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The National Cancer Center launches risk widget based on data on 1.
5 million Chinese women
Colorectal cancer (CRC) is the third most common cancer in the world, with 1.
1 million new cases each year, making it the second leading
cause of cancer death.
About 15% to 30% of patients are in the metastatic stage, while 20% to 50% of patients with initial localized disease will have metastases, with the most common site of metastasis being the liver, followed by the lungs, peritoneum, and distant lymph nodes
.
Although the incidence of CRC is higher in upper-middle-income countries, thanks to screening, early detection and better treatment, more patients have access to long-term disease control or even cure
.
The recently updated European Society for Medical Oncology (ESMO) clinical practice guidelines for metastatic colorectal cancer (mCRC) propose improvements in the diagnosis, staging and treatment of mCRC based on existing evidence-based and multidisciplinary expert opinions, and provide guidance
for the comprehensive management of patients with mCRC.
The Medical Oncology Channel has specially compiled this "state-of-the-art" guide into a chart, which is convenient for you to view ~
screenshot of the first page of the guide
1
Diagnostic, pathology, and molecular biologyAdequate radiographic imaging and histologic examination of the primary tumor or metastases should always be performed prior to any treatment to confirm clinically or biologically suspicious mCRC
.
2
After the diagnosis of mCRC is confirmed by staging and risk assessment, a complete blood count and biochemistry, including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) (optional) levels
, should be performed in addition to a complete history and physical examination.
Staging is performed primarily by imaging, noting that the same imaging tests
should be used for baseline and post-treatment response assessment.
Different risk factors
should be considered when diagnosing mCRC.
Patients with higher performance status (PS) in the Eastern Cooperative Oncology Group (ECOG) have a poorer prognosis, possibly due to late diagnosis and/or amenable to aggressive treatment
.
3
Treatment ofresectable/potentially resectable disease: surgical resection of R0 resectable colorectal cancer liver metastases (CRLM) is a potentially curative treatment with reported 5-year survival rates of 20% to 45%.
The R0 resectability criteria for CRLM depend on surgical technique and prognostic assessment and experience
with MDT.
Technically, resectability is not limited by number, size, or bilobar metastases, provided that the tumor is resectable and leaves enough residual organs (e.
g.
, ≥ 30% of residual liver).
Other ablation techniques, such as thermal ablation (TA) or stereotactic body radiotherapy (SBRT), can be added to surgery to achieve complete treatment or provide an alternative
to resection when surgery is not possible due to weakness or poor anatomical position of the resection.
1Treatment of potentially resectable mCRC
Topical treatment
of mCRC.
Purple: general category or stratification; Orange: surgery; Dark green: radiotherapy; Blue: systemic anticancer therapy; White: Other aspects of treatment
.
4
Treatment of advanced and metastatic disease without potential for conversion is recommended for MDT discussion to determine the best treatment for each patient.Note that several factors established in the 2016 ESMO consensus guidelines, such as clinical presentation (imminent symptoms at diagnosis, site of primary tumor), histologic and molecular biology of the tumor, patient characteristics (age, PS, comorbidities, socioeconomic factors), treatment goals, and treatment-related issues (toxicity, quality of life, etc.
) should be taken into account
.
1First-line treatment
First-line treatment
for stage IV unresectable mCRC.
Purple: general category or stratification; Blue: systemic anticancer therapy; White: Other aspects of treatment
.
2
for stage IV unresectable mCRC.
Purple: general category or stratification; Blue: systemic anticancer therapy; White: Other aspects of treatment
.
3Second-line therapy
of stage IV unresectable mCRC.
Purple: general category or stratification; Blue: systemic anticancer therapy; White: Other aspects of treatment
.
4Third-line and more late-line therapy
of stage IV unresectable mCRC.
Purple: general category or stratification; Blue: systemic anticancer therapy; White: Other aspects of treatment
.
5
Follow-up, long-term effects, and survivalinclude assessment and management
of long-term toxicity associated with surgery, local therapy, chemotherapy, targeted therapy, or immunotherapy.
References:
[1]Cervantes A,Adam R,RosellóS,Arnold D,Normanno N,Taïeb J,Seligmann J,De Baere T,Osterlund P,Yoshino T,Martinelli E; ESMO Guidelines Committee.
Metastatic colorectal cancer:ESMO Clinical Practice Guideline for diagnosis,treatment and follow-up†.
Ann Oncol.
2022 Oct 19:S0923-7534(22)04192-8.
doi:10.
1016/j.
annonc.
2022.
10.
003.
Epub ahead of print.
PMID:36307056.
