The development of county-level hospitals in China is unbalanced. Due to relatively backward equipment, personnel, departments and fund allocation, the diagnosis and treatment of colorectal cancer cannot be carried out in strict accordance with the international guidelines for diagnosis and treatment of colorectal cancer. However, the county-level hospitals need to serve a large number of people, which is the primary diagnosis unit for most colorectal cancer patients. Therefore, it is very important to develop guidelines for diagnosis and treatment of colorectal cancer in county-level hospitals. Based on the ″China Colorectal Cancer Diagnosis and Treatment Standards″ issued by the national health commission of the People′s Republic of China in 2017, a total of 71 county-level hospitals in eastern, central and western of China have been investigated in terms of colorectal cancer operation, diagnostic equipment, department support, diagnosis and treatment process obstacles, etc. In the guideline, and the changes adapted to county-level hospitals have been made on the basis of the original guideline according to the current situation of county-level hospitals combined with the new progress of diagnosis and treatment after summarizing and analyzing. It is hoped that this edition of the guideline can standardize and improve the level of diagnosis and treatment of colorectal cancer in primary hospitals in China.

According to the data released by the National Cancer Center in 2019, the morbidity and mortality of colorectal cancer in China are on the rise. This mainly related to the lack of basic medical treatment standards, and the overall level of diagnosis and treatment is still low. Especially in county-level hospitals, due to the relatively backward allocation of various resources, it is impossible to completely follow the international treatment guidelines, and the medical level is uneven. Since county-level hospitals are the first unit of treatment for most patients with colorectal cancer, and the number of people who need services is large, it is especially important to develop guidelines for colorectal cancer diagnosis and treatment suitable for county-level hospitals. To this end, Professional Committee of Internal Medicine, Colorectal Cancer Committee of Chinese Medical Doctor Association drafted, discussed, and finally released Guidelines Internal Medicine Section for county physicians in diagnosis and treatment of stageⅡ and Ⅲ colorectal cancer in China, to standardize stage Ⅱ and Ⅲ colorectal cancer medical treatment.

Surgical resection is the only possible cure method for colorectal liver metastases (CRLM), but about 70% of patients with CRLM will relapse after hepatectomy. Neoadjuvant therapy is an effective means to reduce the recurrence rate and prolong the survival of patients. The targeted drugs have also been widely used in neoadjuvant therapy for its high objective response rate. However, the new version of the NCCN guidelines in 2017 revised the recommendation of neoadjuvant chemotherapy combined with targeted therapy as a recommendation for neoadjuvant chemotherapy alone, due to the lack of clinical evidence. It was of great importance for clinical practice to take an objective view on the changes in the recommendations of the NCCN guidelines. Therefore, this article will focus on the role and status of targeted drugs in neoadjuvant therapy.

The 2014 ESMO guideline for anal cancer is used for diagnosis, treatment and follow-up of squamous cell carcinoma of the anus, including anatomically anal canal, anal margin and perianal skin. High risk includes anal intercourse, HIV infection and HPV infection. The current staging system for anal cancer is still the UICC/AJCC TNM classification for malignant tumor. Treatment goal for localized anal cancer is to achieve good control for primary lesion and preserve the function of anal sphincter. Standard primary treatment for this setting is 5-fluorouracil (5-FU)-based concurrent chemoradiation (CRT), leading to complete tumour regression in 80%~90% of patients. In this setting, surgery is used mainly as a salvage treatment, or the primary option for small lesion involving perianal skin. For metastatic disease, systemic chemotherapy with 5-FU and cisplatin-based regimen is the primary treatment.

The last decade has seen a rapid increase in the reported incidence of ulcerative colitis(UC)in China.Outside specialized centers which dedicated in inflammatory bowel diseases(IBD), a lack of contemporary knowledge of management of UC(either diagnostic or medical or surgical)is still seen among many gastroenterologists and surgeons in the field of general surgery.This is mainly attributed to the relative low incidence of UC in history and lack of specialization of colorectal surgery in most hospitals.As compared to the contemporary concept of UC treatment worldwide, surgical management of UC in China differs in the following aspects: 1, a longer duration of medical therapy both in acute and chronic UC; 2, a significant lower rate of surgery; 3, a significant lower rate of use of ileal pouch anal anastomosis and a higher rate of ileorectal anastomosis; 4, poor cancer surveillance and delayed diagnosis of cancer in UC patients.To catch up with the western status of UC treatment, concerted efforts must be made in continuing education and setting up regional centers dedicated to IBD treatement and practice of multidisciplinary treatment and promoting the awareness of guidelines in UC management among physicians in primary hospitals.

Anorectal malignant melanoma(ARMM)is a malignant tumor with low incidence and poor prognosis.ARMM lacks specific clinical manifestations, and routine pathological examination is hard to diagnose.The treatment of ARMM includes surgical operation, radiotherapy, chemotherapy and targeted therapy.Surgical operation excision remains the main method to cure the disease because of its poor sensitivity to chemotherapy and radiotherapy.The author analyzed the treatment guidelines in recent years on ARMM, discussed the progress of the diagnosis and biological characteristics, which is helpful for clinical diagnosis and treatment.

As the rare tumor in gastrointestinal(GI)tract, the incidence of GISTs is nearly 1/100000.But GISTs are the most common soft tissue sarcoma in the GI tract.It can arise anywhere along the GI tract, but stomach(60%)and small intestine(30%)are the most common sites, followed by colorectal(5% to 6%)primary site(rectum: 4% and colon: 1%~2%). This review consists of overview, diagnosis, principle of surgery, postoperative recurrence risk assessment, targeted therapy and follow up based on 2014 NCCN guidelines version on soft tissue sarcoma and 2014 ESMO guidelines version on GISTs.We hope that it will offer a little help to gastroenterology, especially to the surgeons.

Gastrointestinal stromal tumor Committee belonging to the Chinese Society of Clinical Oncology was establish in 2010.The expert consensus of managements in GIST had been published ever since. While the National Comprehensive Cancer Network guideline is most widely accepted all over the world. This article makes a overall review and compare of them both in order to get benefits in guiding clinical practice.

It is significant that National Comprehensive Cancer Network(NCCN) Guidelines for specification of colorectal cancer diagnosis and treatment.The contents is updated every year, which means the hot, difficulty or doubt spots of the field of cancer research.This paper reviews the focus of the 2008-2012 Guide updates, looking back at the stories of colorectal cancer diagnosis and treatment progress, hoping to find a little inspiration.