THE NATIONAL COMPREHENSIVE Cancer Network® (NCCN®) recently announced the publication of a new set of recommendations focused on cancers in the small intestine. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Bowel Adenocarcinoma are the first treatment guidelines in the United States (and second worldwide) to address this rare cancer type, which is increasing in incidence. Small bowel cancers (of which adenocarcinomas are the most common) are responsible for about 3% of all digestive system cancers, with an estimated 10,590 new cases expected in 2019.1
The rates for many other gastrointestinal malignancies have been on the decline in recent years, in part as a result of increases in screening. At the same time, the rates for small bowel cancers have increased 1.8% between 2006 and 2015.2 There is not currently a consensus on screening for small bowel adenocarcinoma, since it’s located higher on the gastrointestinal tract and therefore not detected during routine colonoscopy. However, it has been shown to be associated with Lynch syndrome (among other familial syndromes), Crohn’s disease, and colitis.
Updates in Colorectal Cancer Guidelines
THE NCCN recently released updates to the NCCN Guidelines for Genetic/Familial Risk Assessment: Colorectal Cancer—reflecting the commitment to enhancing surveillance strategies that would increase early colorectal cancer detection rates, particularly as it relates to individuals with a personal or family history. The extensive update includes a clarified step-by-step process for the assessment of hereditary colorectal cancer syndromes and a greater emphasis on the importance of genetic counseling.
Heather Hampel, MS, LGC
“Many of these changes reflect the widespread adoption of multigene panel testing for hereditary cancer syndromes, which allows assessment for even rare causes of polyposis and other cancer syndromes,” explained Heather Hampel, MS, LGC, of The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, Member of the NCCN Guidelines Panel for Genetic/Familial Risk Assessment: Colorectal Cancer. “We’ve added a section on the principles of cancer risk assessment and counseling and also refined the initial approach to assessing hereditary colorectal cancer syndromes, included rare genetic causes for multiple adenomatous polyps, and updated the criteria for evaluation of Lynch syndrome.”
The NCCN Guidelines for Colorectal Cancer Screening were also recently updated. The panel of experts behind those guidelines is closely following emerging studies regarding new colorectal cancer diagnoses in younger people.
Dawn Provenzale, MD, MS
“The panel has reviewed the recent data for initiating screening of average-risk individuals before age 50,” said Dawn Provenzale, MD, MS, of Duke Cancer Institute, Chair, NCCN Guidelines Panel for Colorectal Cancer Screening. “Based on those data, the panel continues to endorse screening of average-risk individuals at age 50. The panel will continue to review this strategy and monitor data as they emerge.”
The NCCN Guidelines for Small Bowel Adenocarcinoma, Colorectal Cancer Screening, and Genetic/ Familial High-Risk Assessment: Colorectal are all available free-of-charge for noncommercial use at NCCN.org, or via the virtual library of NCCN Guidelines App for smartphone and tablet. ■
1. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2019. CA Cancer J Clin 69:7-34, 2019.
2. Noone AM, Howlader N, Krapcho M, et al: SEER Cancer Statistics Review, 1975-2015. Available at https://seer.cancer.gov/csr/1975_2015/. Accessed August 9, 2019.