Practice Guideline

. 2025 Mar;45(3):332-379.

doi: 10.1002/cac2.12639. Epub 2024 Dec 31.

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update

Feng Wang¹, Gong Chen², Zhen Zhang³, Ying Yuan⁴, Yi Wang⁵, Yuan-Hong Gao⁶, Weiqi Sheng⁷, Zixian Wang¹, Xinxiang Li⁸, Xianglin Yuan⁹, Sanjun Cai⁸, Li Ren¹⁰, Yunpeng Liu¹¹, Jianmin Xu¹⁰, Yanqiao Zhang¹², Houjie Liang¹³, Xicheng Wang¹⁴, Aiping Zhou¹⁵, Jianming Ying¹⁶, Guichao Li³, Muyan Cai¹⁷, Gang Ji¹⁸, Taiyuan Li¹⁹, Jingyu Wang²⁰, Hanguang Hu⁴, Kejun Nan²¹, Liuhong Wang²², Suzhan Zhang²³, Jin Li²⁴, Rui-Hua Xu²⁵

Affiliations

¹ Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China.
² Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, P. R. China.
³ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁴ Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
⁵ Department of Radiology, Peking University People's Hospital, Beijing, P. R. China.
⁶ Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, The State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P. R. China.
⁷ Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁸ Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁹ Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
¹⁰ Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
¹¹ Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, P. R. China.
¹² Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P. R. China.
¹³ Department of Oncology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P. R. China.
¹⁴ Department of Gastrointestinal Oncology, Cancer Medical Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
¹⁵ Department of Medical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
¹⁶ Department of Pathology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
¹⁷ Department of Pathology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P. R. China.
¹⁸ Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, P. R. China.
¹⁹ Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China.
²⁰ Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, P. R. China.
²¹ Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China.
²² Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
²³ Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
²⁴ Department of Medical Oncology, Shanghai GoBroad Cancer Hospital, China Pharmaceutical University, Shanghai, P. R. China.
²⁵ Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China.

PMID: 39739441
PMCID: PMC11947620
DOI: 10.1002/cac2.12639

Practice Guideline

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update

Feng Wang et al. Cancer Commun (Lond). 2025 Mar.

. 2025 Mar;45(3):332-379.

doi: 10.1002/cac2.12639. Epub 2024 Dec 31.

Authors

Affiliations

¹ Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China.
² Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, P. R. China.
³ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁴ Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
⁵ Department of Radiology, Peking University People's Hospital, Beijing, P. R. China.
⁶ Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, The State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P. R. China.
⁷ Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁸ Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
⁹ Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
¹⁰ Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
¹¹ Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, P. R. China.
¹² Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P. R. China.
¹³ Department of Oncology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P. R. China.
¹⁴ Department of Gastrointestinal Oncology, Cancer Medical Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
¹⁵ Department of Medical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
¹⁶ Department of Pathology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
¹⁷ Department of Pathology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P. R. China.
¹⁸ Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, P. R. China.
¹⁹ Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China.
²⁰ Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, P. R. China.
²¹ Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China.
²² Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
²³ Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.
²⁴ Department of Medical Oncology, Shanghai GoBroad Cancer Hospital, China Pharmaceutical University, Shanghai, P. R. China.
²⁵ Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China.

PMID: 39739441
PMCID: PMC11947620
DOI: 10.1002/cac2.12639

Abstract

The 2024 updates of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for the diagnosis and treatment of colorectal cancer emphasize standardizing cancer treatment in China, highlighting the latest advancements in evidence-based medicine, healthcare resource access, and precision medicine in oncology. These updates address disparities in epidemiological trends, clinicopathological characteristics, tumor biology, treatment approaches, and drug selection for colorectal cancer patients across diverse regions and backgrounds. Key revisions include adjustments to evidence levels for intensive treatment strategies, updates to regimens for deficient mismatch repair (dMMR)/ microsatellite instability-high (MSI-H) patients, proficient mismatch repair (pMMR)/ microsatellite stability (MSS) patients who have failed standard therapies, and rectal cancer patients with low recurrence risk. Additionally, recommendations for digital rectal examination and DNA polymerase epsilon (POLE)/ DNA polymerase delta 1 (POLD1) gene mutation testing have been strengthened. The 2024 CSCO Guidelines are based on both Chinese and international clinical research, as well as expert consensus, ensuring their relevance and applicability in clinical practice, while maintaining a commitment to scientific rigor, impartiality, and timely updates.

Keywords: Chinese Society of Clinical Oncology (CSCO); adjuvant; chemotherapy; colorectal cancer; diagnosis; immunotherapy; neoadjuvant; radiotherapy; surgery; targeted therapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**FIGURE 1**
The diagnostic and treatment process for postoperative recurrence of rectal cancer. Abbreviations: CEA, carcinoembryonic antigen; CT, computed tomography; MRI, magnetic resonance imaging; FDG‐PET, A fludeoxyglucose‐18 (FDG)‐positron emission tomography (PET); SUV, standardized uptake value; MDT, multidisciplinary team.

**FIGURE 2**
Familial adenomatous polyposis genetic testing process. Abbreviations: *APC*, adenomatous polyposis coli; *MUTYH*, mutY DNA glycosylase.

**FIGURE 3**
Lynch syndrome familial hereditary genetic testing scheme 1. Abbreviations: *MSH2*, mutS homolog 2; *MLH1*, mutL homolog 1; *MSH6*, mutS homolog 6; *PMS2*, postmeiotic segregation increased 2.

**FIGURE 4**
Lynch syndrome familial hereditary genetic testing scheme 2. Abbreviations: *BRAF*, v‐raf murine sarcoma viral oncogene homolog B; MSI‐H, microsatellite instability‐high; MMR, mismatch repair; IHC, Immunohistochemistry; *MLH1*, mutL homolog 1.

See this image and copyright information in PMC

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The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update

Affiliations

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update

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