Overview
Metastatic colorectal cancer (mCRC) presents a significant challenge, impacting quality of life and survival 23. Management strategies are evolving, with systemic chemotherapy remaining a cornerstone, while surgical interventions are being explored for select cases 23.Diagnosis
Diagnosis and staging involve cytologic or histologic evaluation, combined with imaging and lymph node sampling 1.
Biomarker testing is recommended for mCRC 3.Management
Systemic chemotherapy is the current mainstay for metastatic disease 23.
First-line treatment for mCRC deficient in mismatch repair/microsatellite instability-high includes checkpoint inhibitors 3.
Targeted therapy options are available for mCRC that is HER2-amplified or BRAF V600E mutation-positive 3.
Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a promising option for select patients with colorectal peritoneal metastases 2.
Multimodal therapy may include chemotherapy, immunotherapy, radiation therapy, and surgery 1.
Supportive care includes nutritional support and pain management 1.Key Recommendations
Systemic chemotherapy is the mainstay of management for metastatic colorectal cancer 23. (Evidence: Strong)
For mCRC that is deficient mismatch repair/microsatellite instability-high, first-line use of checkpoint inhibitors is recommended 3. (Evidence: Strong)
Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a promising option with survival benefit for select patients with colorectal peritoneal metastases 2. (Evidence: Moderate)
Biomarker testing, including for HER2-amplification and BRAF V600E mutation, is expanded in recommendations for mCRC 3. (Evidence: Moderate)References
1 Christensen J, Johnson K, Ettinger S, Garrett L, Gordon I, Ireifej S et al.. AAHA Oncology Guidelines for Dogs and Cats. Journal of the American Animal Hospital Association 2026. link
2 Wach MM, Dineen SP. ASO Practice Guideline Series: Management of Colorectal Peritoneal Metastases. Annals of surgical oncology 2025. link
3 Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK et al.. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2021. link