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Colon, Rectal, and Anal CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of colorectal and anal cancers.
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A Shifting Paradigm for Patients with Head and Neck Cancer: Transoral Robotic Surgery (TORS)The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of transoral robotic surgery (TORS) improves upon current transoral techniques to the oropharynx and supraglottis. This review will report on the evolution of robotic-assisted surgery: We will cover its applications in head and neck surgery by examining early oncologic and functional outcomes, training of surgeons, costs, and future directions.
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Treating Anaplastic Oligodendrogliomas and WHO Grade 2 Gliomas: PCV or Temozolomide? The Case for TemozolomideThere is no evidence that PCV is more effective than TMZ for the treatment of glioblastoma. However, there is unequivocal evidence that PCV is more toxic than TMZ.
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Management of DeliriumMs. B is a 44-year-old married African-American female who was diagnosed with locally advanced right breast cancer in 2002. Immunohistochemistry in the original tumor was estrogen- and progesterone-receptor-negative, HER2-positive. Her past medical history is significant for hypertension and miscarriage in 1995.
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Current and Emerging Treatments for Brain MetastasesConventional methods for treating brain metastasis, such as surgery, WBRT, and SRS, each compete with and complement one another. A plethora of recent studies have helped define and expand the utility of these tools.
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Expert Highlights Safety Profile of Oral Azacitidine in Lower-Risk MDSAdverse effects associated with oral azacitidine in low- or intermediate-risk MDS are typically transient, according to Mikkael A. Sekeres, MD, MS.
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Management of Small Bowel AdenocarcinomaSmall bowel adenocarcinoma is a relatively rare malignancy. Only limited information is available on the incidence, prognosis, and role of chemotherapy in the treatment of this disease. We present a review of currently
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TCGA's Breast Cancer Project May Yield Important Therapeutic Benefits, but It's Too Early to Be SureThe strongest aspect of TCGA is that the data are publically available, fueling the input needed for unparalleled discovery. As the broader scientific community continues to analyze and integrate TCGA data with their own datasets, it is highly likely that breast cancer patients will benefit.
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Targeting the Insulin Growth Factor Pathway in Gastrointestinal CancersThis review highlights the current status of the research in targeting the insulin growth factor pathway with a specific focus on gastrointestinal cancers.
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Neoadjuvant Therapy for Gastric CancerGastric cancer is a global health issue. Most cases are diagnosed atan advanced stage with poor prognosis. Current therapies have a modestimpact on survival. Surgery remains the only potentially curativetreatment, but is associated with a high rate of locoregional recurrenceand distant metastases. Total gastrectomy for proximal cancers is complicatedby postoperative morbidity and quality-of-life impairment.Combined-modality therapy may improve outcomes in this disease.Adjuvant therapy for gastric cancer has now become the standard inthe Western world. However, adjuvant therapy improves survival by onlya few months and is associated with high morbidity. Neoadjuvant therapyis commonly used for esophageal and gastroesophageal junction cancers,but is still regarded as investigational in gastric cancer. Severalsmall phase II studies indicate the feasibility of neoadjuvant strategies.The incorporation of novel, targeted agents into neoadjuvant programsand an assessment of biologic changes within the tumor may refinetherapy. This article provides a concise review of the literature onneoadjuvant therapy for gastric cancer and suggests avenues for furtherinvestigation.
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A Clinician’s Perspective on ASCO 2001: Going After the Epidermal Growth Factor ReceptorAmong the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.
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Update on Malignant MesotheliomaMesotheliomas are uncommon in the United States, with an incidenceof about 3,000 new cases per year (or a risk of about 11 per million Americansper year). Incidence and mortality, however, are probably underestimated.Most are associated with asbestos, although some have arisen inports of prior radiation, and a reported association with simian virus (SV)40remains controversial. About 85% of mesotheliomas arise in the pleura,about 9% in the peritoneum, and a small percentage in the pericardiumor tunica vaginalis testis. The histology of about half of mesotheliomas isepithelial (tubular papillary), with the remainder sarcomatous or mixed.Multicystic mesotheliomas and well-differentiated papillary mesotheliomasare associated with long survival in the absence of treatmentand should be excluded from clinical trials intended for the usual rapidlylethal histologic variants of the disease. The median survival isunder a year, although longer median survivals for selected patients,particularly those with epithelial histology, have been reported in somecombined-modality studies. Recent randomized trials have shown significantimprovement in time to progression and survival for the additionof new antifolates to platinum-based chemotherapy.
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Commentary (Edgerton): Management of Congenital Vascular Lesions of the Head and NeckThere is a clear need to improve the clinical management of vascular lesions of the head and neck. This paper by Waner and Suen corrects some of the common misconceptions and emphasizes that each vascular lesion must be recognized, understood, and treated on an individual basis.
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Management of Congenital Vascular Lesions of the Head and NeckCongenital vascular lesions are often misdiagnosed and, for the most part, left untreated. The absence of a uniformly accepted classification of these lesions and confusion over their natural history are partly responsible. A new classification of these lesions recognizes two distinct groups of lesions, hemangiomas and vascular malformations.
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Clinical Management of Medullary Thyroid CarcinomaIn this interview on medullary thyroid carcinoma we discuss treatment strategies, prognostic biomarkers, surveillance following treatment, and more.
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Does WBRT Still Have a Role for Cancer Patients With Brain Metastases?In this interview we discuss new data on the use of radiotherapy in cancer patients with brain metastases.
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The Role of UFT in Combined- Modality TherapyFluorinated pyrimidines have long been used as radiosensitizers in combined-modality therapy for solid tumors. Nonetheless, the most commonly used drug, 5-fluorouracil (5-FU), is inconvenient to administer, particularly
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Highlights From the 2008 Meeting of the American Society for Clinical OncologyThe 44th Annual Meeting of the American Society of Clinical Oncology, held May 30th to June 2nd, brought more than 30,000 attendees to Chicago for the presentation of nearly 5,000 new studies. The following research findings represent a few of the highlights, as announced by ASCO before the meeting.
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Malignant Angiomyolipoma: a Rare Entity With Unusual BiologyThe authors present an interesting case of a very rare renal neoplasm, malignant epithelioid angiomyolipoma (AML), which belongs to a family of mesenchymal tumors known as perivascular epithelioid tumors (PEComas).
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Cancer Management Chapter 41: Fluid complicationsMalignant pleural effusion complicates the care of approximately 150,000 people in the United States each year. The pleural effusion is usually caused by a disturbance of the normal Starling forces regulating reabsorption of fluid in the pleural space, secondary to obstruction of mediastinal lymph nodes draining the parietal pleura.
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UFT Plus Carboplatin for Head and Neck CancerCisplatin plus fluorouracil (5-FU) is widely accepted as neoadjuvant and adjuvant chemotherapy in the treatment of head and neck squamous cell carcinoma; UFT is also an active agent against this disease. In the first retrospective study, we examined the efficacy of UFT as adjuvant chemotherapy in patients with maxillary cancer.
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UFT Plus Cisplatin for Advanced Gastric CancerIn a laboratory study using an experimental peritoneum model of gastrointestinal cancer, the UFTP [tegafur and uracil (UFT) plus cisplatin] regimen was shown to provide a survival benefit compared with the UFTM (UFT plus
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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Delirium in Palliative CareDelirium is highly prevalent in cancer patients with advanced disease.Frequently a preterminal event, the condition is a sign of significantphysiologic disturbance, typically involving multiple medical etiologiesincluding infection, organ failure, adverse medication effects,and in rare situations, paraneoplastic syndromes. Unfortunately, deliriumis frequently underrecognized or misdiagnosed and, therefore,inappropriately treated or untreated in terminally ill patients. The clinicalfeatures of delirium are numerous and encompass a variety of neuropsychiatricsymptoms common to other psychiatric disorders. Threeclinical subtypes of delirium, based on arousal disturbance and psychomotorbehavior, have been described: hyperactive, hypoactive, andmixed. The differential diagnosis for delirium includes depression,mania, psychosis, and dementia. Numerous instruments have been developedto aid the clinician in rapidly screening for the disorder. Standardmanagement requires an investigation of the etiologies, correctionof the contributing factors, and management of symptoms. Symptomaticand supportive therapies, including numerous pharmacologicapproaches, are important, but several aspects of the use of neurolepticsand other agents in the management of delirium in the dying patientremain controversial.
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Head and Neck TumorsThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.
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Improving Adherence to Endocrine Therapies: The Role of Advanced Practice NursesWith the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.
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Face-Off: Award CeremonyFollowing a comprehensive debate on the treatment of patients with non–small cell lung cancer, Edward Kim, MD, presents the winning team with the title of victors of this CancerNetwork® Face-Off event.
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Current and Future Roles of Lapatinib in HER2-Positive Breast CancerIn this article, we review the underlying biology and pharmacology behind lapatinib and summarize clinical trials with lapatinib. We also describe the ongoing clinical trials that use lapatinib as part of adjuvant and neoadjuvant therapy. These trials could change the standard of care in the next few years.
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Current and Future Roles of Lapatinib in HER2-Positive Breast CancerIn this article, we review the underlying biology and pharmacology behind lapatinib and summarize clinical trials with lapatinib. We also describe the ongoing clinical trials that use lapatinib as part of adjuvant and neoadjuvant therapy. These trials could change the standard of care in the next few years.
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Routine 3D Treatment Planning: Opportunities, Challenges, and HazardsThree-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to
