Key points of the revision of JSCCR Guidelines 2024 for the clinical practice of hereditary colorectal cancer: familial adenomatous polyposis

Abstract

　The “JSCCR Guidelines for the Clinical Practice of Hereditary Colorectal Cancer” was published in 2012 and have been revised every four years since then, with the 2024 edition published this time. In this article, we list the main revisions of the guidelines for familial adenomatous polyposis (FAP): 1) In recent years, multiple genes causing adenomatous polyposis of the colon have been identified. In light of this, we have added the terms “FAP”, “APC-related polyposis”, “adenomatous polyposis”, etc., as well as diseases and conditions that require differentiation, and have mentioned the need for genetic testing in view of future advances in multigene panel testing. 2) A reliable treatment that can avoid cancer death due to colorectal cancer is prophylactic proctocolectomy, but since insurance now covers Intensive Downstaging Polypectomy (IDP) for sparse type FAP patients who do not wish to undergo surgery, this article details this treatment method. 3) A new classification proposed in Japan for desmoid tumors associated with FAP was introduced, and new agents were also mentioned. 4) Five issues that are controversial in the development of the FAP practice algorithm are addressed as CQs. We hope that the updated guideline will be useful for appropriate diagnosis and treatment of patients.