The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vaginal Cancer outline the recommended diagnostic workup, staging considerations, and treatment options for this rare malignancy. Because vaginal cancer is uncommon and shares many biologic and clinical characteristics with cervical cancer, several management recommendations, particularly systemic therapy, are extrapolated from evidence and practices established for cervical cancer. This guideline excerpt summarizes key components of management, including diagnostic evaluation and workup, principles of staging, pathology considerations, radiation therapy principles, and primary treatment recommendations for both early-stage and advanced disease. It also details approaches to manage relapses, including locoregional recurrence and distant metastases, and provides an in-depth overview of systemic therapy recommendations for vaginal cancer.

Neuroblastoma is the most common extracranial solid tumor in early childhood. Its clinical behavior is highly variable, ranging from spontaneous regression to fatal outcome despite intensive treatment. The International Society of Pediatric Oncology Europe Neuroblastoma Group (SIOPEN) Radiology and Nuclear Medicine Specialty Committees developed consensus-based imaging recommendations for high-risk neuroblastoma at first presentation and throughout follow-up. These expert opinions aim to improve reproducibility and enhance diagnostic performance in order to advance the current standard of care and assist in the development of future trials.

Esophageal cancer incidence is rising globally, with at least 500,000 new cases diagnosed annually. Management options for non-metastatic disease include primary resection, neoadjuvant or perioperative therapies, or definitive non-surgical treatment, with the choice being guided by tumor staging, histology, patient fitness, and available resources. However, even with the use of advanced diagnostic modalities, preoperative clinical staging is challenging with respect to accuracy of both tumor and nodal assessment. Early-stage esophageal cancer may be managed with local therapies, such as endoscopic mucosal resection or submucosal dissection, while for more advanced tumors managed with curative intent neoadjuvant oncologic therapy is commonly recommended. However, between these two groups lies an infrequent but important subgroup of patients, clinically staged cT2N0M0 esophageal cancer. Guidelines such as the NIH's National Cancer Institute recommends either surgery alone or neoadjuvant therapy followed by surgery for AJCC Stage I cancers, and add the option of definitive chemoradiation for Stage II disease. With cT2N0 disease straddling both AJCC classifications, management guidance is lacking. This guideline will provide an evidence-based recommendation from the International Society For Disease Of The Esophagus on the management of cT2N0 esophageal cancer, of all types. The recommendations are intended to support surgeons, oncologists, and patients in decisions about the best practice preoperative oncologic management of cT2N0M0 esophageal cancer. A Working Group within the International Society for Diseases of the Esophagus (ISDE) Guidelines Committee performed a systematic review of the literature. Results of the systematic review were presented to a panel of experts and these results informed the panel discussion about the guideline. This panel used Grading of Recommendations Assessment, Development, and Evaluation approach to deliberate and formulate recommendations. The panel agreed on a conditional recommendation for the use of neoadjuvant therapy followed by surgery over primary surgical resection (PSR) for adult patients with cT2N0M0 esophageal cancer. Preoperative clinical staging of esophageal cancer is uncertain, with deficiencies in all diagnostic modalities. However, when all modern staging techniques are utilized, the ISDE recommends neoadjuvant therapy followed by surgical resection as the favored treatment of cT2N0 esophageal cancer. Certain patient groups may still be offered PSR, particularly those unable to tolerate neoadjuvant therapies, or those patients with very low risk of lymph node metastasis as suggested by histological features, small tumor size, and other features.

Early detection of oral potentially malignant disorders and oral cavity cancer can improve patient prognosis. The guideline panel addressed the use of cytology adjuncts to screen adults without mucosal abnormalities and determine the need for biopsy among adults with mucosal abnormalities.

The present REFCOR guidelines define indications for radiotherapy in sinonasal carcinoma and mucosal melanoma.

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer with a high risk of regional lymph-node metastasis. Accurate pathological evaluation of sentinel lymph nodes (SLN) is therefore critical for staging and clinical management, yet current practices remain heterogeneous across centres. An expert panel within the European Organisation for Research and Treatment of Cancer (EORTC) reviewed available evidence and contemporary practice to develop updated consensus guidance for the pathological assessment of SLN in MCC. The recommendations address specimen handling, lymph-node sectioning strategies, tumour-burden definitions, standardized reporting elements, and a pragmatic approach to ancillary immunohistochemistry (IHC). The proposed protocol provides clear guidance on SLN processing and sectioning to optimize the detection of micrometastatic disease, together with an algorithmic IHC framework that prioritizes sensitive screening markers followed by confirmatory stains to ensure reliable identification of occult nodal involvement. Emphasis is placed on consistent documentation of tumour burden and pN classification to support reproducible reporting and informed clinical decision-making.

The first guidelines of the French Expertise Network on Rare ENT Cancers (REFCOR) on the management of nasal cavity and sinus cancer date back to 2009. The objective of the present study was to update these guidelines using a search of the literature between 2009 and 2020.

This Clinical Practice Update (CPU) expert review will advise clinicians on the diagnosis and management of gastric mucosal polyps. Gastric polyps are raised epithelial lesions of the gastric mucosa that can arise from various mucosal alterations and perturbations, including mucosal hyperplasia, adenoma, fundic gland proliferation, and enterochromaffin-like cell proliferation. Current guidance on the management of gastric polyps remains limited. This CPU provides a framework for understanding the natural history and epidemiology of gastric polyps and advises on best practices for the endoscopic detection and classification of gastric polyps, the endoscopic resection of gastric polyps, and endoscopic surveillance following resection. Because gastric polyps often occur within a field of altered gastric mucosa (eg, mucosal atrophy, pseudo-pyloric and intestinal metaplasia), we will advise on best practices for the sampling and surveillance of mucosal pathology giving rise to gastric polyps. This CPU is intended to complement other documents issued by the American Gastroenterological Association (AGA) Institute on gastric neoplastic and pre-neoplastic lesions, including the clinical practice guidelines on management of gastric intestinal metaplasia, as well as AGA CPUs on atrophic gastritis, high-quality upper endoscopy, and screening and surveillance of individuals at increased risk for gastric cancer.

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by the accumulation of protein fibrils with an abnormal 3D configuration in the myocardium. The introduction of targeted therapies for the two most common forms, light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), has made prompt recognition and accurate typing of the amyloid protein indispensable. Although in some ATTR cases a diagnosis can be reached with noninvasive imaging methods, diagnostic confirmation by peripheral or endomyocardial biopsy remains fundamental for many patients with ATTR and for all those with AL or rarer CA variants. The available typing complementary techniques are immunohistochemistry, immunofluorescence, immune electron microscopy, and mass spectrometry, each with specific strengths and limitations. This review describes the current indications for tissue analysis and compares the options for amyloid typing, with the aim of providing guidance relevant to clinical practice.

Precision oncology relies on precision diagnostics, and histopathological diagnosis, along with biomarker evaluation, currently represents the cornerstone for personalized treatment. In gastrointestinal neoplasms, diagnostic assessment and molecular profiling are often performed on biopsy tissue, which may be quantitatively/qualitatively limited. Therefore, appropriate sample management is essential to avoid unnecessary waste and to obtain all the information necessary for treatment planning. Several factors may significantly impact biomarker testing: (i) pre-analytical issues; (ii) heterogeneity in biomarker expression; (iii) lack of standardization in biomarker testing and evaluation. Moreover, in the metastatic setting, inadequate/incomplete clinical information can lead to inappropriate sample handling, with negative implications. The application of appropriate guidelines in testing and reporting biomarker status according to clinical context is, therefore, strongly encouraged. In this position paper, the Italian Group of Gastrointestinal Pathologists (GIPAD), a section of the Italian Society of Pathological Anatomy and Cytology (SIAPeC-IAP), aims to summarize all the clinical and pathological requirements for adequate assessment of prognostic and predictive biomarkers in the gastrointestinal oncology patient, from biopsy acquisition to diagnostic reporting.

Nasopharyngeal carcinoma is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy is the cornerstone of locoregional treatment of non-disseminated disease and, in combination with chemotherapy, improves survival rates. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy, and patients may achieve a long survival time. In these guidelines (updated in 2025), we summarize current evidence and available therapies for the medical management of advanced nasopharyngeal carcinoma.

Focal therapy (FT) represents a promising strategy for the management of localized prostate cancer (PCa). However, due to limited long-term evidence and the heterogeneity of prostate cancer, its use must be carefully considered, and patient selection must be stringent. A panel of urologists with expertise in PCa and FT was selected by the Italian Society of Urology (SIU - Società Italiana di Urologia) and proposed criteria to consider in FT for PCa, with the aim of supporting its use in clinical practice. The ideal candidate for FT is a patient with a unilateral, localized, multiparametric MRI-visible lesion, harboring intermediate-risk PCa (ISUP Grade Group 2) and a life expectancy greater than 10 years. The different energy sources used in FT (cryotherapy, high-intensity focused ultrasound, irreversible electroporation, and transperineal laser ablation) offer comparable oncological and functional outcomes. The choice of energy modality primarily depends on tumor location, physician expertise, and local availability of the technology. Different FT failure definitions exist. Standard follow-up should always include PSA monitoring and mpMRI. Follow-up biopsy should not be routinely performed in every patient except for centers starting a FT program. Per protocol biopsy should be considered depending on the risk of PCa treated with FT. The SIU position paper on FT aims to guide its use in clinical practice by providing recommendations to select, treat and follow-up patients.

Paediatric low-grade gliomas (pLGG) are the most common brain tumours in children. Radiotherapy, once the standard treatment for unresectable pLGG, is now used less frequently due to concerns about late side effects. The Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group aims to provide consensus guidelines on the use of radiotherapy for pLGG, addressing the current controversies and facilitating decision-making. Patient/material and methods: The guidelines were developed by clinical/radiation oncologists from the Nordic and Baltic countries and two international experts during a 2-day working group meeting. The meeting included presentations from the international experts and was preceded by a survey on radiotherapy practices and a non-systematic review of the literature on pLGG.

The treatment landscape for soft tissue sarcomas (STS) is evolving constantly. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for STS specific to surgical management and systemic therapy recommendations for various subtypes.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer provide recommendations for diagnostic workup, staging, and treatment. These NCCN Guidelines Insights highlight recent updates, with a particular focus on changes to systemic therapies and radiation treatment in the NCCN Guidelines for Small Cell Lung Cancer.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cervical Cancer provide diagnostic workup, staging, and various treatment recommendations for cervical cancer based on clinical and surgical staging. This selection from the NCCN Guidelines for cervical cancer specifically focuses on diagnosis and workup, principles of staging and surgery, and primary treatment recommendations for early-stage and advanced disease and provides a detailed overview of systemic therapy recommendations for cervical cancer.

Anal cancer is rare but increasingly common, currently accounting for 2% of all digestive neoplasms. Some 50% of anal cancers are diagnosed at the localized stage, 29% as locoregional disease, and 12% as metastatic disease. When clinical suspicion of anal cancer exists, histological confirmation, correct local staging with MRI and distant staging with thoraco-abdominal CT, and management by a multidisciplinary team are mandatory. Chemoradiotherapy with 5-FU and mitomycin C (MMC) is the standard of care for early and locally advanced disease, while combination chemotherapy with a platinum-containing compound and taxanes is the treatment of choice for metastatic disease.

Well-differentiated rectal neuroendocrine tumors (rNETs) are among the most common NETs and account for approximately 12-27% of all gastrointestinal NETs in North America. Significant discrepancies persist in the management of NETs regarding surveillance strategies, staging modalities, high-risk features, and criteria for surgical intervention. This guideline updates current practices of stage I-III rectal NETs with the utilization of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and Delphi method of consensus among leading experts in the North American region. We found that several technological advances, such as 68Ga- or 64Cu-DOTATATE SSTR PET/CT, and broad adoption of pelvic MRI have improved staging of rNETs, along with modified endoscopic mucosal and submucosal resection and full-thickness excision techniques that demonstrate efficacy and safety for resection. Pivotal long-term outcome studies provide insight into i) risk factors for regional lymph node metastasis, ii) the impact of R1 excision (endoscopic), iii) best practices for intermediate-sized rNETs (11-20 mm), and iv) risk in small rNETs (≤10 mm). Recommendations were developed upon evidence-based conclusions from the GRADE review to define the role of baseline staging with MRI, advanced endoscopy, and transanal endoscopic surgical methods appropriate for T1 rNETs, the role of salvage therapy in cases of R1 resection, and the consideration of pathologic variables to direct definitive treatment and surveillance. We conclude that advances in screening programs and imaging allow for improved detection and staging of rNETs, while long-term outcome studies can better direct patients toward evidence-based treatment management and rectal organ preservation through less radical resection methods.

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in theASCO Guidelines Methodology Manual. ASCO Living Guidelines follow theASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2). Updates are published regularly and can be found atwww.asco.org/genitourinary-cancer-guidelines.

Most primary retroperitoneal soft tissue tumors are malignant, with liposarcomas and leiomyosarcomas being the most common. However, other sarcomas and benign tumors can also occur in this location. Pathologic evaluation of retroperitoneal sarcomas (RPS) presents unique challenges. Sarcomas are a heterogeneous group with overlapping microscopic features, making accurate classification essential for prognosis and evolving targeted therapies. Core biopsies often capture only a small portion of the tumor, which may result in underestimation of key features such as differentiation, necrosis, and proliferation, leading to undergrading. Surgical management is complicated by the RPS's tendency to involve adjacent organs. Resections are often large and en bloc, and formalin fixation can obscure anatomic landmarks, making it difficult to identify and assess true surgical margins. In addition to the standard data elements required for cancer staging, specific pathologic features of RPS should be reported to aid in prognosis and treatment planning. This position paper/consensus statement was developed by members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) based on evidence and expert opinion. A detailed description of specimen handling, specimen sampling, and the inclusion of the key diagnostic elements required for an accurate pathology report are provided. The aim of this manuscript is to offer a comprehensive critical reappraisal of the role of pathologic evaluation of surgical specimens in RPS surgery, as well as to propose a standard pathology report to harmonize reporting and facilitate future data collection and interpretation for future research development.