Medical Oncologist
CION Cancer Clinics
Follow-up after an APR: what the five-year schedule involves | CION Cancer Clinics
Follow-up after an abdominoperineal resection (APR) for rectal cancer means regular visits for about five years. Each round includes a CEA blood test, a CT scan at set intervals, a camera check of the remaining bowel through the stoma, and a look at the colostomy and the wound between the legs. This page explains the typical schedule, what each test is for, what it cannot tell you, and which symptoms should not wait for the next visit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What does follow-up after an APR actually involve?
- What does a typical five-year schedule look like?
- What is being checked, and why?
- Words you will see on follow-up reports, in plain language
- What follow-up cannot tell you, and who it does not suit
- Four things families tell us about follow-up, and what is true
- Common questions about follow-up after an APR
The short answer
What does follow-up after an APR actually involve?
Follow-up after an abdominoperineal resection (APR) means regular visits for about five years, with a blood test called CEA, scans of the chest, abdomen and pelvis, and a camera check of the remaining bowel. Each visit also looks at your colostomy (the opening on the belly for stool) and the wound between the legs.
Why it continues for years
Rectal cancer can come back in the pelvis, in the liver or in the lungs, and it does so most often in the first few years after surgery. The visits are timed to catch a return while it is small and while something can still be done about it. That is the whole purpose of the schedule. It is not a sign that your team expects trouble.
Who sets the schedule
Your surgical oncologist and, if you had chemotherapy, your medical oncologist set the schedule together. It depends on the stage on your pathology report (the laboratory examination of what was removed), on whether you had treatment before or after the operation, and on your general health. The schedule on this page is typical. Yours may differ.
Bring the discharge summary, the pathology report and any scan discs to every visit.Year by year
What does a typical five-year schedule look like?
These are typical intervals from international guidance. Your team will adjust them to your stage and your treatment.
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The first six weeks
Frequent visits for the wound between the legs and the stoma. The pathology report is explained, and any chemotherapy to follow is planned. Ask now what your own schedule will be.
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The first two years
A visit and a CEA blood test every three to six months. A CT scan of the chest, abdomen and pelvis every six to twelve months. A colonoscopy about one year after surgery, unless the whole bowel was checked shortly before the operation.
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Years three to five
Visits and CEA usually stretch to every six months. CT scans continue at the interval your team sets, up to five years. If the first colonoscopy was clear, the next is commonly at three years.
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After five years
Routine scans and CEA tests usually stop. Colonoscopy continues at the interval your team advises, because the remaining bowel still needs checking. Stoma care continues for life.
Not sure whether this applies to you?
Ask an oncologistAt each visit
What is being checked, and why?
CEA blood test
CEA is a protein some rectal cancers release into the blood. A steady rise across two or three tests prompts a scan. A single raised value does not, because smoking, liver conditions and infections can raise it too.
CT scan
Looks at the liver, the lungs and the pelvis, the three places rectal cancer most often returns. If something is unclear, a PET-CT or an MRI of the pelvis may be added.
Scar tissue in the pelvis after an APR can look worrying on a scan and be entirely harmless.Colonoscopy
A camera passed through the stoma to check the rest of the large bowel for new polyps or a second cancer. It is not looking for the original cancer, which was removed along with the rectum.
The stoma and the wound
Your surgeon or stoma nurse checks the skin around the colostomy, looks for a bulge (a parastomal hernia) and examines the wound between the legs until it has fully closed.
Say if you have
- Leaking bags or sore skin
- A new bulge beside the stoma
- Discharge or pain between the legs
!
Do not wait for the next appointment
Call the helpline or go to the nearest emergency department the same day if the stoma turns dark purple or black, if nothing has passed into the bag and your belly is swollen and you are vomiting, if there is heavy bleeding from the stoma, or if the wound between the legs starts to discharge and you have a fever. These are not things to note down for the next visit.
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On your reports
Words you will see on follow-up reports, in plain language
- Surveillance
- The doctor's word for this schedule of tests. It means watching, not treating.
- Recurrence
- The cancer coming back. Local recurrence means in the pelvis, where the rectum was. Distant recurrence means in another organ, most often the liver or lungs.
- CEA
- Carcinoembryonic antigen, a protein measured in the blood. Your team watches the trend across tests, not one number on its own.
- Adjuvant
- Treatment given after surgery to lower the chance of the cancer returning. Neoadjuvant means the same treatment given before.
- No evidence of disease
- Nothing was found on this round of tests. It describes today's result, not a promise about the future, which is why the schedule continues.
- Metachronous polyp
- A new growth found in the remaining bowel at colonoscopy. Most are removed during the same test and are not cancer.
Being straight with you
What follow-up cannot tell you, and who it does not suit
Follow-up cannot promise that the cancer will not return. It can only find a return early. A clear scan means nothing was seen that day, at the size a scan can see. Your team will not give you a percentage for your own chance of it coming back, because that figure does not exist for one person.
When the schedule is lighter
Someone who is frail, or who has other serious illnesses, may be offered fewer scans, because if a return were found they might not be well enough for further surgery or chemotherapy. That is a decision to make openly with your team, not one to have made for you. Ask what would happen if a scan found something, and decide together whether that scan is worth doing.
What to ask at the first review
Ask for your schedule in writing, with the dates. Ask who to call between visits, and whether the stoma nurse can be reached by phone. Ask whether tests can be done nearer home in your district and the reports sent to Hyderabad, which saves a full day of travel for a blood test.
This page does not tell you whether you personally need chemotherapy after surgery, or how often you should be scanned. Those decisions belong to your treating team.Commonly believed
Four things families tell us about follow-up, and what is true
"He feels fine, so we can skip this visit."
A return in the liver or lungs usually causes no symptoms until it is large. Feeling well is the reason to attend, not the reason to skip. The visits exist to find what you cannot feel.
"The CEA has gone up, so the cancer is back."
One raised reading is not a diagnosis. Smoking, liver conditions and ordinary infections raise it. Your team repeats the test and orders a scan only if the trend keeps rising.
"More scans mean more safety."
Scans beyond the guidance find more scars and harmless spots, each of which leads to worry and sometimes to a biopsy that was not needed. The interval is set to balance finding a return early against chasing shadows.
"After five years, I am done with doctors."
Routine scans usually stop, but the colonoscopy schedule continues and the stoma needs care for life. A parastomal hernia or sore skin can appear many years later and is worth seeing someone about.
Questions we are asked
Common questions about follow-up after an APR
How often will I need to come to Hyderabad?
In the first two years, usually every three to six months, and less often after that. Blood tests can often be done in your district and the report sent ahead, so that only the visits with a scan or an examination need the journey. Ask your team which visits truly need you in person.
Can the colonoscopy be done through the stoma?
Yes. The camera goes in through the colostomy rather than the back passage, because the rectum and anus have been removed. You take a bowel preparation first, as anyone would, and the stool passes into a bag rather than the toilet. Ask the stoma nurse how to manage the preparation at home.
What if my CEA was never raised before surgery?
Some rectal cancers do not release CEA, and in that case the blood test is a weaker guide. Your team will still check it, but will lean more on scans and examination. Tell your doctor if you are unsure what your level was before the operation, because it changes how the test is read.
Will I still see the stoma nurse after discharge?
Yes, and you should ask to. The bag that fitted in hospital often needs changing as swelling settles and the stoma shrinks over the first weeks. Sore skin, leaks and a new bulge are all things a stoma nurse can sort out in one visit. Ask for a phone number.
The wound between my legs is still not closed. Is that normal?
It is common, particularly after radiotherapy, and it is one of the reasons early visits are frequent. Slow healing on its own is not alarming. New discharge, a bad smell, growing pain or a fever is different, and should be seen the same day rather than waiting.
Do I need a PET-CT at every visit?
No. Routine follow-up uses a CT scan. A PET-CT is added when a CT or a rising CEA has raised a question that the CT alone cannot answer. Asking for a PET-CT at every visit adds cost and radiation without adding safety, so it is not part of the standard schedule.
What happens if a scan finds something?
Your case goes back to the tumour board, where surgeons, medical and radiation oncologists look at it together. A spot may be watched, biopsied or treated. A return found early in the liver or lungs can sometimes be removed. What is offered depends on where it is and on your fitness.
Is follow-up covered by Aarogyasri or insurance?
Consultations are often not covered, while scans and colonoscopy may be, depending on the scheme and the policy. Aarogyasri, CGHS, ECHS and EHS each treat follow-up differently. Call the helpline with your card or policy details before the visit and we will check what is covered.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- American Cancer Society — Living as a colorectal cancer survivor
- Cancer.Net — Colorectal cancer: follow-up care
- Cancer Research UK — Bowel cancer treatment
- NHS — Colostomy
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Recovery Timeline After APRWhat the first weeks and months usually look likeParastomal Hernia After APRThe bulge beside the stoma that follow-up checks forWhy the Perineal Wound Heals SlowlyWhy early visits focus on the wound between the legsThe Pathology Report After SurgeryThe report your follow-up schedule is built onComplications and Red FlagsSymptoms that need same-day care after any cancer surgery
Talk to us
Unsure what your own follow-up should be?
Send us your discharge summary and pathology report, or call the helpline. A surgical oncologist will go through the schedule with you and tell you what can be done nearer home. One helpline serves every CION centre.