Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer

Abstract

Colorectal cancer is a major cause of death in Japan, where it accounts for the largest number of deaths from malignant neoplasms among women and the third largest number among men. Many new methods of treatment have been developed during recent decades. The Japanese Society for Cancer of the Colon and Rectum Guidelines 2014 for treatment of colorectal cancer (JSCCR Guidelines 2014) have been prepared as standard treatment strategies for colorectal cancer, to eliminate treatment disparities among institutions, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding among health-care professionals and patients by making these guidelines available to the general public. These guidelines have been prepared as a result of consensuses reached by the JSCCR Guideline Committee on the basis of careful review of evidence retrieved by literature searches and taking into consideration the medical health insurance system and actual clinical practice in Japan. They can, therefore, be used as a guide for treating colorectal cancer in clinical practice. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. As a result of the discussions of the Guideline Committee, controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories, on the basis of consensus reached by Guideline Committee members. Here we present the English version of the JSCCR Guidelines 2014.

Fig. 1

Treatment strategies for cTis (M) cancer and cT1 (SM) cancer

Fig. 2

Surgical treatment strategies for cStage 0 to cStage III colorectal cancer

Fig. 3

Treatment strategies for Stage IV colorectal cancer

Fig. 4

Treatment strategies for recurrent colorectal cancer

Fig. 5

Treatment strategies for hematogenous metastases

Fig. 6

Chemotherapy for unresectable colorectal cancer

Fig. 7

An example of a surveillance schedule after curative resection of pStage I to pStage III colorectal cancer

Fig. 8

Graph of cumulative incidence of recurrence according to stage (project study by the JSCCR: patients in years 1991–1996)

Fig. 9

Graph of cumulative incidence of recurrence according to the site of recurrence (project study by the JSCCR: patients in years 1991–1996)

Fig. 10

Treatment strategies for pT1 (SM) cancer after endoscopic resection

Fig. 11

Method for measuring depth of SM invasion. a When it is possible to identify or estimate the location of the muscularis mucosae, depth of SM invasion is measured from the lower border of the muscularis mucosae. b, c When it is not possible to identify or estimate the location of the muscularis mucosae, depth of SM invasion is measured from the surface layer of the muscularis mucosae. (b) Sessile lesion; (c) pedunculated lesion. d For pedunculated lesions with a tangled muscularis mucosae, depth of SM invasion is measured as the distance between the point of deepest invasion and the reference line, which is defined as the boundary between the tumor head and the stalk. e Invasion by pedunculated lesions that is limited to within the head is defined as “head invasion”

Fig. 12

Venous invasion (arrow in a). a Located in the vicinity of an artery (a). b Elastic fibers in the vein wall have become clear as a result of Victoria blue staining

Fig. 13

Lymphatic invasion (arrow in a). a A cancer cell nest is visible in the interstitial space. b Double staining for cytokeratin and D2-40. Cancer cells are stained brown, and the lymphatic endothelium is stained purplish red

Fig. 14

Space formed by artifacts during preparation of the specimen (arrow in a). a A cancer cell nest is visible in the interstitial space. b Double staining for cytokeratin and D2-40. The interstitial space is D2-40-negative

Fig. 15

Budding (arrow in b). A cancer cell nest consisting of 1 or fewer than 5 cells that has infiltrated the interstitium at the invasive margin of the cancer is seen. b Is the square area in a