–30 ) months , compared with only 46 percent for sites of recurrent disease other than the liver . CONCLUSIONS : CEA was the first indicator of recurrent disease in 58 percent of all patients and in 80 percent of patients with liver metastases . The diagnosis of recurrent disease may be made several months earlier by investigating the first abnormal CEA level , although any benefit in terms of survival remains to be proven OBJECTIVE To assess prospect ively the impact on survival and health-related quality of life of two follow-up protocol s in patients with early breast cancer . DESIGN R and omized controlled clinical trial . SETTING Multicenter study involving 26 general hospitals in Italy . PATIENTS A consecutive sample of 1320 women younger than 70 years with stage I , II , and III unilateral primary breast cancer . INTERVENTION Patients were r and omly assigned to an intensive surveillance , which included physician visits and performance of bone scan , liver echography , chest roentgenography , and laboratory tests at predefined intervals ( n = 655 ) , or to a control regimen ( n = 665 ) , in which patients were seen by 
    Output:
    
Intensive follow up after curative resection for colorectal cancer improves survival .