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© J P C -P R O D ; R O ST 9 / S H U TT ER ST O C K .C O M T he National Comprehensive Cancer Network (NCCN) recently issued the first set of guidelines in the United States for the treatment of small bowel adenocarcinoma (SBA), a rare cancer type that is increasing in incidence. Adenocarcinomas are the most common type of small bowel cancer and account for approximately 3% of all digestive system cancers. Approximately 10,590 cases are expected to have been diagnosed in 2019. Although rates of many gastrointestinal malignancies have been declining in recent years (mostly attributed to early screening), those for small bowel cancers were found to have increased by 1.8% between 2006 and 2015. Because the disease is located higher in the gastrointestinal tract, it cannot be detected through a routine colonoscopy, and as a result, there is no expert consensus concerning whether to screen for it. In the past, SBA was not well studied because of its rarity. Because of that knowledge gap, the disease has been managed in the same way as colorectal cancer. However, new research and biological findings have indicated that treatments for the 2 disease types can differ, according to Katrina Pedersen, MD, an SBA expert at the Washington University School of Medicine in St. Louis, Missouri, and a member of the NCCN Guidelines® Panel for Colorectal Cancer. Among some of the newer treatments for SBA is the use of taxanes, a type of drug that blocks cell growth by stopping mitosis. At the same time, physicians are de-emphasizing the use of EGFR inhibitors because they do not demonstrate a clear benefit for patients. In addition to expanding its guidelines to include rare subsets, the NCCN also recently made changes to its guidelines for genetic/familial risk assessment in colorectal cancer in an effort to increase early detection. That new update includes a step-bystep process for assessing hereditary colorectal cancer syndrome through multigene panel testing and a heightened emphasis on genetic counseling. The NCCN also continues to recommend screening for average-risk individuals starting at age 50. All guidelines are available for free at NCCN.org or through the Virtual Library of the NCCN Guidelines App® for smartphones and tablets.