NCCN Updates colorectal assessment guidelines

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THE NATIONAL COMPREHENSIVE CANCER NETWORK updated its clinical practice guidelines in oncology for Genetic/Familial High-Risk Assessment: Colorectal.

  • For colon cancer, the colonoscopy screening recommendations were changed to “Colonoscopy at age 25-30 y or 2-5 y prior to the earliest colon cancer if it is diagnosed before age 30 y and repeat every 1-2 y” from “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.”
    For extra colonic, 1st sub-bullet was changed to “For endometrial and ovarian cancer, see surveillance for MLH1, MSH2 and EPCAM carriers (See LS-3)” from “Consider prophylactic hysterectomy and BSO in women who have completed childbearing.”
  • A new clinical testing criteria was added for Lynch Syndrome based on personal and family history: “Consider testing individuals with ≥5% risk of LS on any mutation prediction model (eg, MMRpro, PREMM[1,2,6], MMRpredict).”
  • In Juvenile Polyposis Syndrome, a new heading title was added called, “Genetic Testing.”
    The following bullet was added and revised: “Clinical genetic testing is recommended with approximately 50% of JPS cases occurring due to mutations in the BMPR1A and SMAD4 genes. If known SMAD4 mutation in family, genetic testing should be performed within the first 6 months of life due to hereditary hemorrhagic telangiectasia (HHT) risk.”
    “Hemorrhagic Telangiectasia (HHT)” was added to the table with a recommendation, “In individuals with SMAD4 mutations, screen for vascular lesions associated with HHT.” The initiation age was added: “Within first 6 mo of life.”
  • In Colonic Adenomatous Polyposis of Unknown Etiology:
    Personal history of >10-<100 adenomas: Small adenoma burden manageable by colonoscopy and polypectomy, the sub-bullet for management/surveillance was revised: “Clearing of all polyps is recommended preferable but not always possible.Repeat at short interval if residual polyps are present.”
    Personal history of >10- <100 adenomas: Dense polyposis or large polyps not manageable by polypectomy, the management/surveillance was revised: “Subtotal colectomy or proctocolectomy depending on adenoma density and distribution,” and a new bullet was added: “Consider proctocolectomy if there is dense rectal polyposis not manageable by polypectomy.”
    For each family history phenotype, “consider” was added to each of the management/surveillance recommendations and a corresponding footnote “b” was added: “There are limited data to suggest definitive recommendations for when to initiate screening or the interval of screening.”
  • In Peutz-Jeghers Syndrome, MRI was added as a screening procedure option of the small intestine, and age to initiate screening for pancreatic cancer was changed from “25-30 y” to “30-35 y.”

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The University of California, San Francisco and global oncology communities mourn the death of Felix Y. Feng, MD, a radiation oncologist and a leading figure in genitourinary cancer research. A professor of radiation oncology, urology and medicine, and vice chair of translational research at the UCSF Helen Diller Family Comprehensive Cancer Center, Feng died from cancer on Dec.10, 2024. He was 48.
The late Felix Feng, MD (center) with researchers Jonathan Chou, MD, PhD (left) and Lisa Chesner, PhD (right), in 2019.Photo by Noah BergerFelix Y. Feng, a genitourinary cancer research leader, died on Dec. 10, 2024. He was 48.This article is republished with permission by NRG Oncology.Dr. Feng was the former NRG Oncology Genitourinary Cancer Committee chair and an RTOG Foundation member. After years of dedicated and enthusiastic commitment to the NRG and previously the RTOG Genitourinary Cancer Committee, chairing or co-chairing 13 research protocols for NRG and RTOG, Dr. Feng was appointed committee chair in March 2018, following in the footsteps of Dr. Howard Sandler, his mentor. Dr. Feng was also a member of the RTOG Foundation Board of Directors.

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