How should I approach the follow-up care for a patient who has completed treatment for rectal cancer?

Follow-up care for a patient who has completed treatment for rectal cancer should focus on detecting local recurrence and distant metastases for the first 3 years after potentially curative surgery. This follow-up should include regular serum carcinoembryonic antigen (CEA) testing and CT scans of the chest, abdomen, and pelvis to monitor for recurrence.

Patients should be informed about the possibility of low anterior resection syndrome (LARS) if they had sphincter-preserving surgery, including symptoms such as increased stool frequency, urgency, incontinence, incomplete emptying, stool fragmentation, and difficulty differentiating gas from stool. Use of a validated patient-administered questionnaire like the LARS score is recommended to assess symptoms.

Management of bowel dysfunction symptoms can be initiated in primary care with dietary advice, laxatives, anti-bulking agents, anti-diarrhoeal agents, or anti-spasmodics, with referral to secondary care if symptoms persist.

It is important to provide patients with information about possible short-term, long-term, permanent, and late side effects of treatment, including altered bowel, urinary, and sexual function, nerve damage, neuropathy, and mental health changes such as anxiety and depression. Patients should also receive advice on adapting physical activity, diet, weight management, and healthy lifestyle choices, as well as guidance on when and where to seek help if side effects become problematic.