Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.

The incidence of rectal cancer in the European Union is ∼125 000 per year, i.e. ∼35% of the total colorectal cancer incidence, reflecting 15–25 cases/100 000 population per year and is predicted to increase further in both genders. The mortality is 4–10/100 000 population per year. Median age at diagnosis is ∼70 years, but predictions suggest that this figure will rise in the future.

Almost one million (951 600) new cases of gastric cancer were diagnosed globally in 2012, resulting in ∼723 100 deaths [1]. Of these ∼140 000 cases and ∼107 000 deaths occurred in Europe [2]. Gastric cancer displays significant global variation in incidence; the highest rates are seen in Eastern Asia, Eastern Europe and South America, with lower rates in North America and Western Europe. A gradual decline in the incidence of gastric cancer has been observed in Western Europe and North America over the past 60 years and more recent declines in high-prevalence countries have also become apparent. This is epidemiologically distinct from the relative increase in tumours of the gastroesophageal junction, which are discussed in a separate guideline document.

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.

A recent study estimating cancer epidemiology in 2014 (within Europe) showed that pancreatic cancer was the fourth most fatal cancer in men after lung, colorectal, and prostate cancers [1]. Similarly, pancreatic cancer was found to be the fourth most fatal cancer in women after breast, colorectal and lung cancers [1]. With a life expectancy of ∼5% at 5 years, the prognosis of this cancer has not improved over the past 20 years, and incidence and mortality rates are very similar. Death due to pancreatic carcinoma is increasing in Europe with the number rising from 75 439 in 2009 to a projected 82 300 deaths in 2014 (+19%) [1]. It usually arises in elderly patients with a mean age at onset of 71 years for men and 75 years for women. The majority of patients with pancreatic cancer progress to either metastatic or locally advanced disease in the asymptomatic phase. Surgical excision is the definitive treatment with a 5-year survival rate (after resection) of ∼20%, but it is only possible in 15%–20% of the patients. The opportunity to detect pancreatic cancer, while it remains curable, depends on the ability to identify and screen high-risk populations before their symptoms arise. Defining the treatment strategy for patients suffering from pancreatic carcinoma requires a specialised multidisciplinary team that includes: surgeons, medical oncologists, gastroenterologists, radiation therapists, radiologists, and supportive and palliative care specialists.