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NCCN Guidelines and Compendium Updated

NCCN Flash Update sent May 16, 2013
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colorectal Cancer Screening. These NCCN Guidelines® are currently available as Version 1.2013.

  • Increased Risk Based on Personal History of Colorectal Cancer
    • For a personal history of colorectal cancer, a new column titled "Testing" was added. Two approaches to determine who should have Lynch syndrome screening are recommended, and methodologies for Lynch syndrome screening are delineated. (CSCR-4)
    • The surveillance recommendations were removed, and the user is now directed to the surveillance recommendations in "NCCN Guidelines for Colon Cancer" and "NCCN Guidelines for Rectal Cancer." (CSCR-4)
  • High Risk Syndromes
  • New criteria for individuals who should have a further risk evaluation for a high-risk syndrome was added: "Individual with a desmoid tumor." (HRS-1)
  • Lynch Syndrome (LS)
    • The current surveillance recommendations were specified as being for MLH1 and MSH2 mutation carriers (LS-2), and new surveillance recommendations were added for MLH6 and PMS2 mutation carriers (LS-3).
    • For MLH1 and MSH2 mutation carriers, under colonoscopy, a new bullet was added: "There are data to suggest that aspirin may decrease the risk of colon cancer in LS; however, at this time the data are not sufficiently robust to make a recommendation for its standard use." (LS-2)
    • For MLH1 and MSH2 mutation carriers, under extra-colonic cancers, the following screening recommendations were revised: (LS-2)
      • Gastric and small bowel cancer: There is no clear evidence to support screening for gastric, duodenal, and small bowel cancer for LS. Selected individuals or families or those of Asian descent may consider EGD with extended duodenoscopy (to distal duodenum or into the jejunum) at 2- to 3-y intervals every 3-5 y beginning at age 30-35 y. Consider capsule endoscopy for small bowel cancer at 2- to 3-y intervals beginning at age 30-35 y.
      • Pancreatic cancer: Due to limited data, Despite data indicating an increased risk for pancreatic cancer, no effective screening techniques have been identified; therefore, no screening recommendation is possible at this time."
    • For MLH1 and MSH2 mutation carriers, under extra-colonic cancers, the following screening recommendation was added: (LS-2)
      • Breast cancer: There have been suggestions that there is an increased risk for breast cancer in LS patients; however, due to limited data no screening recommendation is possible at this time.
    • For MSH6 mutation carriers, the following surveillance recommendations were added: (LS-3)
      • Colon cancer: "Colonoscopy at age 30-35 y (may need to be earlier in some families, depending on ages of cancers observed) every 2-3 y, and then after age 40 y every 1-2 y."
      • Extra colonic: "Consider prophylactic hysterectomy and BSO in women who have completed childbearing" and "The risk of other LS-related cancers is reportedly low; however, due to limited data no screening recommendation is possible at this time."
    • For PMS2 mutation carriers, the following surveillance recommendations were added: (LS-3)
      • Colon cancer: "Colonoscopy at age 35-40 y (may need to be earlier in some families, depending on ages of cancers observed) every 2-3 y, and then after age 50 y every 1-2 y."
      • Extra colonic: "The risk of other LS-related cancers is reportedly low; however, due to limited data no screening recommendation is possible at this time."
    • The table titled, "Cancer Risk Up to Age 70 Years in Individuals with Lynch Syndrome Compared to the General Population" has been updated to include cancer risk associated with MSH6 and PMS2 gene mutations. (LS-D)
  • Familial Adenomatous Polyposis
    • Phenotype: "Duodenal cancers (4%-12%)" was added. (FAP/AFAP-1)
    • Colon cancer surveillance: the bullet regarding chemoprevention was changed from "Consider nonsteroidal anti-inflammatory drug (NSAID) chemoprevention to reduce polyp burden as a pharmacological adjunct to endoscopic surveillance. A clinical trial is encouraged" to "The use of chemoprevention is to facilitate management of the remaining rectum post-surgery. There are no FDA-approved medications for this indication at present. While there are data to suggest that sulindac is the most potent polyp regression medication, it is not known if the decrease in polyp burden decreases cancer risk." (FAP-1) This change was also made for Attenuated Familial Adenomatous Polyposis (AFAP-1) and MUTYH-Associated Polyposis (MAP-2).
  • Attenuated Familial Adenomatous Polyposis
    • Phenotype: a minimum number of adenomas was added: "Presence of 10-<100 adenomas." (FAP/AFAP-1)
  • MUTYH-Associated Polyposis
    • The algorithms related to MAP were extensively revised. (MAP-1)
  • APC and MUTYH Genetic Testing Criteria
    • A new page was added describing APC and MUTYH genetic testing criteria, testing strategies, and treatment/surveillance. (APC/MUTYH-1)
  • Colonic Adenomatous Polyposis of Unknown Etiology
    • A new page describing the management/surveillance of colonic adenomatous polyposis of unknown etiology was added. (CPUE-1)

For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®,and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium™, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients®, please visit NCCN.com.

Free NCCN Guidelines mobile apps for iPad and Android are now available! Visit NCCN.org/apps