The First International Management Guidelines for Early-Onset Colorectal Cancer

March 20, 2023

This March, the Clinical Gastroenterology and Hepatology journal published the first management guidelines for Early-Onset Colorectal Cancer (eo-CRC) patients.

eo-CRC is CRC in the population younger than 50. Adults born around 1990, compared with the ones born around 1950, double their risk of colon cancer and quadruple their risk of rectal cancer; 11% of colon cancers and 23% of rectal cancers will occur in young individuals (<50 years) by 2030.[1][2]

Numerous studies have reported that the epidemiology of eo-CRC has changed over the past decades; since the1990s, there has been an increase in incidence rates of eo-CRC across the globe in both high- and low-income.countries[3]

Guidelines are not age-specific when it comes to managing patients with eo-CRC. To develop evidence-based recommendations for eo-CRC, an international multidisciplinary group (DIRECt) of 69 experts was convened. After three rounds of voting preceded by expert discussion and confrontation, only statements receiving ≥80% agreement were accepted and included in the guidelines.

The guidelines comprise 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was a strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive genetic testing, ideally before surgery, to determine the possible hereditary nature of their disease.

In light of current evidence, endoscopic, surgical, and oncological treatment of eo-CRC should not differ from that for later-onset CRC. Fertility preservation and sexual health are critical to addressing eo-CRC survivors.

The expert group highlighted areas with knowledge gaps that should be prioritised in future research, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eo-CRC patients.

These guidelines represent an advance in the recognition and management of eo-CRC. They collect and summarise all available evidence on eo-CRC and provide high-quality risk assessment and disease management guidance for healthcare professionals who care for eo-CRC patients.

Access the full document here.

[1] Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 2017; 109: 8.

[2] Bailey CE, Hu CY, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg 2015; 150: 17–22

[3] Cavestro GM, et al Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines CLINICAL PRACTICE GUIDELINES. Clinical Gastroenterology and Hepatology 2023;21:581–603

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