Clinical usefulness of biochemical monitoring in colorectal cancer

Although the great part of patients with colorectal cancer undergoes curative surgery, 50% of them eventually die of the disease. Early detection of recurrences must then be regarded as a major effort in order to improve post surgical survival. Recently, the determination of tumor markers with the aim of obtaining earlier detection of recurrences and reliable information that may guide the decision whether performing second look surgery has been proposed in clinical protocols as a complementary tool to clinical and instrumental investigations. Despite the quite promising data on the value of increased serum levels of some tumor markers, mainly the carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and CA 19-9, in predicting tumor reappearance, the real gain in terms of survival remains to be defined. This article reviews the current available data on the clinical role and the usefulness of biochemical monitoring in this tumor type, identifying and discussing the key issues of a rational approach for the use of tumor markers in colorectal cancer patient follow-up programs.