Guideline: Global Guidelines , Gastrointestinal Cancer

Early Detection for Colorectal Cancer Resource-Stratified Guideline

Guideline Status: Current

Published Online: February 25, 2019

Last Updated: September 20, 2024

Published online February 25, 2019, DOI:10.1200/JGO.18.00213

Gilberto Lopes, Mariana C. Stern, Sarah Temin, Ala I. Sharara, Andres Cervantes, Ainhoa Costas-Chavarri, Rena Engineer, Chisato Hamashima, Gwo Fuang Ho, Fidel David Huitzil, Mona Malekzadeh Moghani, Govind Nandakumar, Manish A. Shah, Catherine Teh, Sara E. Vázquez Manjarrez, Azmina Verjee, Rhonda Yantiss, Marcia Cruz Correa

Purpose

To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers.

Methods

ASCO convened a multidisciplinary, multinational panel of medical oncology, surgical oncology, surgery, gastroenterology, health technology assessment, cancer epidemiology, pathology, radiology, radiation oncology, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (Consensus Ratings Group) for two round(s) of formal ratings.

Results

Existing sets of guidelines from eight guideline developers were identified and reviewed; adapted recommendations form the evidence base. These guidelines, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of 75% or more.

Conclusion

In nonmaximal settings, for people who are asymptomatic, are ages 50 to 75 years, have no family history of colorectal cancer, are at average risk, and are in settings with high incidences of colorectal cancer, the following screening options are recommended: guaiac fecal occult blood test and fecal immunochemical testing (basic), flexible sigmoidoscopy (add option in limited), and colonoscopy (add option in enhanced). Optimal reflex testing strategy for persons with positive screens is as follows: endoscopy; if not available, barium enema (basic or limited). Management of polyps in enhanced is as follows: colonoscopy, polypectomy; if not suitable, then surgical resection. For workup and diagnosis of people with symptoms, physical exam with digital rectal examination, double contrast barium enema (only in basic and limited); colonoscopy; flexible sigmoidoscopy with biopsy (if contraindication to latter) or computed tomography colonography if contraindications to two endoscopies (enhanced only).

 

In Basic and Limited settings, fecal-based occult blood testing is the standard & preferred recommendation. In Maximal and Enhanced settings, the addition of endoscopy-based methods is recommended.

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