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(NCCN Guidelines®) Colorectal Cancer Screening

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(NCCN Guidelines®) Colorectal Cancer Screening NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colorectal Cancer Screening Version 2.2017 — November 14, 2017 NCCN.org Continue Version 2.2017, 11/14/17 © 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 2.2017 Panel Members NCCN Guidelines Index Table of Contents Colorectal Cancer Screening 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 Francis M. Giardiello, MD, MBA ¤ Patrick M. Lynch, MD, JD ¤ NCCN The Sidney Kimmel Comprehensive The University of Texas Ndiya Ogba, PhD Cancer Center at Johns Hopkins MD Anderson Cancer Center Mary Dwyer, MS William Grady, MD ¤ ¤ Gastroenterology Fred Hutchinson Cancer Research ∆ Cancer genetics Center/Seattle Cancer Care Alliance Þ Internal medicine † Medical oncology Continue ≠ Pathology ¶ Surgery/Surgical oncology ¥ Patient advocacy NCCN Guidelines Panel Disclosures * Discussion Writing Committee Member Version 2.2017, 11/14/17 © 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 2.2017 Table of Contents NCCN Guidelines Index Table of Contents Colorectal Cancer Screening Discussion NCCN Colorectal Cancer Screening Panel Members Clinical Trials: NCCN believes that Summary of the Guidelines Updates the best management for any patient with cancer is in a clinical trial. • Risk Assessment for Colorectal Cancer (CSCR-1) Participation in clinical trials is especially encouraged. Average Risk To find clinical trials online at NCCN Member Institutions, click here: • Average Risk (CSCR-2) nccn.org/clinical_trials/physician.html. Increased Risk NCCN Categories of Evidence and • Personal History of Adenomatous or Sessile Serrated Polyps (CSCR-4) Consensus: All recommendations • Personal History of Colorectal Cancer (CSCR-5) are category 2A unless otherwise • Personal History of Inflammatory Bowel Disease (CSCR-6) indicated. • Increased Risk Based on Positive Family History (CSCR-8) See NCCN Categories of Evidence and Consensus. • Screening Modality and Schedule (CSCR-A) • Definitions of Common Colorectal Resections (CSCR-B) For High-Risk Colorectal Cancer Syndromes, see NCCN Genetic/Familial High-Risk Assessment: Colorectal 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 2.2017, 11/14/17 © 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 2.2017 Updates NCCN Guidelines Index Table of Contents Colorectal Cancer Screening Discussion Updates in Version 2.2017 of the NCCN Guidelines for Colorectal Cancer Screening from Version 1.2017 include: MS-1 • The Discussion section has been updated to reflect the changes in the algorithm. Updates in Version 1.2017 of the NCCN Guidelines for Colorectal Cancer Screening from Version 2.2016 include: CSCR-2 CSCR-3 Average Risk Screening Average Risk Screening (continued) • Screening modality and schedule: • The following footnotes were moved to be bullets on CSCR-A 1 of 5: ◊ “Colonoscopy, the criteria after polypectomy was revised: “Low-sensitivity guaiac-based stool testing has been shown to reduce CRC in Hyperplastic polyps non-SSP, and <1 cm in size rectum and randomized trials (category 1). Studies have demonstrated that high sensitive sigmoid only” guaiac-based testing is more sensitive than low-sensitivity guaiac-based testing and that FIT testing is more sensitive than high-sensitivity guaiac-based ◊ “Adenoma/SSP Hyperplastic polyps >1 cm in size” testing.” • Footnotes “A multi-target stool DNA combined with FIT test has recently been approved Footnote “e” was added: “A blood test that detects circulating by the FDA as a primary screening modality for colorectal cancer (Imperiale methylated SEPT9 DNA was recently FDA-approved and may TF, et al. N Engl J Med 2014;370:1287-1297). At this time, there are limited data provide an option for screening for those who refuse other screening available to determine an appropriate interval between screening; however, modalities but its ability to detect colorectal cancer and advanced every 3 y has been suggested. Berger BM, et al. Clin Colorectal Cancer. adenoma is inferior to other recommended screening modalities. The 2015 Dec 18. The data in an average-risk individual indicates that stool DNA interval for repeating testing is unknown.” performs well. There are no or limited data in high-risk individuals and the Footnote “f” was added: “Screening should be individualized and use of stool DNA should be individualized. If a result is determined to be a include a discussion of the risks and benefits of each modality.” false positive, clinical judgment and shared decision-making should be used Footnote “i” was added: “There are insufficient data to determine regarding future patient management. Redwood DG, et al. Mayo Clin Proc 2017;91:61-70.” whether individuals with small hyperplastic polyps proximal to • The following footnote was removed, “Evidence for interval high-sensitivity rectum or sigmoid colon should be considered increased risk and FOBT or FIT is largely based on modeling data.” managed differently.” • CT colonography Footnote “j” was added, “There are limited data to support whether The recommendations were revised based on size and number of polyps. individuals with hyperplastic polyps >1 cm in size represent an increased risk group. Some data suggest that many of these polyps CSCR-4 are in fact SSPs that have been incorrectly characterized.” Also for Increased Risk Based on Personal History of Adenomatous Polyp or Sessile CSCR-3 and CSCR-4) Serrated Polyp Footnote was removed: “SSPs without dysplasia are generally • Footnote “o” was revised from “Shorter intervals may be necessary when there managed like adenomas; SSP-cd are managed like high-risk is uncertainty about completeness of removal of large and/or sessile polyps, adenomas and may need even more frequent surveillance (Rex if the colonic preparation was suboptimal, and for SSP-cds. Some authorities D, et al. Am J Gastro 2012;107:1315-1329; Leiberman D, et al. recommend surveillance at 1- to 3-year intervals for SSP-cds because they are Gastroenterology 2012;143:844-857).” thought to rapidly progress to CRC (Rex D, et al. Am J Gastro 2012;107:1315- 1329)” to “These intervals may be individualized based on the colonic preparation and completeness of polypectomy (based on endoscopy and pathology reports, and on histology). Surveillance at 1- to 3-year intervals for SSP-cds has been recommended because they are thought to progress rapidly to cancer (Rex D, et al. Am J Gastro 2012;107:1315-29).” Continued on next page Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any patient with cancer is in
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