What are the guideline sources, guidelines and references for Appendiceal neoplasm ?
Guideline sources The following summarized guidelines for the evaluation and management of appendiceal neoplasm are prepared by our editorial team based on guidelines from the National Comprehensive Cancer Network (NCCN 2021) and the American Society of Colon and Rectal Surgeons (ASCRS 2019). 1 2 Calculator Calculator TNM classification for appendic TNM classification for appendic Guidelines 1. Diagnostic investigations Clinical examination: elicit a complete history and perform physical examination in patients with appendiceal neoplasms. B Diagnostic imaging: https://web.pathway.md/diseases/recIrRYbWtlfkgXmh 1/4 6/23/23, 2:40 AM Appendiceal neoplasm Pathway g g g As per NCCN 2021 guidelines, obtain abdominal/pelvic multiphase CT or MRI in patients with appendiceal appendiceal NETs > 2 cm or incomplete resection or positive nodes/margins. B Show 2 more As per ASCRS 2019 guidelines: Do not obtain NET-specific imaging in all patients with appendiceal NETs. D Obtain cross-sectional imaging with CT or MRI at diagnosis of appendiceal epithelial neoplasms and routinely after resection. B Laboratory tests: As per NCCN 2021 guidelines, obtain biochemical testing as clinically indicated in patients with locoregionally advanced or metastatic appendiceal NETs. B As per ASCRS 2019 guidelines: Obtain biochemical testing in patients with localized or metastatic appendiceal NETs to establish baseline measures for future surveillance and disease monitoring. B Obtain tumor markers at diagnosis of appendiceal epithelial neoplasms and routinely after resection. B Preoperative assessment: Include the following in preoperative assessment of patients with appendiceal NETs: history and physical examination CT or MRI of chest, abdomen and pelvis colonoscopy. B 2. Diagnostic procedures Colonoscopy: perform colonoscopy in patients with confirmed or suspected appendiceal neoplasms. B Peritoneal cytology: do not obtain routine peritoneal cytology in patients with appendiceal neoplasms. D 3. Medical management Management of advanced/metastatic disease: As per NCCN 2021 guidelines, observe with imaging or offer octreotide or lanreotide in asymptomatic patients with locoregionally advanced or metastatic appendiceal NETs with low tumor burden. B Show 3 more As per ASCRS 2019 guidelines: Consider administering systemic chemotherapy to improve survival in patients with metastatic high-grade appendiceal mucinous neoplasms. B https://web.pathway.md/diseases/recIrRYbWtlfkgXmh 2/4 6/23/23, 2:40 AM Appendiceal neoplasm Pathway Insufficient evidence to support the use of systemic chemotherapy in patients with low-grade lesions with peritoneal spread. I 4. Therapeutic procedures Hyperthermic intraperitoneal chemotherapy: consider administering intraperitoneal chemotherapy to reduce peritoneal disease recurrence in selected patients with appendiceal epithelial neoplasms. B 5. Surgical interventions Indications for surgery: As per NCCN 2021 guidelines, perform simple appendectomy in patients with appendiceal NETs 2 cm. B Show 3 more As per ASCRS 2019 guidelines, perform cytoreductive surgery in selected patients with appendiceal neoplasms and evidence of peritoneal involvement. B Show 4 more 6. Follow-up and surveillance Follow-up assessment: As per NCCN 2021 guidelines, obtain follow-up assessment in patients with NETs after resection: Situation Guidance History and physical examination 12 weeks to 12 months Biochemical markers (24-hour urine or serum 5-HIAA, testing for Cushing's syndrome) as clinically indicated Abdominal +/- pelvic multiphase CT or MRI as clinically indicated History and physical examination 1-10 years (every 1-2 years) Biochemical markers (24-hour urine or serum 5-HIAA, testing for Cushing's syndrome) as clinically indicated Abdominal +/- pelvic multiphase CT or MRI Obtain surveillance as clinically indicated. B > 10 years https://web.pathway.md/diseases/recIrRYbWtlfkgXmh 3/4 6/23/23, 2:40 AM Appendiceal neoplasm Pathway As per ASCRS 2019 guidelines, include the following in the surveillance after resection of appendiceal NETs with a curative intent: physical examination serial biochemical testing CT or MRI of the chest, abdomen and pelvis. B References 1. Sean C Glasgow, Wolfgang Gaertner, David Stewart et al. The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms. Dis Colon Rectum. 2019 Dec;62 12 1425 1438. Open 2. Manisha H Shah, Whitney S Goldner, Al B Benson et al. Neuroendocrine and Adrenal Tumors, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology. NCCN. 2021 Aug 13. Open https://web.pathway.md/diseases/recIrRYbWtlfkgXmh 4/4