Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2024 for the clinical practice of hereditary colorectal cancer

Sep 23, 2026

Approximately 5% of colorectal cancers have a strong genetic component and are classified as hereditary colorectal cancer (HCRC), often presenting with early onset, synchronous or metachronous cancers, and additional tumors in other organs. These patterns require management strategies for diagnosis, treatment, and surveillance that differ from sporadic colorectal cancer. Accurate diagnosis supports targeted surveillance and risk-reduction, improving outcomes. The 2024 JSCCR update synthesizes systematic review evidence and committee consensus, providing clinical recommendations for managing FAP and Lynch syndrome.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Guideline objective

Principles underlying development of these guidelines

International Journal of Clinical Oncology (2026) 31:1–66 [https://doi.org/10.1007/s10147-025-02892-1](https://doi.org/10.1007/s10147-025-02892-1) Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2024 for the clinical practice of hereditary colorectal cancer Kohji Tanakaya1 · Tatsuro Yamaguchi2 · Keiji Hirata3 · Masayoshi Yamada4 · Kensuke Kumamoto5 · Yasuki Akiyama3 · Kei Ishimaru6 · Koichi Okamoto7 · Yuko Kawasaki8 · Keigo Komine9 · Akira Sakamoto10 · Kunitoshi Shigeyasu11 · Yoshiko Shibata12 · Yusaku Shimamoto13 · Hideki Shimodaira14 · Shigeki Sekine15 · Akinari Takao16 · Misato Takao10 · Yasuyuki Takamizawa17 · Yoji Takeuchi18 · Noriko Tanabe19 · Fumitaka Taniguchi20 · Akiko Chino21 · Hourin Cho22 · Satoru Doi23 · Takeshi Nakajima24 · Sakiko Nakamori10 · Yoshiko Nakayama25 · Toshiya Nagasaki26 · Hisashi Hasumi27 · Kouji Banno28 · Takao Hinoi29 · Kenji Fujiyoshi30 · Takahiro Horimatsu31 · Kenta Masuda32 · Masashi Miguchi33 · Yusuke Mizuuchi34 · Yasuyuki Miyakura35 · Michihiro Mutoh36 · Takahiro Yoshioka37 · Shinji Tanaka38 · Kazuhiro Sakamoto39 · Kentaro Sakamaki40 · Michio Itabashi41 · Hideyuki Ishida42 · Naohiro Tomita43 · Kenichi Sugihara44 · Yoichi Ajioka45 on behalf of Japanese Society for Cancer of the Colon, Rectum Received: 21 May 2025 / Accepted: 22 September 2025 / Published online: 10 November 2025 © The Author(s) 2025 Abstract Approximately 5% of all colorectal cancers have a strong genetic component and are classified as hereditary colorectal cancer (HCRC) . Some of the unique features commonly seen in HCRC cases include early age of onset, synchronous/metachronous cancer occurrence, and multiple cancers in other organs. These characteristics require different management approaches, including diagnosis, treatment or surveillance, from those used in the management of sporadic colorectal cancer. Accurate diagnosis of HCRC is essential because it enables targeted surveillance and risk reduction strategies that improve patient outcomes. Recent genetic advances revealed several causative genes for polyposis and non-polyposis syndromes. The Japanese Society for Cancer of the Colon and Rectum (JSCCR) first published guidelines for the management of HCRC in 2012, with subsequent revisions every 4 years. The 2024 update to the JSCCR guidelines for HCRC was developed by meticulously reviewing evidence from systematic reviews and the consensus of the JSCCR HCRC Guidelines Committee, which includes representatives from patient advocacy groups for FAP and Lynch syndrome. These guidelines provide an up-to-date summary of HCRC, along with clinical recommendations for managing FAP and Lynch syndrome. Keywords Hereditary colorectal cancer · Guidelines · Familial adenomatous polyposis · Lynch syndrome Introduction Guideline objective The number of patients with colorectal cancer (CRC) has been increasing in Japan, and societal interest is high given that it is one of the most common types of cancer. Most CRCs are thought to arise from the accumulation of gene variants in the colonic mucosa caused by the effects of lifestyle, environmental factors, and aging. Between 20 and 30% of all CRCs develop in relatives (i.e. , familial clustering) and are sometimes called familial CRCs. A causative gene is identified in up to 5% of CRCs, regardless of familial clustering, and these cases are collectively referred to as hereditary colorectal cancer (HCRC) . HCRC tends to be complicated by a young onset, synchronous/metachronous CRC, and multiple cancers in other organs. Therefore, it is necessary to take measures different from those for sporadic CRC. However, awareness of HCRC is not always high among clinicians. The most common HCRCs are familial adenomatous polyposis (FAP) and Lynch syndrome. FAP is diagnosed by the characteristic clinical finding of colorectal adenomatous polyposis. However, recent investigations have found that Extended author information available on the last page o

FAQs

What proportion of colorectal cancers are classified as hereditary colorectal cancer (HCRC)?

About 5% of colorectal cancers have a strong genetic component and are classified as HCRC.

Why are management approaches for HCRC different from those for sporadic colorectal cancer?

HCRC often involves young onset, synchronous/metachronous cancers, and multiple cancers in other organs, requiring different diagnosis, treatment, and surveillance strategies.

How do the 2024 JSCCR guidelines update the recommendations?

The update is developed by systematically reviewing evidence and using consensus from the JSCCR HCRC Guidelines Committee, incorporating input including representatives from patient advocacy groups for FAP and Lynch syndrome.

Sep 23, 2026

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