The treatment landscape of invasive early-stage and metastatic breast cancer is evolving constantly. These NCCN Guidelines Insights focus on recent updates included in the most recent version (version 5.2025) of the NCCN Guidelines for Breast Cancer specific to workup, locoregional therapy, surveillance, and systemic neoadjuvant/adjuvant therapy recommendations for invasive, nonmetastatic breast cancer.

The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions for patients with prostate cancer across the disease spectrum. The Guidelines sections included in this article focus on metastatic castration-sensitive prostate cancer (mCSPC), nonmetastatic castration-resistant prostate cancer (CRPC), and metastatic CRPC (mCRPC). For patients with mCSPC, disease characteristics, such as whether metastases arose synchronously or metachronously and the degree of metastatic burden, impact therapy decisions, including how much treatment intensification is appropriate and when prostate-directed and/or metastasis-directed therapy should be considered. In the mCRPC setting, androgen deprivation therapy is continued with the sequential or concurrent addition of certain androgen receptor pathway inhibitors, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies. The NCCN Prostate Cancer Panel emphasizes a shared decision-making approach in all disease settings based on patient preferences, prior treatment exposures, biomarkers, the extent and location of metastases, symptoms, and potential side effects.

Liver cancer is the sixth most common cancer worldwide, with 905,677 new cases in 2020, and the third leading cause of cancer-related deaths globally. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and accounts for approximately 75% to 85% of cases. Ultimately, the management of HCC encompasses multiple disciplines including hepatologists, diagnostic radiologists, pathologists, transplant surgeons, surgical oncologists, radiation oncologists, and more. The development of a multidisciplinary clinic with dedicated tumor board review has been shown to increase survival in these patients with HCC. This document aims to guide the imaging of HCC, including screening, staging, active surveillance during liver-directed therapy, and in the setting of previously treated HCC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Ovarian cancer remains the sixth most common cause of cancer mortality in women in the United States and is a leading cause of mortality among patients with gynecologic malignancies. Imaging plays an important role in pretreatment staging of epithelial ovarian cancers, the evaluation of posttreatment response, and follow-up. Accurate pretreatment imaging is integral to determine appropriate first-line therapy. By delineating the extent of disease, imaging can assist decision making regarding the likelihood of optimal primary cytoreduction or need for neoadjuvant chemotherapy when optimal cytoreduction is not felt to be achievable. Contrast-enhanced CT serves as a mainstay modality for the pretreatment assessment of ovarian cancer, with MRI, PET/CT, and, in some instances, PET/MRI used in the pretreatment setting. CT and PET/CT are also integral to assessing response, including in the suspected recurrence setting, with MRI and PET/MRI being used in select cases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Imaging associated with staging and follow-up of leukemia can play an important role in accurately assessing disease; however, the type of imaging and usefulness varies significantly by the subtype of leukemia. This document reviews the current literature regarding the impact of imaging for both staging and surveillance of several of the most common leukemic variants. These include acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, Richter transformation, and chronic myeloid leukemia. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

In rectal cancer, because of the need for high-resolution anatomic detail in determining local tumor extension, imaging for local staging and restaging of the primary tumor in the pelvis is considered separately from the evaluation of distant metastatic disease in the chest, abdomen, and pelvis, often resulting in the need for a combination of modalities to fully stage the patient. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

The role of imaging in initial staging of colon cancer, and in posttreatment restaging or surveillance, is most beneficial in identifying distant metastases in the chest, abdomen, and pelvis, regardless of primary T or N stage. Appendiceal cancers are classified separately and managed differently than colon cancer; however, initial staging and postoperative surveillance is also primarily focused on detection of distant metastatic disease, usually in the abdomen and pelvis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Pancreatic ductal adenocarcinoma is a highly lethal cancer that often presents with vague and indolent symptoms leading to advanced stage diagnosis. Imaging plays a crucial role in the diagnosis, assessment of locoregional and metastatic disease, surgical planning, and surveillance after neoadjuvant therapy and surgery. This document reviews available imaging modalities that are best used for these clinical scenarios, and a summary of current evidence is provided to support the use of the various modalities in each of the clinical contexts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Background: Developed by members of the American Thyroid Association (ATA) Clinical Affairs Committee, this executive summary of the 2025 ATA guidelines for adult patients with differentiated thyroid cancer provides a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines. Summary: The updated guidelines emphasize individualized care through the DATA framework (Diagnosis, risk/benefit Assessment, Treatment decisions, and response Assessment) with the goal of enhancing shared decision-making and personalized care. Highlights include expanded role of molecular diagnostics, refined risk stratification, greater emphasis on active surveillance and lobectomy, inclusion of ablative procedures, and selective use of external beam radiation therapy and chemoradiotherapy. De-escalation of surveillance for low-risk patients and introduction of the concept of complete remission are also new. Conclusions: This executive summary aims to provide a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines.

Breast cancer is one of the most common malignancies among women in China. According to GLOBOCAN 2022, more than 350,000 new breast cancer cases were diagnosed in China, ranking second among all newly diagnosed cancers in women. Although breast cancer has entered an era of chronic disease management and overall survival has improved substantially, the prognosis of metastatic breast cancer (MBC) remains unsatisfactory. The genome of MBC is characterized by spatiotemporal heterogeneity and may undergo dynamic evolution. With the continuous identification of actionable alterations, targeted therapies guided by genomic testing have emerged as an important approach to improving patient outcomes. Therefore, the implementation of standardized genomic testing in clinical practice has become an urgent priority. While several international and domestic guidelines have recommended genomic testing for MBC, China still lacks detailed technical specifications and clinical pathways tailored to advanced disease in the local healthcare context. Accordingly, it is imperative to establish a guideline for genomic testing in advanced breast cancer that reflects national realities, ensures strong clinical operability, unifies testing standards, and optimizes workflows, thereby expanding access to precision therapy and improving patient prognosis. Against this background, the Breast Cancer Committee of the Chinese Anti-Cancer Association convened a multidisciplinary working group experts. Following predefined methodological procedures-including clinical question prioritization, systematic evidence retrieval, graded evaluation, and formulation of recommendations-the guideline was developed. It integrates the latest evidence with multidisciplinary expert consensus, providing specific recommendations on key aspects of genomic testing for MBC, including patient eligibility, specimen selection, testing methodologies, and prioritization of target genes. In addition, the guideline systematically summarizes available targeted therapeutic strategies for different genomic alterations, and provides graded recommendations based on both levels of evidence and drug accessibility, thereby ensuring clarity and facilitating clinical implementation. This guideline is closely aligned with the realities of clinical practice and drug accessibility in China, with a strong emphasis on the feasibility of testing and the actionability of results. It establishes a multidisciplinary consensus on standardized pathways for genomic testing in patients with MBC, aiming to bridge precision diagnostics and individualized targeted therapy, and to provide practical guidance for improving the standardization of advanced breast cancer care nationwide.

Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological subtype of non-Hodgkin lymphoma and the paradigm for the management of aggressive lymphoma. An excisional or incisional lymph node biopsy evaluated by an experienced hematopathologist is recommended to establish the diagnosis. Twenty years following its introduction, the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) remains the standard first-line treatment. No modification of this scheme (increased chemotherapy dose intensity, new monoclonal antibodies, or the addition of immunomodulators or anti-target agents) has significantly improved the clinical outcomes, whereas therapy for recurrence or progression is evolving rapidly. The introduction of chimeric antigen receptor T cells, polatuzumab vedotin, tafasitamab, and cluster of differentiation (CD)20/CD3 bispecific antibodies is changing the natural history of patients with relapsed DLBCL and will challenge R-CHOP as the benchmark for newly diagnosed patients. These updated guidelines (2025) summarize current evidence and available therapies for the medical management of DLBCL.

Barrett's esophagus (BE) is the only identifiable precursor to esophageal adenocarcinoma (EAC). Endoscopic surveillance has been proposed for early detection of BE-related neoplasia and reducing EAC mortality. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for surveillance in patients with BE.

RAD51C, RAD51D, and BRIP1 germline pathogenic variants (GPVs) are associated with increased lifetime risks of tubo-ovarian cancer. Resources for managing RAD51C, RAD51D, and BRIP1 heterozygotes in clinical practice are limited.

Merkel cell carcinoma (MCC) is a highly malignant skin cancer characterized by high rates of recurrence and metastasis. Although rare, the incidence has noticeably increased in recent years. It is also known to be a highly immunogenic tumor, and the use of immune checkpoint inhibitors has begun for advanced cases. However, there had been no guidelines for this disease in Japan. Commissioned by the Japanese Dermatological Association (JDA), this revision was undertaken by a committee comprising experts across relevant fields, who meticulously reviewed and systematized a wide range of literature on MCC to create comprehensive, evidence-based guidelines. Literature searches were conducted by the Japan Medical Library Association. The recommendation statements were determined using the GRADE Grid approach. The guidelines were developed in accordance with the "Minds Clinical Practice Guideline Creation Manual 2020 ver.3.0." Four clinical questions (CQs) were established, and corresponding recommendation statements were provided for each. CQ1 concerns primary tumor resection margins, CQ2 concerns sentinel lymph node biopsy, CQ3 concerns postoperative radiotherapy, and CQ4 concerns chemotherapy for advanced disease. These guidelines are the first of their kind in Japan for MCC, and we hope that they will be useful not only in Japan but also in East Asia, where treatment decisions have previously had to be made based on Western guidelines.

Pathological response is a surrogate marker of efficacy of neoadjuvant therapy in various tumour types, but there is no consensus on reporting pathological response for renal cell carcinoma. We aimed to assess the status of pathological response reporting in renal cell carcinoma and develop a recommendation on tissue preparation and response reporting for neoadjuvant treatment. We conducted a systematic review of publications on the PubMed and Web of Science databases to identify manuscripts reporting response to pre-surgical therapy in renal cell carcinoma. 119 eligible papers were identified. Only five (4%) studies included details of how pathological response had been assessed. Qualitative statements on residual tumour were common (55 [46%] studies), but only eight (7%) studies used a quantitative assessment of pathological response. Guidelines for tissue preparation and pathological response reporting were reviewed at an international workshop held at the Netherlands Cancer Institute in October, 2024, and further developed through expert discussions. To assess neoadjuvant pathological response, nephrectomy specimens should be sampled with the use of a standardised baseline approach with consideration for more extensive sampling. Microscopic assessment should quantify the residual viable tumour in 10% intervals and greatest linear extent. Clinical details, including the neoadjuvant therapy received, should accompany the pathological assessment. In this systematic review, we describe a standardised method for assessment and reporting pathological response, initially intended for use in clinical trials or research settings. These guidelines will help investigators to assess whether the degree of pathological response is linked to survival outcomes and will inform future standard reporting practices.

Lung cancer remains a predominant cause of cancer-related deaths worldwide, and there are notable geographic and institutional differences in both diagnostic and staging approaches. To address this, the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary committee to craft evidence-based and evidence-informed recommendations for diagnosing peripheral pulmonary nodules and performing convex probe endobronchial ultrasound (CP-EBUS)-guided mediastinal staging.

Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine skin cancer with the highest mortality rate among skin cancers. Approximately 40 new cases are reported annually in Scotland, with a rising incidence. A significant proportion of these cases result in loco-regional recurrence and patient mortality. Historically, few phase 3 randomised controlled trials have been conducted for MCC, and the existing international guidelines are outdated and lack information on the recent advancements in immunotherapy, surgical margins, sentinel lymph node biopsy and post-operative radiotherapy. The 2024 joint guidelines by ESMO-EURA provide comprehensive best practice recommendations; however, there is no UK-specific guideline for the National Health Service (NHS). To address this gap, the Scottish Consensus Clinical Management Guidelines were developed by a multidisciplinary team of experts, including oncologists, surgeons, radiologists, nurse specialists, pathologists, dermatologists and Mohs surgeons from various NHS Scotland health boards. Initial meetings were held in December 2023, followed by further discussions in 2024, including the Scottish Clinical Imaging Network to ratify the use of PET-CT scans for initial imaging. The final draft of the guidelines was approved at the Scottish skin cancer meeting in March 2025 and is accessible within NHS Scotland through local cancer networks. These guidelines recommend initiating MCC treatment within 8 weeks from diagnosis to improve patient outcomes, representing the first UK-based guideline for MCC. The development process and final guideline, aligned with the RIGHT checklist, aimed at enhancing the multidisciplinary management of MCC in the NHS.

Over the years since the 4th Breast Cancer Consensus Conference, a substantial body of new evidence based on clinical trial results has been published, necessitating an update of the 2020 recommendations. This professional guideline primarily reflects the current ESMO, NCCN, ABC, and St. Gallen Consensus Conference statements and recommendations. From a didactic perspective, the text first addresses early-stage breast cancer, followed by locally advanced, locoregionally recurrent, and metastatic breast cancer. At the beginning of both the early-stage and metastatic breast cancer sections, we provide a summary of general principles relevant to the respective field, which apply to the subsequent subsections. Within these subsections, therapeutic options are discussed according to genomic subgroups. At the end of the recommendations, considerations for the management of certain rare clinical scenarios are summarized. The appendices cover, among other topics, multidisciplinary team (tumor board) requirements, recommended chemotherapy protocols, and the definition of menopause.

Endometrial cancer (EC) is the most common gynecological malignancy in developed countries. Although most cases are diagnosed at an early stage, prognosis in case of relapse or metastasis remains poor. Molecular characterization of EC is highly recommended as it allows more accurate risk stratification and may modify treatment recommendations. The updated FIGO 2023 staging of EC highlights the importance of traditional clinicopathological factors, while underlining the need for molecular classification to predict outcomes. In early-stage EC, standard treatment consists of total hysterectomy and bilateral salpingo-oophorectomy. Lymph node evaluation remains controversial, as the benefits of systematic lymphadenectomy are unclear. Adjuvant treatment, consisting of radiotherapy, brachytherapy, and chemotherapy, should be chosen according to risk category. In women with advanced or recurrent EC, the combination of carboplatin and paclitaxel has long been standard treatment. However, therapeutic options have changed recently due to advances in immunotherapy. The aim of this guideline is to summarize the current evidence for the diagnosis, treatment, and follow-up of EC, and to provide evidence-based recommendations for clinical practice.