Treatment

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Early Detection of Colorectal Cancer

American Society of Clinical Oncology

Publication Date: Feb 25, 2019

Page Last Updated: May 5, 2026

Recommendation Grading

Type	Evidence Quality	Strength of Recommendation
EB	Evidence-based	H	High	Strong
I	Intermediate	Moderate
IC	Informal consensus	L	Low	Weak
Ins	Insufficient

Document Overview

Document Title: Early Detection of Colorectal Cancer

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Feb 25, 2019

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JGO.18.00213

Source Citation: DOI: 10.1200/JGO.18.00213 Journal of Global Oncology , no. 5 (December 01, 2019) 1-22.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers.

Scope: Assessment and Screening, Diagnosis, Prevention

Diseases/Conditions (MeSH)

D003108 - Colonic Diseases

D003113 - Colonoscopy

D015179 - Colorectal Neoplasms

D003108 - Colonic Diseases

D003113 - Colonoscopy

D015179 - Colorectal Neoplasms

Keywords: CRC, Early Detection, colon cancer, colorectal cancer

Target Patient Population: For people who are asymptomatic, are ages 50 to 75 years, with no family history of colorectal cancer, are at average risk

Target Provider Population: gastroenterologists, surgeons, medical oncologists, radiation oncologists, primary care providers, health planners, policy makers

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

What are the optimal strategies for population-level early detection of colorectal cancer in high-incidence and resource-constrained settings?
What is the optimal reflex testing strategy for people with positive screening results?
What is the optimal strategy for people with premalignant polyps or other abnormal screening results?
What are the optimal methods of diagnosis for patients with signs and symptoms of early colorectal cancer?

Supplemental Methodology Resources: Data Supplement Methodology Supplement

Number of Source Documents: 28

Literature Search Start Date: Monday, January 1, 2007

Literature Search End Date: Sunday, December 31, 2017

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Early Detection of Colorectal Cancer

Treatment

Table 3. Screening: Asymptomatic, Average-Risk Population, High-Incidence Areas, Age 50 - 75

1.1 gFOBT

1.2 FIT

1.3 Flexible Sigmoidoscopy

1.4 Flexible Sigmoidoscopy plus (FIT or FOBT)

1.5 Colonoscopy

1.6 CT colonography

1.7 FIT-DNA

Table 4. Reflex Testing: If Patients Have a Positive Result From CRC Screening

2.

Table 5. People With Positive Pre-Malignant Polyps or Other Abnormal Screening Results

Pedunculated

3.1 Colonoscopy

3.2 Polypectomy

3.3 Evaluation of morphology

3.4 Mucosal tattooing

3.5 Histology/ pathology

3.6 Referral to surgery

Non-Pedunculated

3.7 Colonoscopy

3.8 Polypectomy

3.9 Evaluation of morphology

3.10 Mucosal tattooing

3.11 Histology/ pathology

3.12 Referral to surgery

Table 6. Optimal Strategy For Workup/Diagnosis for Those With Symptoms

4.1 DRE

4.2 Double contrast barium enema

4.3 For those without contraindications to colonoscopy

4.4 For those with contraindications to colonoscopy (or colonoscopy not available) but no contraindications to flexible sigmoidoscopy – if the patient can't tolerate colonoscopy then full visualization.

4.5 Patients with contraindications to colonoscopy and to flexible sigmoidoscopy.

4.6 Patients who have had an incomplete colonoscopy

Recommendation Grading

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology