Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0032-1309802
European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Management of lesions detected in colorectal cancer screening
Publication History
Publication Date:
25 September 2012 (online)
![](https://www.thieme-connect.de/media/endoscopy/2012S03/lookinside/thumbnails/10.1055-s-0032-1309802-1.jpg)
Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on management of lesions detected in colorectal cancer screening includes 32 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of the screening process, including multi-disciplinary diagnosis and management of the disease.
-
References
- 1 Atkin W, Valori R, Kuipers EJ et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Colonoscopic surveillance following adenoma removal. Endoscopy 2012;
- 2 Austoker J, Giordano L, Hewitson P et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Communication. Endoscopy 2012; 44: SE164-SE185
- 3 Bach SP, Hill J, Monson JR et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 2009; 96: 280-290
- 4 Bentrem DJ, Okabe S, Wong WD et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery?. Ann Surg 2005; 242: 472-477
- 5 Boix J, Lorenzo-Zuniga V, Moreno DV et al. Endoscopic removal of large sessile colorectal adenomas: is it safe and effective?. Dig Dis Sci 2007; 52: 840-844
- 6 Borschitz T, Wachtlin D, Mohler M et al. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 2008; 15: 712-720
- 7 Brandimarte G, Tursi A. Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique. Endoscopy 2001; 33: 854-857
- 8 Brooker JC, Saunders BP, Shah SG et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002; 55: 371-375
- 9 Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg 2007; 31: 1485-1490
- 10 Church JM. Experience in the endoscopic management of large colonic polyps. ANZ J Surg 2003; 73: 988-995
- 11 Cotton PB, Williams CB. Colonoscopic polypectomy and therapeutic procedures. Practical Gastrointestinal Endoscopy. 4th. edition Blackwell Science; 1996: 275-302
- 12 Council of the European Union. Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC). Off J Eur Union; 2003: 34-38
- 13 Deenadayalu VP, Rex DK. Colon polyp retrieval after cold snaring. Gastrointest Endosc 2005; 62: 253-256
- 14 Dell'Abate P, Iosca A, Galimberti A et al. Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: techniques and outcome. Dis Colon Rectum 2001; 44: 112-118
- 15 Doniec JM, Lohnert MS, Schniewind B et al. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery?. Dis Colon Rectum 2003; 46: 340-348
- 16 Endreseth BH, Myrvold HE, Romundstad P et al. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 2005; 48: 1380-1388
- 17 Ferlay J, Shin HR, Bray F et al. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. [Internet] Lyon, France: International Agency for Research on Cancer; 2010 Available from: http://globocan.iarc.fr Accessed on 05/04/2012
- 18 Floyd ND, Saclarides TJ. Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 2006; 49: 164-168
- 19 Friedland S, Soetikno R. Colonoscopy with polypectomy in anticoagulated patients. Gastrointest Endosc 2006; 64: 98-100
- 20 Garcia A, Nunez O, Gonzalez-Asanza C et al. Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas. Rev Esp Enferm Dig 2004; 96: 315-321
- 21 Glimelius B, Pahlman L, Cervantes A. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 (05) v82-v86
- 22 Hahnloser D, Wolff BG, Larson DW et al. Immediate radical resection after local excision of rectal cancer: an oncologic compromise?. Dis Colon Rectum 2005; 48: 429-437
- 23 Halloran S, Launoy G, Zappa M. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Faecal Occult Blood Testing. Endoscopy 2012; 44: SE65-SE87
- 24 Hsieh YH, Lin HJ, Tseng GY et al. Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.. Hepatogastroenterology 2001; 48: 1379-1382
- 25 Hui AJ, Wong RM, Ching JY et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 2004; 59: 44-48
- 26 Jameel JK, Pillinger SH, Moncur P et al. Endoscopic mucosal resection (EMR) in the management of large colo-rectal polyps. Colorectal Dis 2006; 8: 497-500
- 27 Kikuchi R, Takano M, Takagi K et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995; 38: 1286-1295
- 28 Kim HS, Kim TI, Kim WH et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 2006; 101: 1333-1341
- 29 Kimchi NA, Broide E, Scapa E et al. Antiplatelet therapy and the risk of bleeding induced by gastrointestinal endoscopic procedures. A systematic review of the literature and recommendations. Digestion 2007; 75: 36-45
- 30 Kuhry E, Schwenk W, Gaupset R et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 2008; 34: 498-504
- 31 Labianca R, Nordlinger B, Beretta GD et al. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol 2010; 21 (05) v70-v77
- 32 Landsorp-Vogelaar I, von Karsa L. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Introduction. Endoscopy 2012; 44: SE15-SE30
- 33 Leslie A, Carey FA, Pratt NR et al. The colorectal adenoma-carcinoma sequence. Br J Surg 2002; 89: 845-860
- 34 Levin B, Lieberman DA, McFarland B et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134: 1570-1595
- 35 Lezoche G, Baldarelli M, Guerrieri M et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008; 22: 352-358
- 36 Makar GA, Ginsberg GG. Therapy insight: approaching endoscopy in anticoagulated patients. Nat Clin Pract Gastroenterol Hepatol 2006; 3: 43-52
- 37 Malila N, Senore C, Armaroli P. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Organisation. Endoscopy 2012; 44: SE31-SE48
- 38 McArdle CS, Hole DJ. Influence of volume and specialization on survival following surgery for colorectal cancer. Br J Surg 2004; 91: 610-617
- 39 Middleton PF, Sutherland LM, Maddern GJ. Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 2005; 48: 270-284
- 40 Min BS, Kim NK, Ko YT et al. Long-term oncologic results of patients with distal rectal cancer treated by local excision with or without adjuvant treatment. Int J Colorectal Dis 2007; 22: 1325-1330
- 41 Minozzi S, Armaroli P, Banzi R et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Appendix 1: Systematic evidence review. 2010. http://bookshop.europa.eu/en/european-guidelines-for-quality-assurance-in-colorectal-cancer-screening-and-diagnosis-pbND3210390/ Accessed 11/2/2012
- 42 Minozzi S, Armaroli P, Segnan N. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Principles of evidence assessment and methods for reaching recommendations. Endoscopy 2012; 44: SE9-SE14
- 43 Mitchell PJ, Haboubi NY. The malignant adenoma: when to operate and when to watch. Surg Endosc 2008; 22: 1563-1569
- 44 Moss S, Ancelle-Park R, Brenner H. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Evaluation and interpretation of screening outcomes. Endoscopy 2012;
- 45 NCCN. NCCN Clinical Practice Guidelines in Oncology – v.3.2010 Colon Cancer. 2010
- 46 NCCN. NCCN Clinical Practice Guidelines in Oncology – v.3.2010 Rectal Cancer. 2010
- 47 NHS. Bowel Screening Programme Clinical Standards. Scotland: NHS Quality Improvement; 2007 http://www.bowelscreening.scot.nhs.uk/wp-content/uploads/2007/06/bowelsc_stnf_feb07.pdf Accessed 11/2/2012
- 48 Otchy D, Hyman NH, Simmang C et al. Practice parameters for colon cancer. Dis Colon Rectum 2004; 47: 1269-1284
- 49 Park IJ, Kim HC, Yu CS et al. Effect of adjuvant radiotherapy on local recurrence in stage II rectal cancer. Ann Surg Oncol 2008; 15: 519-525
- 50 Parra-Blanco A, Kaminaga N, Kojima T et al. Colonoscopic polypectomy with cutting current: is it safe?. Gastrointest Endosc 2000; 51: 676-681
- 51 Paspatis GA, Vardas E, Charoniti I et al. Bipolar electrocoagulation vs conventional monopolar hot biopsy forceps in the endoscopic treatment of diminutive rectal adenomas. Colorectal Dis 2005; 7: 138-142
- 52 Perez Roldan F, Gonzalez CP, Legaz Huidobro ML et al. Endoscopic resection of large colorectal polyps. Rev Esp Enferm Dig 2004; 96: 36-47
- 53 Quirke P, Risio M, Lambert R et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Quality assurance in pathology in colorectal cancer screening and diagnosis. Endoscopy 2012; 44: SE116-SE130
- 54 Quirke P, Steele R, Monson J et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009; 373: 821-828
- 55 Regula J, Wronska E, Polkowski M et al. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study. Endoscopy 2003; 35: 212-218
- 56 Schmiegel W, Pox C, Adler G et al. S3-guideline conference "Colorectal Cancer" 2004. Dtsch Med Wochenschr 2005; 130 (01) 5-53
- 57 Segnan N, Patnick J, von Karsa L (eds.) European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Luxembourg: European Commission, Publications Office of the European Union; 2010
- 58 Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence?. Dis Colon Rectum 2001; 44: 1345-1361
- 59 SIGN. Scottish Intercollegiate Guidelines Network – Guidelines for the management of colorectal cancer. 2003 http://www.sign.ac.uk/pdf/sign67.pdf Accessed 11/2/2012
- 60 Steele RJC, Rey J-F, Lambert R. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Professional requirements and training. Endoscopy 2012; 44: SE106-SE115
- 61 Stergiou N, Riphaus A, Lange P et al. Endoscopic snare resection of large colonic polyps: how far can we go?. Int J Colorectal Dis 2003; 18: 131-135
- 62 Suppiah A, Maslekar S, Alabi A et al. Transanal endoscopic microsurgery in early rectal cancer: time for a trial?. Colorectal Dis 2008; 10: 314-327
- 63 Timothy SK, Hicks TC, Opelka FG et al. Colonoscopy in the patient requiring anticoagulation. Dis Colon Rectum 2001; 44: 1845-1848
- 64 Tjandra JJ, Kilkenny JW, Buie WD et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 2005; 48: 411-423
- 65 Tytherleigh MG, Warren BF, Mortensen NJ. Management of early rectal cancer. Br J Surg 2008; 95: 409-423
- 66 Uno Y, Obara K, Zheng P et al. Cold snare excision is a safe method for diminutive colorectal polyps. Tohoku J Exp Med 1997; 183: 243-249
- 67 Valori R, Rey J-F, Atkin W et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition. Quality assurance in endoscopy in colorectal screening and diagnosis. Endoscopy 2012; 44: SE88-SE105
- 68 Veitch AM, Baglin TP, Gershlick AH et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut 2008; 57: 1322-1329
- 69 von Karsa L, Anttila A, Ronco G et al. Cancer Screening in the European Union. Report on the implementation of the Council Recommendation on Cancer Screening – First Report. Luxembourg: European Commission; 2008 http://ec.europa.eu/health/archive/ph_determinants/genetics/documents/cancer_screening.pdf Accessed 11/2/2012
- 70 von Karsa L, Lignini TA, Patnick J et al. The dimensions of the CRC problem. Best Pract Res Clin Gastroenterol 2010; 24: 381-396
- 71 West NP, Finan PJ, Anderin C et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 2008; 26: 3517-3522
- 72 West NP, Morris EJ, Rotimi O et al. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008; 9: 857-865
- 73 Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol 1995; 90: 24-28
- 74 Wilson JM, Jungner YG. Principles and practice of mass screening for disease. World Health Organization; 1968 http://whqlibdoc.who.int/php/WHO_PHP_34.pdf Accessed 11/2/2012
- 75 Winde G, Nottberg H, Keller R et al. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection.. Dis Colon Rectum 1996; 39: 969-976
- 76 You YN, Baxter NN, Stewart A et al. Is the increasing rate of local excision for stage I rectal cancer in the United States justified? a nationwide cohort study from the National Cancer Database.. Ann Surg 2007; 245: 726-733
- 77 Yousfi M, Gostout CJ, Baron TH et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol 2004; 99: 1785-1789