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.

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.

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.

Localized or locally advanced cervical cancer is treated with a curative intent. Its management requires multidisciplinary expertise and a rigorously structured approach to optimize the probability of success. Initial workup (clinical examination, imaging, pathology) allows precise characterization of the tumour and staging according to TNM and FIGO classifications. Surgical management of early stage cancers, ranging from conization for small tumour to hysterectomy, sometimes including sentinel lymph node biopsy, is based on therapeutic algorithms that take into account stage, pathological criteria (invasion, margins, node involvement) and risk category. Postoperative treatment, when required, includes radiochemotherapy, that can be followed by brachytherapy. In locally advanced cancers, treatment consists of radiochemotherapy followed by uterovaginal brachytherapy and immunotherapy that has recently demonstrated its benefits. Since cervical cancer often develops in young women, its management raises important questions related to fertility and sometimes, to the management of cancer during pregnancy. Finally, although it is not the topic of these recommendations, it is important to highlight the major role of vaccination to avoid the vast majority of these cancers.

This consensus aims to develop a standardised guideline for human epidermal growth factor-2 (HER2) immunohistochemistry interpretation and reporting in Malaysia to support optimal therapeutic decision-making and research compatibility. An expert committee comprising pathologists and oncologists from public, private, and academic institutions convened to review existing international recommendations and taking into the consideration of local healthcare resource variations. The committee aims to harmonise reporting terminology in the reporting of HER2 testing, with emphasis on HER2-low and HER2-ultralow categories. A standardised HER2 reporting is crucial to ensure Malaysian patients benefit equitably from emerging HER2-targeted therapies. We hope this guideline could prepare the national pathology community in leading the evolving landscape of breast cancer management.

Unresectable stage III non-small cell lung cancer (NSCLC) exhibits substantial heterogeneity and complexity. The landmark LAURA and POLESTAR studies have established a standard therapeutic model involving targeted consolidation therapy with osimertinib or aumolertinib after definitive chemoradiotherapy for NSCLC patients harboring EGFR-sensitive mutations. However, treatment strategies for patients with other driver gene mutations (e.g., ALK fusions, ROS1 rearrangement) still lack robust support from high-level evidence-based medical study. To enhance the standardization of diagnosis and treatment for unresectable stage III driver-positive NSCLC patients, the Radiotherapy Committee of the Chinese Society of Clinical Oncology convened an expert working group. This group identified common clinical practice issues and conducted an in-depth, problem-oriented analysis of domestic and international guidelines alongside evidence-based medical data. Through multiple rounds of comprehensive discussion and expert voting, this consensus was jointly developed. It provides evidence-based recommendations addressing frequently encountered clinical questions regarding unresectable stage III driver-positive NSCLC, aiming to serve as a key reference for clinical practice.

Conflicting practice recommendations regarding the grading of intraductal carcinoma of the prostate (IDCP) from two leading uropathology societies, the Genitourinary Pathology Society (GUPS) and the International Society of Urological Pathology (ISUP), are confusing for both pathologists and treating clinicians. The objectives of this consultation were to clarify unresolved issues regarding IDCP and atypical intraductal proliferation (AIP) terminology, diagnostic criteria, grading, and management implications, as well as to develop uniform reporting guidelines for IDCP and AIP, endorsed by both societies. A 32-member expert panel, composed of five core members, 25 expert urological pathologists, and two expert urologists, employed a modified Delphi process consisting of multiple rounds of consultation and voting. These were supplemented by discussions at the 2025 United States and Canadian Academy of Pathologists Annual Meeting to achieve expert consensus (defined as at least 67% agreement). Consensus was reached on several key issues. IDCP was regarded most commonly as reflecting the retrograde spread of invasive prostate cancer (PCa). IDCP diagnosis should be based on the Guo and Epstein criteria, supported by basal cell immunohistochemistry in cases that are difficult to distinguish from invasive PCa. The term AIP should be used only in equivocal proliferations where IDCP is favoured but the criteria are not fully met, and these should be reported as 'AIP, suspicious for IDCP'. In the presence of invasive PCa, IDCP should generally be incorporated into Gleason grading irrespective of Grade Group (GG). However, a significant minority (30%) favoured excluding IDCP from the Gleason score if the invasive component was solely Gleason pattern (GP) 3. Pure IDCP (not associated with invasive PCa) and AIP, suspicious for IDCP, should not be graded. IDCP should not be incorporated in the grading of invasive PCa when it is spatially distinct from invasive PCa. A second opinion from a senior or dedicated GU pathologist and discussion within a multidisciplinary management setting should be considered, in the rare settings of pure IDCP or GP3 + IDCP (formerly GG1 + IDCP scenario). This joint GUPS-ISUP consultation provides unified recommendations for the diagnosis, terminology, grading, and reporting of IDCP and AIP, and will pave the way for the development of future IDCP/AIP WHO guidelines. Their adoption should reduce interobserver variation, facilitate consistent communication with clinicians, and improve patient management.

The management of large B-cell lymphomas (LBCL) has undergone major changes over the last 5 years. These changes reflect the availability of new therapies (immunotherapies, cell therapies, targeted molecules), but also a better compartmentalization of the entities and their specific clinical characteristics. Numerous first-, second- and third-line therapeutic strategies are available, and each practitioner is committed to selecting the treatment that offers the best balance between efficacy and toxicity. Advances in the understanding of LBCL biology, coupled with improvements in diagnostic and monitoring tools and therapeutic approaches, have significantly enhanced patient outcomes in recent years. In this article, we present a set of pragmatic guidelines developed by the LYSA (Lymphoma Study Association) for the management of LBCL. These guidelines address key aspects of diagnosis, staging, response evaluation, and treatment, integrating the latest evidence from clinical trials, expert consensus, and real-world practice. They aim to provide clinicians with a clear, practical framework to optimize care for patients with LBCL, ensuring that the best available evidence is translated into clinical practice.

Gastric cancer is one of the leading causes of cancer mortality in Chile. To optimize early detection and surveillance of gastric premalignant conditions, the Chilean Association of Digestive Endoscopy (ACHED), together with the Chilean Society of Gastroenterology, updated its 2014 clinical guideline. Using the AGREE II methodology, multidisciplinary working groups conducted systematic reviews in PubMed, Cochrane, and Scielo through December 2024. Recommendations were agreed upon via a Delphi panel (≥80% agreement) and graded according to GRADE, assessing evidence quality and recommendation strength. An expert panel of Chilean and international gastroenterology, endoscopy and pathology specialists reviewed the evidence and reached consensus to issue recommendations for opportunistic gastric cancer screening and surveillance using upper GI endoscopy in adults. These recommendations are feasible to implement in Chile and other Latin American countries with a high incidence of gastric cancer that have the necessary resources available. They complement any future efforts at population screening and aim to improve early detection and prognosis of gastric cancer in high-risk populations.

It has been five years since the last version of the clinical practice guidelines for the management of adult diffuse gliomas was published by the Asian Glioma Genome Atlas (AGGA). Significant progress and revisions have occurred in the diagnosis and treatment of adult diffuse gliomas in recent years. In response to these updates, the joint guideline committee of the Chinese Glioma Cooperative Group (CGCG), the Society for Neuro-Oncology of China (SNO-China), and the Chinese Brain Cancer Association (CBCA) has revised the clinical practice guidelines. This updated guideline emphasizes molecular and pathological diagnostics, as well as the primary treatment modalities of surgery, radiotherapy, chemotherapy, and targeted therapy. Additionally, we have incorporated findings from recent clinical trials of new therapies to align with cutting-edge treatment strategies. This guideline is designed to serve as a practical resource for all professionals involved in managing adult diffuse glioma patients, while also providing valuable information for insurance companies and other institutions responsible for regulating cancer care costs in China and beyond.

This guideline provides a comprehensive overview of the management of localized rectal cancer, highlighting recent major advances in therapeutic strategies. Accurate staging remains essential, as it informs treatment decisions and facilitates risk assessment. A pivotal development in rectal cancer treatment is the adoption of total neoadjuvant therapy (TNT), which has demonstrated improved tumor response, reduced risk of systemic recurrence, and enhanced survival outcomes. This approach enables a "watch-and-wait" strategy and conservative management that may render surgery unnecessary and preserves rectal function in patients who achieve a complete clinical response. By emphasizing a structured approach to staging, multidisciplinary evaluation, and innovative treatment pathways, this guideline aims to improve outcomes while minimizing the morbidity associated with rectal cancer treatment.

Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. As a result of the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages. In recent years, locoregional and systemic therapies have increasingly been directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates, have also improved outcomes in some patient subgroups. This clinical practice guideline for early-stage breast cancer (updated in 2025) is based on a systematic review of relevant studies and on the consensus of experts from the Spanish Breast Cancer Research Group (GEICAM), Spanish Collaborative Group for the Study, Treatment and Other Experimental Strategies in Solid Tumors (SOLTI), and Spanish Society of Medical Oncology (SEOM).

Gliomas are the most frequent malignant primary brain tumours in adults. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, Karnofsky performance status) and tumour characteristics (histology, molecular biology, tumour location), and strongly depends on available and associated treatments, such as surgery, radiotherapy, and chemotherapy. The knowledge of molecular biomarkers is currently essential; they are increasingly evolving as additional factors that facilitate diagnostics and therapeutic decision-making. We present the update of the recommendations of the Société française de radiothérapie oncologique (the French Society for Radiation Oncology) on the indications and the technical procedures for performing radiotherapy in patients with gliomas.

Neuroendocrine neoplasms (NENs) of the gastroenteropancreatic (GEP) tract represent a rare and heterogeneous group of malignancies. They are distinguished into well-differentiated and poorly differentiated neoplasms, with clinical behavior ranging from relatively indolent to fast-growing, respectively. Surgery is the curative option for localized disease, especially in well-differentiated neoplasms, while various systemic therapies are approved and clinically available for advanced disease. However, considering the complexity of these malignancies, the choice of therapeutic strategy must take into account multiple factors, such as histological diagnosis, primary site, extent of disease, evolution features, functional status, patients and treatment characteristics, treatment availability, and safety profile. A multidisciplinary approach dedicated to NENs and conducted by experienced teams is therefore strongly recommended. Since 2013, the Italian Association of Medical Oncology (AIOM), in collaboration with the Italian Association for Neuroendocrine Tumors (ITANET), has produced guidelines using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach for assessing the certainty of evidence. This updated version (2024) summarized the main diagnostic and therapeutic decision-making processes on specific topics selected by a panel of experts from the AIOM, ITANET, and other national scientific societies with the aim of guiding clinicians in the diagnosis, treatment, and monitoring of patients with GEP-NENs. The integration of these guidelines into daily clinical practice is expected to improve patient care and drive the evolving landscape of GEP-NEN management.

This article presents an update of the French national guidelines for the management of penile cancer, with recommendations on dose and volume for radiotherapy and brachytherapy. Multidisciplinary management and centralization in high-level of expertise centres is key for the management of this rare malignancy. For patients at high-risk of having micrometastatic disease (stage T1b or higher), a dynamic sentinel node biopsy should be offered as surgical staging and human papillomavirus status should be obtained. Organ-preservation with brachytherapy should be discussed whenever it is possible (tumours limited to the glans). For locoregionally advanced diseases, chemoradiotherapy as primary treatment could be discussed.

Advanced breast cancer represents a challenge for patients and physicians due to its dynamic genomic changes, which are associated with resistance to treatments. The main goals of treatment in advanced breast cancer are to improve patient quality of life and to increase patient survival. This is achieved using the most appropriate sequence of treatments based on knowledge of the natural history of the disease. In these guidelines (updated in 2025), we summarize current evidence and available therapies for the medical management of advanced breast cancer.