Table 1.
Colon cancer: Precancerous lesions and invasive cancer: assessment and management.
| Topic | NCCN a Recommendations | ESMO b Recommendations | JSCCR c Recommendations |
|---|---|---|---|
| Polyp with Invasive Cancer | |||
| Assessment | Pathology review, colonoscopy and marking of cancerous polyp MMR/MSI testing |
Not formally stated | Not formally stated |
| Management | Observe (pedunculated polyp) or colectomy with regional lymphadenectomy (sessile polyp, or incomplete excision) | Observe (pedunculated polyp) Colectomy with regional lymphadenectomy (sessile polyp) or frequent surveillance after endoscopic removal, if surgery not possible due to comorbidities |
Polypectomy or snare EMR if <2 cm ESD if 2–5 cm |
| Resectable colon cancer | |||
| Assessment | Pathology review, colonoscopy, CEA levels, CT chest-abdomen-pelvis | Pathology review Colonoscopy Blood tests with CEA CT chest-abdomen-pelvis PET-CT not recommended Consider other tests e.g., virtual colonoscopy when complete colonoscopy is not feasible MRI abdomen (to clarify ambiguous lesions or define pT4b) |
Not formally stated |
| Management | Colectomy with regional lymphadenectomy +/− diversion or stent if obstructed Consider neoadjuvant chemotherapy or immunotherapy for advanced disease. |
Tis/T1N0: local excision >T1N0: colectomy with regional lymphadenectomy pT4b: en block resection of adjacent organ-invaded portions must be carried out Obstructing: one or two-stage procedures Colonic stenting as a bridge to elective surgery in expert centres |
Extent of lymphadenectomy (D0–D3) varies with stage (depth of invasion and extent of lymph node metastasis) |
Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Guideline Colon Cancer V.1.2022. © 2022 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data become available; EMR = endoscopic mucosal resection; ESD = endoscopic submucosal dissection; CEA = carcinoembryonic antigen; MMR = mismatch repair; MSI = microsatellite instability; 5FU = 5-fluorouracil; RT = radiotherapy; a NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) [13]; b European Society of Medical Oncology (ESMO) guidelines [15]; c Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines [18].