My surgeon indicated there were very strict guidelines for admission to their Watch and Wait program. I believe this paper by Dr Habr-Gama outlines the guidelines, sorry this link only gives the abstract unless you pay: http://www.hemonc.theclinics.com/article/S0889-8588(14
Also, of course, the "Watch" part of the strategy is very important so if there is a recurrence it's caught before it spreads. The Kaiser "Watch" procedures are:
1. Six months of folfox or xelox chemotherapy to kill any remaining cancer cells. I was encouraged to start chemo without delay.
2. A CEA, a rectal exam, a flex sig, and a special pelvic MRI every three months for the first two years, and then every six months for the following three years.
3. An annual colonoscopy.
4. An annual CT scan of chest, abdomen, and pelvis.
The special pelvic MRI was developed at Kaiser and scans the rectum in much greater detail than a standard abdominal MRI. The results of the scan are determined by a designated radiologist.
Yes, the three month follow ups are a pain but I understand the need for them, and know if I don't the alternative could be much worse. So far I've been very lucky, if I'd been diagnosed just a year earlier this program would not have been available.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 2,000 mg Xeloda each day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 10/15
NED but still early days.