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Mindy E. Goldman

Traditionally, the physical, psychological, and psychosocial long-term needs of cancer survivors have received little attention compared with screening for cancer recurrence and secondary cancers. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Survivorship offer recommendations for various survivorship concerns, and those for improving menopausal symptoms were presented at the NCCN 22nd Annual Conference. Key considerations in managing menopausal symptoms in cancer survivors were reviewed, with chemotherapy-induced amenorrhea, fertility concerns, and both hormonal and nonhormonal therapeutic options featured.

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Rodger J. Winn

Although it is certainly true that each step in any NCCN algorithm must receive due consideration, sometimes it is the most obvious things that need restating, lest the eye skip over something that might, on superficial reading, appear perfunctory. A case in point is the carefully worded Genetics/Familial High Risk Assessment Clinical Practice Guideline. In keeping with the formula for NCCN supportive care guidelines, the algorithm proposes screening as the first step, followed by a detailed risk assessment if the screening result is positive. What must not be glossed over, however, is the important recommendation joining these clinical decision nodes: “Referral to cancer genetics professional recommended.” The geneticist is the health care professional who can perform the sophisticated pedigree analysis that determines whether genetic screening is warranted. If the patient decides to undergo testing, the geneticist's role becomes even more involved, with a mandate to “provide counseling, including psychosocial support and assessment, risk counseling, education, and discussion of genetic testing, and obtain informed consent.” This mandate is a far cry from a well-meaning but inadequately trained oncologist taking a cursory family history and ordering a blood test, the results of which might be delivered by a member of the office staff. Special attention should be given to the components of a meaningful informed consent. The American Society for Clinical Oncology Special Article on Genetic Testing for Cancer Susceptibility1 details 12 basic elements needed for truly informed consent for cancer susceptibility testing: information on the specific test; implications of a positive...
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Natalie B. Jones, Manisha H. Shah and Mark Bloomston

Neuroendocrine tumors (NETs) are increasing in incidence. Incidental NETs that may have little clinical significance, such as gastric and rectal primaries, are often identified because of increased screening efforts and advanced imaging modalities. Although NETs are biologically indolent cancers, many patients present with incurable metastatic disease to the liver at initial diagnosis. Some literature suggests a delay averaging almost 5 years in making the correct diagnosis based on clinical symptoms. Although surgical resection offers the only potentially curative therapy, liver-directed therapies, such as embolization and ablation, offer effective alternatives to control symptoms and potentially impact overall survival. This article reviews the latest liver-directed approaches to the management of advanced NETs.

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Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States, and in 2002, an estimated 107,300 new cases of colon cancer will have occurred. Despite these statistics, mortality from colon cancer has decreased over the past 30 years, possibly because of earlier diagnosis through screening and better treatment modalities. The NCCN clinical practice guidelines for managing colon cancer discuss these advances and provide a comprehensive management algorithm.

For the most recent version of the guidelines, please visit NCCN.org

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Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States, and in 2005, an estimated 104,950 new cases of colon cancer will occur. Despite these statistics, mortality from colon cancer has decreased over the past 30 years, possibly because of earlier diagnosis through screening and better treatment modalities. The NCCN guidelines summarize the management of colon cancer, from disease presentation through management of recurrent disease and patient surveillance.

For the most recent version of the guidelines, please visit NCCN.org

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Bernardo H. L. Goulart and Scott D. Ramsey

The Authors' Reply: We appreciate the insightful comments from Dr. Detterbeck and colleagues, which certainly enrich a timely discussion about the economic implications of lung cancer screening with low-dose computed tomography (LDCT). 1 To

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Frank Detterbeck, Lynn Tanoue and Amanda Reid

To the Editor: In the February 2012 issue of JNCCN , Goulart et al 1 performed a careful cost-effectiveness analysis of low-dose computed tomography (LDCT) screening for lung cancer. They relied predominantly on data from the National Lung

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Prostate cancer is the most commonly diagnosed cancer in American men and the second leading cause of cancer deaths. In 2004, nearly 20 million men in the United States will be confronted with important decisions regarding early detection for prostate cancer. In brief, the dilemma is that because not all men with prostate cancer die of the disease, treatment is not necessary for some patients. However, an estimated 29,900 patients will die of prostate cancer in 2004. Therefore, differentiating between patients whose cancer is clinically insignificant and those whose disease will progress is a challenge. The NCCN Prostate Cancer Early Detection Clinical Practice Guidelines in Oncology provide a set of sequential recommendations detailing a screening and subsequent work-up strategy for maximizing the detection of prostate cancer in an organ-confined state while attempting to minimize unnecessary procedures.

For the most recent version of the guidelines, please visit NCCN.org

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By 2030, researchers estimate that 20% of the U.S. population will be 65 years or older. More than 50% of all new cancers in the United States occur in this patient population. In addition, the increased incidence and prevalence of cancer in older patients and the increased lifespan of older adults mean that cancer in older individuals is becoming an increasingly common problem. Specific issues include geriatric screening and assessment, preventing or decreasing complications from therapy, accounting for disease-specific issues, and managing patients who cannot tolerate standard treatment. The NCCN Senior Adult Oncology Panel has developed guidelines for addressing these issues and for assessing the risks and benefits of treatment in older patients with cancer.

For the most recent version of the guidelines, please visit NCCN.org

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Lung cancer is still the leading cause of cancer death worldwide, and non-small cell lung cancer accounts for 80% to 85% of all lung cancer cases. Surgery, radiation therapy, and chemotherapy are the 3 modalities commonly used to treat patients with NSCLC and can be used either alone or in combination depending on the disease status. The 2006 NCCN Non-Small Cell Lung Cancer Guidelines provide the latest updates in the management of this disease, including stage regrouping and changes in screening recommendations for high-risk patients and in treatment recommendations for several stages. In addition, principles of systemic therapy were expanded to include adjuvant treatment.

For the most recent version of the guidelines, please visit NCCN.org