NCCN Revises Guidelines for Gastric Cancer

07/31/17

The National Comprehensive Cancer Network (NCCN) has updated their guidelines for the management of gastric cancer to include surveillance and risk assessment recommendations.

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The most recent update to the guidelines (July 26, 2017) featured revised follow-up and surveillance recommendations, criteria for risk evaluations and genetic counseling assessments, and new sections for principles of surveillance and survivorship.

For those patients successfully treated by endoscopic resection, upper gastrointestinal endoscopy every 6 months for a year, then annually for 3 years, is recommended. Routine imaging is further recommended as clinically indicated based on symptoms and concern for recurrence. For patients with stage I disease, varying frequencies of upper gastrointestinal endoscopy are suggested based on previous treatment. For patients with stage II/III disease who had partial or subtotal gastrectomy, upper gastrointestinal endoscopy is suggested as clinically indicated.

Referral to a cancer genetics professional is recommended for patients with one or more of the following: diagnosis before age 40; diagnosis before age 50 with one first- or second-degree relative affected with gastric cancer; any age with at least two relatives affected with gastric cancer; diagnosis of gastric and breast cancer before age 50; and diagnosis at any age with a family history of breast cancer, juvenile polyps, gastrointestinal polyposis, or cancers associated with Lynch syndrome.

Risk assessment and genetic counseling should include detailed family history, medical and surgical history, directed examination for related manifestations, psychosocial assessment and support, risk counseling, education support, discussion of genetic counseling, and informed consent.

Cowden syndrome was added to the list of hereditary syndromes of gastric cancer.

The new section for principles of surveillance suggest that after 5 years or remission, additional follow-up may be considered based on risk factors and comorbidities. Recommendations for follow-up in early-stage disease vary based on the depth of invasion and treatment modality.

The new section for principles of survivorship provides recommendations including management of long-term sequelae of disease or treatment, counseling regarding health behaviors, cancer screening recommendations for average-risk survivors, and survivorship care planning and coordination.—Zachary Bessette