Led by the Chinese Anti-Cancer Association (CACA), top oncology experts across various fields collaborated over a year to develop China’s first integrated oncology guideline, the CACA Integrated Cancer Diagnosis and Treatment Guideline, which was published in 2022. As part of a national educational tour on the guideline, Dr. Ye Wei from Huadong Hospital Affiliated to Fudan University recently shared insights with Oncology Frontier on the clinical impact of the CACA guideline for colorectal cancer (CRC).

Oncology Frontier: The CACA Integrated Cancer Diagnosis and Treatment Guideline was created by experts across multiple cancer fields and published in 2022 after over a year of collaborative work, followed by a series of national workshops. How does the CACA guideline for colorectal cancer differ from other guidelines?

Dr. Ye Wei: The CACA guideline emphasizes integrated medical care and focuses on educating physicians on basic and clinical advancements in colorectal cancer, especially for healthcare providers across all levels, including tertiary hospitals. Unlike high-level hospitals that may prioritize cutting-edge developments, the guideline serves a broader purpose by providing accessible, essential knowledge, particularly regarding early-stage CRC diagnosis, localized treatment, standard surgical options, minimally invasive robotic surgery, and adjuvant therapy updates. Notable recent changes include updates on MSI-H-type colorectal cancer.

Overall, the primary purpose of this guideline is to disseminate the latest clinical advances and updated treatment concepts, especially to grassroots doctors. Although CRC is a common disease, patient volumes in many hospitals remain low. Therefore, top-tier hospitals are where most cancer patients seek treatment, limiting clinical experience with CRC in smaller facilities. In these settings, the guideline offers valuable support, helping doctors navigate diagnosis and management even if they are less familiar with the disease. In addition, these guidelines are now accessible via books and mobile apps, offering critical guidance when needed.

Oncology Frontier: How do the CRC treatment and diagnosis approaches differ between China and Japan based on recent guideline updates?

Dr. Ye Wei: Currently, there are minimal differences between China and Japan in CRC diagnosis and treatment. Japan, drawing heavily from Western approaches, may lead slightly in treatment methodology and concept innovation. However, the primary gap between Western countries and China lies in pharmaceutical availability. The progress seen in survival rates for metastatic CRC patients largely stems from drug advancements rather than surgical techniques, which have seen limited change over the past century. Japan and Western countries have made strides in early CRC screening and detection, which we are learning from to reduce the number of late-stage cases.

In China, much work is still needed to popularize early screening. Many regions lack awareness of the importance of early detection, yet only through proactive screening can we identify patients at earlier stages of CRC, some of whom may avoid surgery altogether.

Oncology Frontier: What are your current research priorities in colorectal cancer?

Dr. Ye Wei: Our ongoing research in CRC focuses on shifting treatment paradigms, particularly in rectal cancer. Treatment advances for colon cancer have been relatively fewer, as surgery alone is often curative and pre- and post-operative treatments are already well standardized. While the proportion of rectal cancer patients has declined from around 60% to 40%, treating rectal cancer remains more complex, with higher risks of recurrence and metastasis. We are actively conducting clinical studies in this area, and we hope these efforts will help reshape CRC treatment approaches.

Dr. Ye Wei

• Deputy Director of General Surgery, Huadong Hospital Affiliated to Fudan University
• Leader of Gastrointestinal Surgery, Chief Physician, Doctoral Supervisor
• Deputy Director, Shanghai Colorectal Tumor Minimally Invasive Engineering Technology Research Center
• Deputy Group Leader, Colorectal and Anorectal Surgery Group, Shanghai Medical Association
• Vice Chairman, Tumor Metastasis Committee, Colorectal Surgery Branch, Chinese Medical Doctor Association
• Vice Chairman, NOSES Committee, Colorectal Cancer Branch, Chinese Medical Doctor Association
• Vice Chairman, Laparoscopic Committee, Gastrointestinal Tumor Minimally Invasive Committee, Shanghai Anti-Cancer Association
• Member, Minimally Invasive and Endoscopy Committee, Colorectal Surgery Branch, Chinese Medical Doctor Association
• Member, Laparoscopic Group, Minimally Invasive Tumor Treatment Committee, Shanghai Anti-Cancer Association
• Standing Committee Member, Integrated Oncology Committee, Chinese Anti-Cancer Association
• Member, Colorectal Cancer Group, Oncology Branch, Chinese Medical Association
• Member, Robotics Group, Colorectal Tumor Committee, Chinese Medical Doctor Association
• Member, Colorectal Cancer Committee, Shanghai Anti-Cancer Association