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Colorectal cancer is one of the main cancers that threaten the lives and health of Chinese residents and has caused a serious social burden
.
Initiated by the National Cancer Center, the "Guidelines for Screening and Early Diagnosis and Treatment of Colorectal Cancer in China (2020, Beijing)" were jointly formulated with multidisciplinary experts
.
Regarding colorectal cancer screening, the guidelines mainly give the following recommendations
.
Definition of general risk population ➤Those who do not have the following risk factors can be defined as "general risk population": (1) First-degree relatives have a history of colorectal cancer (including family history of non-hereditary colorectal cancer and family of hereditary colorectal cancer History); (2) I have a history of colorectal cancer; (3) I have a history of intestinal adenoma; (4) I have a chronic inflammatory bowel disease that does not heal for 8-10 years; (5) I have a stool occult blood test Positive (strong recommendation, GRADE evidence grade: medium)
.
Definition of high-risk population of sporadic colorectal cancer ➤ The definition of high-risk population of sporadic colorectal cancer should be based on basic information such as individual age, gender, body mass index, family history of colorectal cancer, intestinal polyps and other diseases, as well as smoking, drinking, etc.
Risk factors are used for comprehensive judgment (strong recommendation, GRADE evidence classification: medium)
.
➤In order to improve the performance of risk prediction, the results of fecal occult blood test and other laboratory tests can be combined with the actual situation of the applicable population, and other factors with higher risk levels can be considered to finally determine the criteria for determining the high-risk population of colorectal cancer (strongly recommended , GRADE grade of evidence: low)
.
Definition of high-risk population of hereditary colorectal cancer ➤ Hereditary colorectal cancer includes non-polyposis colorectal cancer and polyposis colorectal cancer syndrome (strong recommendation, GRADE evidence grade: high)
.
➤Non-polyposis colorectal cancer includes Lynch syndrome (Lynch Syndrome) and familial colorectal cancer type X Lynch-like syndrome (strong recommendation, GRADE evidence grade: high)
.
➤Polyposis colorectal cancer syndrome includes familial adenomatous polyposis, MUTYH gene-related polyposis, hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome), juvenile polyp syndrome, serrated polyp Disease syndrome, etc.
(strong recommendation, GRADE evidence grade: high)
.
General population screening start and end age ➤ It is recommended that the general population be assessed for colorectal cancer risk starting from 40 years old (weak recommendation, GRADE evidence grade: low), and it is recommended that people assessed as medium and low risk receive colorectal cancer screening at the age of 50 to 75 ( Strong recommendation, GRADE evidence classification: medium).
It is recommended that people whose assessment results are high-risk receive colorectal cancer screening from 40 to 75 years old (strong recommendation, GRADE evidence classification: medium)
.
➤If one or more first-degree relatives suffer from colorectal cancer, the recommended starting age for colorectal cancer screening is 40 years old or 10 years earlier than the youngest patient in the first-degree relatives (weak recommendation, GRADE evidence classification: medium)
.
Screening start and end age for high-risk populations of hereditary colorectal cancer ➤High-risk populations with Lynch syndrome caused by MLH1/MSH2 mutations start colonoscopy screening at 20-25 years old or earlier than the youngest patient in the family 2 to 5 years (strong recommendation, GRADE evidence grade: low)
.
➤The initial age of colonoscopy screening for high-risk populations with Lynch syndrome caused by MSH6/PMS2 mutations is 30-35 years or 2 to 5 years earlier than the age of onset of the youngest patient in the family (strong recommendation, GRADE evidence classification: Low)
.
➤The initial age of colonoscopy screening for high-risk groups of familial colorectal cancer type X Lynch-like syndrome is 5-10 years before the age of onset of the youngest patient in the family (strong recommendation, GRADE evidence grade: low)
.
➤High-risk populations in a typical FAP family begin to undergo colonoscopy screening from 10 to 11 years old, colonoscopy is performed every 1 to 2 years, and continues for life (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups in families with mild FAP should start colonoscopy every 2 years from 18 to 20 years old, and continue for life (strong recommendation, GRADE evidence grade: low)
.
➤The starting age of colonoscopy screening for high-risk groups of MUTYH gene-associated polyposis is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups of hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome) begin colonoscopy screening from 18 to 20 years old (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups of juvenile polyp syndrome begin to undergo colonoscopy screening at the age of 15 (strong recommendation, GRADE evidence grade: low)
.
➤The initial age of colonoscopy screening for high-risk groups of serrated polyposis syndrome is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence grade: low)
.
Colorectal cancer screening and early diagnosis tools ➤ Colonoscopy is the gold standard for colorectal cancer screening (strong recommendation, GRADE evidence grade: high)
.
➤The fecal occult blood test (FIT) immunoassay is suitable for colorectal cancer screening.
It has high sensitivity for the diagnosis of colorectal cancer, but has limited sensitivity for precancerous lesions (strong recommendation, GRADE evidence classification: medium)
.
➤Sigmoidoscopy can be used for colorectal cancer screening, and it has high sensitivity and specificity for distal colorectal cancer (weak recommendation, GRADE evidence classification: medium)
.
➤Colon CT imaging technology can be used for colorectal cancer screening under certain conditions, and has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE evidence grade: low)
.
➤Multi-target stool FIT-DNA test can be used for colorectal cancer screening under certain conditions.
It has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE evidence grade: low)
.
Yimaitong compiled from: National Cancer Center China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines Development Expert Group.
China Colorectal Cancer Screening, Early Diagnosis and Early Treatment Guidelines (2020, Beijing)[J].
China Cancer, 2021, 30 (1):1-28.
.
Initiated by the National Cancer Center, the "Guidelines for Screening and Early Diagnosis and Treatment of Colorectal Cancer in China (2020, Beijing)" were jointly formulated with multidisciplinary experts
.
Regarding colorectal cancer screening, the guidelines mainly give the following recommendations
.
Definition of general risk population ➤Those who do not have the following risk factors can be defined as "general risk population": (1) First-degree relatives have a history of colorectal cancer (including family history of non-hereditary colorectal cancer and family of hereditary colorectal cancer History); (2) I have a history of colorectal cancer; (3) I have a history of intestinal adenoma; (4) I have a chronic inflammatory bowel disease that does not heal for 8-10 years; (5) I have a stool occult blood test Positive (strong recommendation, GRADE evidence grade: medium)
.
Definition of high-risk population of sporadic colorectal cancer ➤ The definition of high-risk population of sporadic colorectal cancer should be based on basic information such as individual age, gender, body mass index, family history of colorectal cancer, intestinal polyps and other diseases, as well as smoking, drinking, etc.
Risk factors are used for comprehensive judgment (strong recommendation, GRADE evidence classification: medium)
.
➤In order to improve the performance of risk prediction, the results of fecal occult blood test and other laboratory tests can be combined with the actual situation of the applicable population, and other factors with higher risk levels can be considered to finally determine the criteria for determining the high-risk population of colorectal cancer (strongly recommended , GRADE grade of evidence: low)
.
Definition of high-risk population of hereditary colorectal cancer ➤ Hereditary colorectal cancer includes non-polyposis colorectal cancer and polyposis colorectal cancer syndrome (strong recommendation, GRADE evidence grade: high)
.
➤Non-polyposis colorectal cancer includes Lynch syndrome (Lynch Syndrome) and familial colorectal cancer type X Lynch-like syndrome (strong recommendation, GRADE evidence grade: high)
.
➤Polyposis colorectal cancer syndrome includes familial adenomatous polyposis, MUTYH gene-related polyposis, hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome), juvenile polyp syndrome, serrated polyp Disease syndrome, etc.
(strong recommendation, GRADE evidence grade: high)
.
General population screening start and end age ➤ It is recommended that the general population be assessed for colorectal cancer risk starting from 40 years old (weak recommendation, GRADE evidence grade: low), and it is recommended that people assessed as medium and low risk receive colorectal cancer screening at the age of 50 to 75 ( Strong recommendation, GRADE evidence classification: medium).
It is recommended that people whose assessment results are high-risk receive colorectal cancer screening from 40 to 75 years old (strong recommendation, GRADE evidence classification: medium)
.
➤If one or more first-degree relatives suffer from colorectal cancer, the recommended starting age for colorectal cancer screening is 40 years old or 10 years earlier than the youngest patient in the first-degree relatives (weak recommendation, GRADE evidence classification: medium)
.
Screening start and end age for high-risk populations of hereditary colorectal cancer ➤High-risk populations with Lynch syndrome caused by MLH1/MSH2 mutations start colonoscopy screening at 20-25 years old or earlier than the youngest patient in the family 2 to 5 years (strong recommendation, GRADE evidence grade: low)
.
➤The initial age of colonoscopy screening for high-risk populations with Lynch syndrome caused by MSH6/PMS2 mutations is 30-35 years or 2 to 5 years earlier than the age of onset of the youngest patient in the family (strong recommendation, GRADE evidence classification: Low)
.
➤The initial age of colonoscopy screening for high-risk groups of familial colorectal cancer type X Lynch-like syndrome is 5-10 years before the age of onset of the youngest patient in the family (strong recommendation, GRADE evidence grade: low)
.
➤High-risk populations in a typical FAP family begin to undergo colonoscopy screening from 10 to 11 years old, colonoscopy is performed every 1 to 2 years, and continues for life (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups in families with mild FAP should start colonoscopy every 2 years from 18 to 20 years old, and continue for life (strong recommendation, GRADE evidence grade: low)
.
➤The starting age of colonoscopy screening for high-risk groups of MUTYH gene-associated polyposis is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups of hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome) begin colonoscopy screening from 18 to 20 years old (strong recommendation, GRADE evidence grade: low)
.
➤High-risk groups of juvenile polyp syndrome begin to undergo colonoscopy screening at the age of 15 (strong recommendation, GRADE evidence grade: low)
.
➤The initial age of colonoscopy screening for high-risk groups of serrated polyposis syndrome is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence grade: low)
.
Colorectal cancer screening and early diagnosis tools ➤ Colonoscopy is the gold standard for colorectal cancer screening (strong recommendation, GRADE evidence grade: high)
.
➤The fecal occult blood test (FIT) immunoassay is suitable for colorectal cancer screening.
It has high sensitivity for the diagnosis of colorectal cancer, but has limited sensitivity for precancerous lesions (strong recommendation, GRADE evidence classification: medium)
.
➤Sigmoidoscopy can be used for colorectal cancer screening, and it has high sensitivity and specificity for distal colorectal cancer (weak recommendation, GRADE evidence classification: medium)
.
➤Colon CT imaging technology can be used for colorectal cancer screening under certain conditions, and has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE evidence grade: low)
.
➤Multi-target stool FIT-DNA test can be used for colorectal cancer screening under certain conditions.
It has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE evidence grade: low)
.
Yimaitong compiled from: National Cancer Center China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines Development Expert Group.
China Colorectal Cancer Screening, Early Diagnosis and Early Treatment Guidelines (2020, Beijing)[J].
China Cancer, 2021, 30 (1):1-28.
