Overview
Malignant colorectal neoplasm (colorectal cancer, CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States 23. Screening efforts are directed toward the removal of adenomas and sessile serrated lesions, as well as the detection of early-stage CRC 3.Diagnosis
Digital rectal examination (DRE) is a strengthened recommendation for diagnosis 1.
DNA polymerase epsilon (POLE) and DNA polymerase delta 1 (POLD1) gene mutation testing are strengthened recommendations 1.
Tumor mutational profiling is a key consideration for guiding systemic therapy choices in metastatic CRC 2.Management
Management of disseminated metastatic CRC involves various active drugs, used either in combination or as single agents 2.
The choice of therapy for metastatic CRC is based on the goals of therapy, type and timing of prior therapy, tumor mutational profile, and differing toxicity profiles of drugs 2.
Updated regimens are provided for deficient mismatch repair (dMMR)/microsatellite instability-high (MSI-H) patients 1.
Updated regimens are also available for proficient mismatch repair (pMMR)/microsatellite stability (MSS) patients who have failed standard therapies 1.
Recommendations for rectal cancer patients with low recurrence risk have been updated 1.Key Recommendations
Colorectal cancer screening efforts must be optimized to achieve high rates of adherence, quality monitoring, and follow evidence-based guidelines to effectively reduce CRC incidence and mortality 3. (Evidence: Strong)
Digital rectal examination (DRE) is a strengthened recommendation in the diagnosis and treatment guidelines for colorectal cancer 1. (Evidence: Expert opinion)
DNA polymerase epsilon (POLE) and DNA polymerase delta 1 (POLD1) gene mutation testing are strengthened recommendations for colorectal cancer patients 1. (Evidence: Expert opinion)
Systemic therapy for metastatic colorectal cancer should be individualized, considering the goals of therapy, prior treatments, the tumor's mutational profile, and the toxicity profiles of available drugs 2. (Evidence: Moderate)
Recommendations on the role of aspirin for chemoprevention of colorectal cancer are provided in clinical guidelines 3. (Evidence: Moderate)References
1 Wang F, Chen G, Zhang Z, Yuan Y, Wang Y, Gao YH et al.. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update. Cancer communications (London, England) 2025. link
2 Benson AB, Venook AP, Adam M, Chang G, Chen YJ, Ciombor KK et al.. Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2024. link
3 Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. The American journal of gastroenterology 2021. link