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NCCN Flash Updates™: NCCN Guidelines® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal. These NCCN Guidelines® are currently available as Version 1.2016.

  • Multi-Gene Testing (GENE-1)
    • A new section regarding multi-gene testing was added and reference to these pages was added appropriately throughout the guidelines.
  • High-Risk Colorectal Cancer Syndromes (HRS-1)
    • The criteria for further risk evaluation for high-risk syndromes were extensively revised.
  • Lynch Syndrome
    • Clinical Testing Criteria for Lynch Syndrome (based on personal and family history) (LS-1)
      • A statement was added above the criteria: “Meeting one or more of these criteria warrants further personalized risk assessment, genetic counseling, and often genetic testing and management.”
      • The revised Bethesda criteria and Amsterdam II criteria are now explicitly stated on this page.
    • Routine Tumor Testing Criteria for Lynch Syndrome (LS-3)
      • The option for “CRC patients diagnosed at <70 y and also those ≥70 y who meet the Bethesda Guidelines (See LS-B)” was removed and the corresponding footnote was revised by adding, “The panel recommends universal screening of all CRCs to maximize sensitivity for identifying individuals with Lynch syndrome and to simplify care processes. However, evidence suggests an alternate option would be to limit screening to individuals with CRC diagnosed <70 y plus those >70 meeting Bethesda guidelines.”
    • Lynch Syndrome Management (LS-4, LS-5)
      • The surveillance recommendations for MSH6 and PMS2 were combined with MLH1 and MSH2.
        • Surveillance for colon cancer
          • 2nd bullet was revised: “There are data to suggest that aspirin may decrease the risk of colon cancer in LS but optimal dose and duration of aspirin therapy are uncertain however, at this time the data are not sufficiently robust to make a recommendation for its standard use.
        • Surveillance for other extracolonic cancers
          • 2nd bullet regarding gastric and small bowel cancer surveillance was revised by adding: “Consider testing and treating H.pylori.”
          • 3rd bullet regarding urothelial cancer surveillance was revised: “Consider annual urinalysis starting at 25–30 30–35 y.”
          • Footnote “p” was added: “For MSH6 and PMS2, the risk of other LS-related cancers is reportedly low; however, due to limited data no gene specific screening recommendation are possible at this time.”
  • APC and MUTYH Genetic Testing Criteria (APC/MUTYH-1)
    • The APC testing criteria were revised as follows:
      • 3rd bullet: “Consider testing if a personal history of a desmoid tumor, hepatoblastoma, cribriform-morular variant of papillary thyroid cancer, or multifocal/bilateral CHRPE, or between 10–20 adenomas.”
  • Familial Adenomatous Polyposis
    • Classical FAP Surveillance, Extracolonic (FAP-2)
      • 1st bullet was revised: “Duodenal or periampullary cancer: Upper endoscopy (including side-viewing examination) (including complete visualization of the ampulla of Vater) starting at around age 20–25 y...”
  • Attenuated Familial Adenomatous Polyposis
    • Surveillance, Extracolonic (AFAP-1)
      • 3rd bullet was revised: “Upper endoscopy (including side-viewing examination) (including complete visualization of the ampulla of Vater) starting at around age 20–25 y...”
  • MUTYH-Associated Polyposis
    • Surveillance (MAP-3)
      • 2nd bullet was revised: “Consider upper endoscopy and side viewing duodenoscopy (including complete visualization of the ampulla of Vater) beginning at age 30–35 y...”
  • Juvenile Polyposis Syndrome (JPS-1)
    • Footnote “c” was added: “There may be management issues related to anemia from giant confluent polyps. If anemia develops requiring blood transfusion due to many stomach polyps, gastrectomy can be considered in severe cases.”
  • Colonic Adenomatous Polyposis of Unknown Etiology (CPUE-1)
    • Phenotype, the following were revised:
      • Personal history of >10–<100 >20–<100 adenomas: Small adenoma burden manageable by colonoscopy and polypectomy
      • Personal history of >10–<100 >20–<100 adenomas: Dense polyposis or large polyps not manageable by polypectomy
      • Family history of >10–<100 >20–<100 adenomas in a first-degree relative

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit

To access the NCCN Biomarkers Compendium™, please visit

To view the NCCN Guidelines for Patients®, please visit

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