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Clinical practice guidelines registry — colorectal adenocarcinoma

Last curated: 2026-10-26

Purpose. This registry catalogs screening, hereditary-risk, endoscopic surveillance, pathology, localized colon, rectal, metastatic, survivorship and emergency guidance. The synthesis lives in guidelines.md. Legacy PMIDs were re-retrieved live on 2026-08-30; added PMIDs were retrieved live on 2026-10-12 or 2026-10-19. Web-only sources for new rows were fetched on 2026-10-19; row 39 and the NCCN version check were fetched on 2026-10-26.

Status vocabulary. current means the newest identified document in that lineage/scope; current living means an online guideline updated outside a fixed journal edition; current (aging) means still newest but predates major recent trials; superseded by → records lineage; historical preserves a practice-changing prior document; unknown means current-version status could not be independently confirmed.

Master table

# Body/document Year Region Scope Citation/URL Status
1 USPSTF colorectal screening 2021 USA Average-risk ages/tests JAMA. PMID 34003218; https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening current
2 USPSTF colorectal screening 2016 USA Prior average-risk recommendation JAMA. PMID 27304597 superseded by → #1
3 American Cancer Society screening update 2018 USA Average-risk initiation at 45 CA Cancer J Clin. PMID 29846947 superseded by → #29
4 American College of Gastroenterology screening 2021 USA Tests, ages, family history Am J Gastroenterol. PMID 33657038 current
5 US Multi-Society Task Force post-polypectomy 2020 USA Surveillance after colonoscopy/polypectomy Gastroenterology. PMID 32044092 current
6 US Multi-Society Task Force post-CRC resection 2016 USA Colonoscopy after resection Gastroenterology. PMID 26892199 current (aging)
7 ESGE/ESDO post-resection surveillance 2019 Europe Endoscopy after surgical/endoscopic CRC resection Endoscopy. PMID 30722071 current (aging)
8 ITBCC tumor budding consensus 2016/2017 International Pathology scoring/reporting Mod Pathol. PMID 28548122 current
9 Colorectal resection specimen reporting 2007 International pathology Required pathology elements Hum Pathol. PMID 17270246 historical/aging foundation
10 ASCO stage II colon adjuvant update 2022 International/USA Stage II adjuvant therapy J Clin Oncol. PMID 34936379 current
11 ASCO stage III adjuvant duration 2019 International/USA 3 vs 6 months J Clin Oncol. PMID 30986117 current (aging)
12 ESMO localized colon 2020 Europe Diagnosis, treatment, follow-up Ann Oncol. PMID 32702383 current base document; exercise update → #30
13 ESMO early colon 2013 Europe Prior localized-colon guidance Ann Oncol. PMID 24078664 superseded by → #12
14 Pan-Asian adapted ESMO localized colon 2021 Asia Resource/context-adapted localized care ESMO Open. PMID 34411693 current regional adaptation
15 ASCO early-stage resource-stratified 2019 Global Care by resource level J Glob Oncol. PMID 30802158 current (aging)
16 ASCO locally advanced rectal 2024 International/USA TNT, radiation, organ preservation J Clin Oncol. PMID 39116386 current
17 ESMO rectal cancer 2017 Europe Diagnosis, treatment, follow-up Ann Oncol. PMID 28881920 current fixed publication (aging)
18 NCCN Rectal Cancer Insights 3.2024 2024 USA Selected updates to living guideline J Natl Compr Canc Netw. PMID 39151454 published Insights; living guideline → #35
19 NCCN Rectal Cancer Insights 6.2020 2020 USA Prior update J Natl Compr Canc Netw. PMID 32634771 superseded by → #18
20 NCCN Colon Cancer Insights 2.2018 2018 USA Selected colon guideline updates J Natl Compr Canc Netw. PMID 29632055 historical Insights; living guideline → #34
21 ASCO metastatic CRC 2023 International/USA Biomarkers, systemic and local therapy J Clin Oncol. PMID 36252154 current (predates some 2024–25 phase III results)
22 ESMO metastatic CRC 2023 Europe Diagnosis, systemic/local treatment, follow-up Ann Oncol. PMID 36307056; https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-metastatic-colorectal-cancer superseded by → #31
23 ASCO late-stage resource-stratified 2020 Global Metastatic care by resource setting J Glob Oncol. PMID 32150483 current (aging)
24 ACG hereditary GI syndromes 2015 USA Lynch/polyposis testing and management Am J Gastroenterol. PMID 25645574 current base for non-adenomatous scopes; adenomatous polyposis updated by → #32
25 BSG/ACPGBI/UKCGG hereditary CRC 2020 UK Gene-specific surveillance and surgery Gut. PMID 31780574 current
26 WSES colon/rectal emergencies 2017/2018 International Obstruction and perforation World J Emerg Surg. PMID 30123315 current (aging)
27 ACS survivorship care 2015 USA Surveillance and late effects CA Cancer J Clin. PMID 26348643 current (aging)
28 ASCRS surveillance/survivorship 2021 USA Follow-up after curative treatment Dis Colon Rectum. PMID 33591043 current
29 American Cancer Society screening update 2026 USA Adds stool RNA/next-generation DNA; blood testing only after preferred options declined or incomplete CA Cancer J Clin. PMID 42200680; https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html current (ACS lineage)
30 ESMO localized colon express update 2026 Europe Structured exercise for eligible localized-colon patients ESMO Open. PMID 41741110 current focused update to #12
31 ESMO metastatic CRC guideline / living guideline v2.0 (June 2026) 2026 Europe Diagnosis, treatment, follow-up Ann Oncol. PMID 41990853; https://www.esmo.org/guidelines/guidelines-news current fixed document plus living version
32 ACG adenomatous colorectal polyposis 2026 USA Diagnosis, testing, endoscopic/surgical management of adenomatous syndromes Am J Gastroenterol. PMID 42683623 current for this scope
33 US Multi-Society Task Force serrated polyposis consensus 2026 USA Diagnosis, clearing, surveillance, familial screening Gastroenterology. PMID 42814045 current for this scope
34 NCCN Colon Cancer living guideline 2026 USA Living colon-cancer treatment pathway https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428 (Version 2.2026 displayed 2026-10-19 and again 2026-10-26) current living; recommendation text not on the public page
35 NCCN Rectal Cancer living guideline 2026 USA Living rectal-cancer treatment pathway https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461 (Version 2.2026 displayed 2026-10-19 and again 2026-10-26) current living; recommendation text not on the public page
36 UK CERSI-PGx UGT1A1/irinotecan 2026 UK Pharmacogenetic testing and Cycle-1 dose reduction Br J Clin Pharmacol. PMID 42389808 current for this scope
37 MASLD–CRC Delphi consensus 2026 International CRC risk in metabolic dysfunction-associated steatotic liver disease Gut. PMID 41770836 current consensus; not a society CRC treatment guideline
38 Chinese Society of Colorectal Surgery ICI in LARC 2026 China Perioperative/organ-preservation immunotherapy for locally advanced rectal cancer Gut. PMID 41748160 current regional consensus
39 German S3 guideline, colorectal cancer (Leitlinienprogramm Onkologie) 2026 Germany Prevention, screening, diagnosis, treatment, follow-up across the CRC pathway Z Gastroenterol. PMID 42906536 (guideline report PMID 42906535); https://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom (portal lists Version 3.2 (2026); 3.0 Sept 2025, 3.1 Feb 2026; English version 2.1) current living national guideline; journal edition's version number not stated in the PubMed record

Per-guideline notes

1. USPSTF 2021 screening

  • Applies to asymptomatic average-risk adults.
  • Grade A ages 50–75, B ages 45–49, selective C ages 76–85; stop after 85.
  • Includes annual FIT, stool DNA-FIT 1–3 years, CT colonography 5 years, flexible sigmoidoscopy strategies and colonoscopy 10 years.
  • Excludes blood/serum tests because outcome evidence was insufficient at publication.
  • Direct benefit below 50 was modeled rather than demonstrated in an age-specific randomized trial.

3–4, 29. ACS and ACG screening

  • Both support initiation at 45; ACG distinguishes conditional 45–49 from strong 50–75.
  • ACG privileges colonoscopy/FIT as primary modalities while preserving alternatives.
  • Family-history recommendations start earlier and favor colonoscopy.
  • ACS 2026 adds next-generation stool DNA and stool RNA as preferred options and reserves blood tests for those declining or not completing a preferred test.

5. USMSTF 2020 post-polypectomy

  • Lengthened intervals for 1–2 small tubular adenomas after a high-quality exam.
  • Separates adenoma and serrated categories by size, number and dysplasia.
  • Piecemeal resection of large lesions requires early scar surveillance.
  • Exact intervals rest mainly on observational residual-risk data.

6–7. Post-cancer colonoscopy

  • USMSTF: perioperative clearing, one-year colonoscopy and subsequent interval by findings.
  • ESGE/ESDO: similar separation of endoscopic metachronous-neoplasia surveillance from systemic recurrence testing.
  • Both depend on a complete high-quality colon examination.

8–9. Pathology

  • ITBCC defines a bud as one cell or cluster ≤4, one 0.785-mm² hotspot, three tiers.
  • Structured resection reporting includes site, type, grade, depth, margins, nodes, deposits, vascular/perineural invasion, budding, treatment response and MMR/MSI.
  • TNM editions and tumor-deposit definitions continue to evolve; registry users must record edition.

10. ASCO stage II

  • No routine chemotherapy for low-risk stage II.
  • T4 should be offered adjuvant treatment; <12 nodes, LVI/PNI, poor grade, obstruction, perforation and high budding support consideration.
  • Oxaliplatin is not routine; it is a preference-sensitive addition.
  • dMMR/MSI-high generally argues against fluoropyrimidine monotherapy.
  • Publication predates mature DYNAMIC five-year and DYNAMIC-III data.

11. ASCO stage III duration

  • Six months offered for T4 and/or N2.
  • Three or six months for T1–3 N1 after regimen-specific recurrence/neuropathy discussion.
  • CAPOX three months has the strongest lower-risk de-escalation basis; FOLFOX estimates favor longer exposure more often.

12–15, 30. Localized colon and resource adaptation

  • ESMO 2020 integrates surgery, stage II/III adjuvant, MMR and surveillance.
  • The focused ESMO 2026 express update adds structured exercise for eligible patients.
  • Pan-Asian adaptation changes recommendations where resource, epidemiology or approval context differs.
  • ASCO resource-stratified guidance explicitly separates basic, limited, enhanced and maximal-resource care.

16–19. Rectal cancer

  • ASCO 2024 makes MRI risk and tumor height central.
  • TNT is preferred for many low/high-risk locally advanced tumors; consolidation is favored when preservation is a priority.
  • PROSPECT-style radiation omission applies only to selected intermediate-risk patients.
  • Watch-and-wait requires a clinical complete response and expert surveillance/salvage.
  • ESMO 2017 predates RAPIDO five-year local recurrence, OPRA five-year and dMMR dostarlimab maturation.
  • NCCN is a living guideline; the 2024 Insights article documents selected updates, not the complete current algorithm.

21–23, 31. Metastatic disease

  • Universal resectability review and MMR/MSI + RAS/BRAF testing.
  • Left-sided RAS/BRAF-WT disease supports anti-EGFR first line; right-sided generally favors bevacizumab-based therapy.
  • dMMR/MSI-high receives checkpoint treatment.
  • BRAF V600E, HER2 and rare fusions receive matched treatment after standard pathways.
  • ASCO 2023 and ESMO 2023 predate CheckMate 8HW, BREAKWATER and some KRAS G12C approvals; use the 2026 ESMO fixed/living edition for current version-specific recommendations.

24–25. Hereditary syndromes

  • Both require tumor-based Lynch screening and syndrome-specific surveillance.
  • BSG/ACPGBI/UKCGG provides more gene-specific Lynch intervals and contemporary polyposis thresholds.
  • ACG 2015 remains foundational but predates broad unselected multigene-panel yield and recent VUS data.

39. German S3 guideline

  • National evidence-based (S3) guideline covering the whole CRC pathway; published in German in Z Gastroenterol (Pox 2026, PMID 42906536) with a separate methods report (Klug 2026, PMID 42906535). PubMed carries no abstract for either, and the full text was not opened this session, so no recommendation content is recorded here.
  • The programme portal lists the long version 3.2 (2026) as current; it was updated twice within ~6 months (3.0 September 2025, 3.1 February 2026), so it behaves as a living guideline. The English translation lags (2.1).

26. Emergencies

  • Resuscitation and sepsis/source control override ideal elective sequencing.
  • Stent, diversion and emergency resection are anatomy-, stability- and expertise-dependent.
  • Stent perforation is an oncologic as well as acute safety event.

27–28. Survivorship

  • Surveillance must be paired with bowel, stoma, neuropathy, sexual/urinary, psychosocial and health-maintenance care.
  • Colonoscopy, CEA and imaging answer different recurrence questions.
  • Both documents predate OPRA-era watch-and-wait survivorship and modern ctDNA surveillance debates.

Verified disagreements and gaps

# Topic Position A Position B / gap Why unresolved
1 Screening test hierarchy USPSTF presents multiple equivalent strategies ACG foregrounds colonoscopy/FIT Capacity, uptake and outcome evidence differ
2 Age 45 evidence US bodies recommend Direct age-specific mortality trial absent Modeling + birth-cohort risk
3 Blood screening Not included in 2021 USPSTF guidance 2026 ACS permits only after preferred options are declined or incomplete Precursor sensitivity and outcomes immature
4 Low-risk adenoma interval Longer USMSTF intervals Some jurisdictions retain shorter recall Observational evidence and quality variation
5 Stage II chemotherapy T4/high-risk offered/considered Absolute benefit small Risk markers are not predictive
6 Stage III duration 3 months for some CAPOX 6 months for high-risk/FOLFOX Regimen-by-risk interaction
7 Rectal short vs long course Both accepted in TNT Long course often favored for preservation RAPIDO local recurrence vs convenience/systemic effect
8 Radiation omission PROSPECT-eligible patients may omit High-risk/low tumors still receive RT Eligibility and preservation goals
9 Watch-and-wait Accepted at expert centers Infrastructure not uniformly defined Response imperfection and surveillance capacity
10 dMMR rectal PD-1 Organ-preserving complete responses Phase II single-arm durability Rare subgroup and no randomized surgery comparison
11 dMMR metastatic regimen PD-1 monotherapy lower toxicity Nivolumab–ipilimumab higher PFS/toxicity; final OS significant vs nivolumab across lines but first-line OS vs nivolumab missed threshold (PMID 42926106) Individual absolute benefit unknown
12 BRAF first line Older guidelines use chemotherapy first BREAKWATER supports targeted triplet Guidelines lag phase III publication
13 Universal germline panels Higher actionable yield VUS/cost/cascade burden Net implementation benefit
14 Surveillance intensity More detection of treatable recurrence False positives, no clear OS gradient Heterogeneous trials
15 Lung metastasectomy Recommended for selected patients PulMiCC cannot establish causal benefit Underpowered randomized evidence
16 Liver transplantation Selected cohorts show high OS Graft allocation and rapid recurrence Extreme selection; randomized trials ongoing

Supersession chains

Watch list

  • Version-specific recommendations in the 2026 ESMO metastatic fixed and living editions, and the ASCO metastatic guideline update now open for comment.
  • Rectal guidance after mature dostarlimab and organ-preservation duration trials; AZUR-1 interim (68% cCR12; PMID 42927858) and UNION interim EFS (PMID 42927765) published October 2026.
  • dMMR colon: whether any guideline adopts neoadjuvant nivolumab–ipilimumab after NICHE-2 3-year DFS (PMID 42906564), and dMMR metastatic first-line choice after CheckMate 8HW final OS (PMID 42926106).
  • Content of German S3 v3.2 (PMID 42906536) once the full text is read.
  • USPSTF/ACG response to the 2026 ACS blood-test hierarchy and new precursor-sensitivity evidence.
  • ASCO stage II/III update after DYNAMIC five-year and DYNAMIC-III.
  • Gene-specific Lynch surveillance interval updates.
  • Randomized liver-transplant versus systemic-treatment results.
  • Standardized minimum infrastructure for watch-and-wait.