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NCCN Guidelines®) Genetic/Familial High-Risk Assessment: Colorectal NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Genetic/Familial High-Risk Assessment: Colorectal Version 3.2017 — October 10, 2017 NCCN.org Continue Version 3.2017, 10/10/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. NCCN Guidelines Version 3.2017 Panel Members NCCN Guidelines Index Table of Contents Genetic/Familial High-Risk Assessment: Colorectal Discussion * Dawn Provenzale, MD, MS/Chair ¤ Þ Michael J. Hall, MD, MS † ∆ Robert J. Mayer, MD † Þ Duke Cancer Institute Fox Chase Cancer Center Dana-Farber/Brigham and Women’s Cancer Center * Samir Gupta, MD/Vice-chair ¤ Amy L. Halverson, MD ¶ UC San Diego Moores Cancer Center Robert H. Lurie Comprehensive Cancer Reid M. Ness, MD, MPH ¤ Center of Northwestern University Vanderbilt-Ingram Cancer Center Dennis J. Ahnen, MD ¤ University of Colorado Cancer Center Stanley R. Hamilton, MD ≠ Scott E. Regenbogen, MD ¶ The University of Texas University of Michigan Travis Bray, PhD ¥ MD Anderson Cancer Center Comprehensive Cancer Center Hereditary Colon Cancer Foundation Heather Hampel, MS, CGC ∆ Niloy Jewel Samadder, MD ¤ Daniel C. Chung, MD ¤ ∆ The Ohio State University Comprehensive Huntsman Cancer Institute at the Massachusetts General Hospital Cancer Center - James Cancer Hospital University of Utah Cancer Center and Solove Research Institute Moshe Shike, MD ¤ Þ Gregory Cooper, MD ¤ Jason B. Klapman, MD ¤ Memorial Sloan Kettering Cancer Center Case Comprehensive Cancer Center/ Moffitt Cancer Center University Hospitals Seidman Cancer Thomas P. Slavin Jr, MD ∆ Center and Cleveland Clinic Taussig David W. Larson, MD, MBA¶ City of Hope Comprehensive Cancer Institute Mayo Clinic Cancer Center Cancer Center Dayna S. Early, MD ¤ Audrey J. Lazenby, MD ≠ Shajanpeter Sugandha, MD ¤ Siteman Cancer Center at Barnes- Fred & Pamela Buffett Cancer Center University of Alabama at Birmingham Jewish Hospital and Washington Comprehensive Cancer Center University School of Medicine Xavier Llor, MD, PhD ¤ Þ Jennifer M. Weiss, MD, MS ¤ James M. Ford, MD † Þ ∆ Yale Cancer Center/ University of Wisconsin Stanford Cancer Institute Smilow Cancer Hospital Carbone Cancer Center Patrick M. Lynch, MD, JD ¤ Francis M. Giardiello, MD, MBA ¤ NCCN The Sidney Kimmel Comprehensive The University of Texas MD Anderson Cancer Center Mary Dwyer, MS Cancer Center at Johns Hopkins Ndiya Ogba, PhD William Grady, MD ¤ Arnold J. Markowitz, MD ¤ ¤ Gastroenterology Fred Hutchinson Cancer Research Memorial Sloan Kettering Cancer Center ∆ Cancer genetics Center/Seattle Cancer Care Alliance Þ Internal medicine Continue † Medical oncology ≠ Pathology ¶ Surgery/Surgical oncology ¥ Patient advocacy NCCN Guidelines Panel Disclosures * Discussion Writing Committee Member Version 3.2017, 10/10/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. NCCN Guidelines Version 3.2017 Panel Members NCCN Guidelines Index Table of Contents Genetic/Familial High-Risk Assessment: Colorectal Discussion MULTI-GENE TESTING SUBCOMMITTEE Samir Gupta, MD ¤ UC San Diego Moores Cancer Center Dennis J. Ahnen, MD ¤ University of Colorado Cancer Center Heather Hampel, MS, CGC ∆ The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute NCCN gratefully acknowledges the following individuals for participating in the review of the Lynch syndrome management recommendations for ovarian and endometrial cancer: Travis Bray, PhD ¥ Hereditary Colon Cancer Foundation Lee-may Chen, MD Ω UCSF Helen Diller Family Comprehensive Cancer Center Marta Ann Crispens, MD Ω Vanderbilt-Ingram Cancer Center Molly Daniels, MS, CGC ∆ The University of Texas MD Anderson Cancer Center ¤ Gastroenterology Ω Gynecologic oncology ∆ Cancer genetics Þ Internal medicine Continue † Medical oncology ≠ Pathology ¶ Surgery/Surgical oncology ¥ Patient advocacy * Discussion Writing Committee Member Version 3.2017, 10/10/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. NCCN Guidelines Version 3.2017 Table of Contents NCCN Guidelines Index Table of Contents Genetic/Familial High-Risk Assessment: Colorectal Discussion NCCN Genetic/Familial High-Risk Assessment: Colorectal Panel Members Clinical Trials: NCCN believes that Summary of the Guidelines Updates the best management for any patient High-Risk Colorectal Cancer Syndromes with cancer is in a clinical trial. • Assessment for Hereditary Colorectal Cancer Syndrome (HRS-1) Participation in clinical trials is especially encouraged. • Obtaining a Comprehensive Assessment for Hereditary Colorectal Cancer (HRS-A) To find clinical trials online at NCCN Non-Polyposis Syndrome Member Institutions, click here: • Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) (LS-1) nccn.org/clinical_trials/physician.html. Principles of IHC and MSI Testing for Lynch Syndrome (LS-A) NCCN Categories of Evidence and Cancer Risk Up to Age 70 Years in Individuals with Lynch Syndrome Consensus: All recommendations Compared to the General Population (LS-B) are category 2A unless otherwise specified. Polyposis Syndromes See NCCN Categories of Evidence • APC and MUTYH Genetic Testing Criteria (APC/MUTYH-1) and Consensus. • Familial Adenomatous Polyposis/AFAP (FAP/AFAP-1) Familial Adenomatous Polyposis (FAP-1) ◊ Surgical Options for Treating the Colon and Rectum in Patients with FAP (FAP-A) Attenuated Familial Adenomatous Polyposis (AFAP-1) MUTYH-Associated Polyposis (MAP-1) • Peutz-Jeghers Syndrome (PJS-1) • Juvenile Polyposis Syndrome (JPS-1) • Serrated Polyposis Syndrome (SPS-1) • Colonic Adenomatous Polyposis of Unknown Etiology (CPUE-1) • Multi-Gene Testing (GENE-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2017. Version 3.2017, 10/10/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. NCCN Guidelines Version 3.2017 Updates NCCN Guidelines Index Table of Contents Genetic/Familial High-Risk Assessment: Colorectal Discussion Updates in Version 3.2017 of the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal from Version 2.2017 include: MS-1 • The discussion section was updated to reflect the changes in the algorithm. Updates in Version 2.2017 of the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal from Version 1.2017 include: HRS-1 HRS-2 • Assessment for hereditary cancer • Footnote f was added to the page, "If evaluation is based on family After "Is there a personal history of a known genetic mutation or known history of >1 relative with polyposis, then type of polyps in affected genetic mutation in the family?" and the reply is "No," the following relative (if known) may guide testing." criteria was added, "Family history of: >1 relative with polyposis". ◊ If the response to these criteria is "No" the next question was revised HRS-3 as, "Is there a personal history of colorectal cancer (CRC), endometrial • The “Criteria For Further Risk Evaluation For High-Risk Syndromes or a Lynch syndrome-related cancer?" For Unaffected (No Personal History of Colorectal or Endometrial ◊ If the response to this question is "No" the next question was revised Cancer or Concerning Polyposis)” heading has been revised as, as, "Is there a family history of colorectal, endometrial or a Lynch "Evaluation to Exclude Lynch Syndrome." syndrome-related cancer? The bullets were updated for both a personal history and family ◊ If the response to this question is "No", then "See NCCN Guidelines for history of a Lynch syndrome-related cancer. Colorectal Cancer Screening - Average risk," was clarified by adding, • Footnote g was added, "Tumor screening for mismatch repair deficiency is appropriate for all colorectal and endometrial cancers "unless other significant personal or family history that may indicate regardless of age at diagnosis, however, germline genetic testing is increased risk for hereditary cancer syndrome." generally reserved for patients with early-age at diagnosis; positive • Footnote a was added to this page, "LS-related cancers include colorectal, family history; or abnormal tumor testing results: MSI or loss of endometrial, gastric, ovarian, pancreas, ureter and renal pelvis, brain mismatch repair protein expression. See LS-A for details on tumor (usually glioblastoma), small intestinal cancers, as well as sebaceous screening
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