Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2020 for the Clinical Practice of Hereditary Colorectal Cancer

Abstract

Hereditary colorectal cancer (HCRC) accounts for < 5% of all colorectal cancer cases. Some of the unique characteristics commonly encountered in HCRC cases include early age of onset, synchronous/metachronous cancer occurrence, and multiple cancers in other organs. These characteristics necessitate different management approaches, including diagnosis, treatment or surveillance, from sporadic colorectal cancer management. There are two representative HCRC, named familial adenomatous polyposis and Lynch syndrome. Other than these two HCRC syndromes, related disorders have also been reported. Several guidelines for hereditary disorders have already been published worldwide. In Japan, the first guideline for HCRC was prepared by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), published in 2012 and revised in 2016. This revised version of the guideline was immediately translated into English and published in 2017. Since then, several new findings and novel disease concepts related to HCRC have been discovered. The currently diagnosed HCRC rate in daily clinical practice is relatively low; however, this is predicted to increase in the era of cancer genomic medicine, with the advancement of cancer multi-gene panel testing or whole genome testing, among others. Under these circumstances, the JSCCR guidelines 2020 for HCRC were prepared by consensus among members of the JSCCR HCRC Guideline Committee, based on a careful review of the evidence retrieved from literature searches, and considering the medical health insurance system and actual clinical practice settings in Japan. Herein, we present the English version of the JSCCR guidelines 2020 for HCRC.

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

“…For radical lymph node dissection, vascular ligation should be performed at the origin of the feeding arteries, the ileocolic, right colic, and middle colic arteries in right-sided colon cancer. This CVL is similar to the concept of D3 dissection in the Japanese Society of Cancer of the Colon and Rectum (JSCCR) guidelines [ 26 ].…”

Current guidelines in the surgical management of hereditary colorectal cancers

“…However, no prospective trials have been conducted to demon-strate a true survival benefit of TAC vs segmental resection[ 16 ]. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is recommended at the same time in LS patients, who have completed childbearing or are postmenopausal, to prevent the occurrence of endometrial/ovarian cancer[ 6 ].…”

“…LS possibility should be individually evaluated in patients with suspicion of LS who have not yet diagnosed by genetic testing[ 6 ].…”

“…Surveillance of LS-associated tumors (in particular gynaecological, urological & gastrointestinal cancers) should be organized depending on the clinical and biochemical results (MSI/IHC). In LS patients with CRC, screening is suggested prior to elective colectomy[ 6 ].…”

“…Guidelines from Association of Coloproctology of Great Britain & Ireland (ACPGBI) (2019), European Society for Medical Oncology (ESMO) along with the American Society of Clinical Oncology (ASCO) (2015) & Japanese Society for Cancer of the Colon and Rectum (JSCCR) (2020) for surveillance and management of both LS and FAP are complementary to each other[ 4 - 6 ] and elaborated further in this review.…”