Colon and Rectal Cancer Guidlines,1.2009

From Medscape Hematology-Oncology

National Comprehensive Cancer Network (NCCN) Colon Cancer and Rectal Cancer Guidelines, Version 1.2009

Posted 02/02/2009

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Medscape Hematology-Oncology is pleased to present the latest update to the NCCN Clinical Practice Guidelines in Oncology^™ Colon Cancer and Rectal Cancer, released in January 2009. The updated NCCN Guidelines, available on Medscape, were developed by a panel of 28 multidisciplinary colon cancer and rectal cancer experts from NCCN Member Institutions. The panel met in July 2008 to review evidence and formulate updated recommendations. All NCCN Guidelines are updated continuously, but at least once a year, with additional updates published when important new data that change practice standards are released. The update process includes extensive review of the current NCCN Guideline via institutional reviews at NCCN Member Institutions and review of recently published data. An agenda for the NCCN Panel meeting is developed and NCCN Panel Members are assigned to present data regarding each agenda item. Relevant publications and results of the institutional review are distributed to NCCN Panel Members before the meeting.

The published NCCN Guideline has 3 parts: an algorithm that follows the step-by-step clinical decision-making process; a manuscript that discusses the data the recommendations are based on and the issues that were considered by the panel; and a bibliography. Each recommendation is categorized according to both the level of evidence supporting the recommendation and the degree of consensus among the NCCN Member Institutions that the recommendation is appropriate.

All panel members volunteer their time and expertise and accept no compensation for their efforts. They declare any potential conflicts of interest both in writing and verbally to each other. Panel members may be excluded from discussion of related topics if it is perceived that they have a significant conflict, at the discretion of the chair. Data may be submitted to the panel by the community, patient advocacy organizations, or industry representatives. Industry representatives are not allowed to participate in the panel discussions, nor are they allowed to make presentations to the panel. The panel has sole responsibility for evaluating data and determining the content of the NCCN Guideline.

Guideline development is completely supported by NCCN Member Institution dues to NCCN. NCCN may accept industry funding only for dissemination of the NCCN Guidelines.

The NCCN Colon and Rectal Cancer Guidelines are two of the Complete Library of NCCN Clinical Practice Guidelines in Oncology^™, which is available free of charge at www.nccn.org. The most recent version of each NCCN Guideline is always available on NCCN's website.

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NCCN Clinical Practice Guidelines in Oncology™ Colon Cancer, Version 1.2009

NCCN Clinical Practice Guidelines in Oncology™ Rectal Cancer, Version 1.2009

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Family history of colorectal cancer

Family history of colorectal cancer linked with reduced risk of cancer recurrence

Among patients with advanced colon cancer receiving treatment that includes chemotherapy, a family history of colorectal cancer is associated with a

significant reduction in cancer recurrence and death, with the risk reduced further by having an increasing number of affected first-degree relatives,

according to a study in the June 4 issue of JAMA.
Approximately 16 percent to 20 percent of patients with colorectal cancer have a first-degree relative with colorectal cancer. Beyond rare but highly

penetrant hereditary colorectal cancer syndromes, numerous studies have demonstrated that a history of colorectal cancer in a first-degree relative increases

the risk of developing the disease by approximately 2-fold. However, the influence of family history on cancer recurrence and survival among patients with

established colon cancer remains uncertain, the authors write.
Jennifer A. Chan, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues examined the association of family history of colorectal cancer

with recurrence and survival of 1,087 patients with stage III colon cancer who were receiving supplemental chemotherapy. Patients provided information on

family history of colorectal cancer at the beginning of the study, and were followed up until March 2007 for cancer recurrence and death (median [midpoint]

follow-up, 5.6 years).
Among the 1,087 participants, 195 (17.9 percent) reported a family history of colorectal cancer in 1 or more first-degree relatives. The researchers found

that a family history of colorectal cancer was associated with a significant reduction in the risk of cancer recurrence or death. Compared with patients

without a family history, those with a family history had a 28 percent lower risk for cancer recurrence or death, which occurred in 57 of 195 patients (29

percent) with a family history of colorectal cancer compared with 343 of 892 patients (38 percent) without a family history.
Examining just the risk for cancer recurrence, patients with a family history of colorectal cancer had a 26 percent reduced risk compared with patients

without a family history. Cancer recurrence occurred in 27 percent of patients with a family history of colorectal cancer and 35 percent of patients without

a family history. The reduced risk of death for patients with a family history of colorectal cancer was 25 percent.
The apparent benefit associated with family history was stronger with an increasing number of affected family members. Compared with participants without a

family history of colorectal cancer, participants with two or more affected relatives had a 51 percent lower risk for cancer recurrence or death.
Beyond rare, well-characterized hereditary colorectal cancer syndromes, our data support the hypothesis that a relatively common though less penetrant

genetic predisposition may not only influence colorectal cancer risk but also patient survival. This finding may reflect a distinct underlying molecular and

pathogenic mechanism in cancers that develop in the setting of a common (i.e., sporadic) family history, the researchers write. Further studies are needed to

more fully elucidate potential mechanisms by which a common family history may influence the outcome for patients with colorectal cancer.
(JAMA. 2008;299[21]:2515-2523. Available pre-embargo to the media at www.jamamedia.org)
Editors Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures,

funding and support, etc.
________________________________________
Editorial: Familial Colorectal Cancer - A Genetics Treasure Trove for Medical Discovery
In an accompanying editorial, Boris Pasche, M.D., Ph.D., of the Northwestern University Feinberg School of Medicine, Chicago, and Contributing Editor, JAMA,

comments on the results of the study by Chan and colleagues.
If these intriguing findings are validated in other studies, family history may well become a new prognostic factor in colorectal cancer. Should this be the

case, genome-wide association studies and tumor gene expression profiling studies will be warranted to identify germline and tumor-specific genetic features

associated with a family history of colorectal cancer and favorable outcome following adjuvant chemotherapy.
Over the past 2 decades, some of the first major molecular genetics inroads were achieved through careful study of patients with a strong family history of

colorectal cancer, Dr. Pasche writes. The study by Chan et al suggests that family history of colorectal cancer will lead to the identification of novel

genetic features predictive of response to chemotherapy. Familial colorectal cancer may therefore confirm its role as a genetics treasure trove for medical

discovery.
(JAMA. 2008;299[21]:2564-2565. Available pre-embargo to the media at www.jamamedia.org)
Editors Note: Please see the article for additional information, including financial disclosures, funding and support, etc.


Contact: Robbin Ray
617-632-4090
JAMA and Archives Journals
Source:Eurekalert