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Sentinel Lymph Node Dissection in Vulvar Carcinoma: What Is the Acceptable False-Negative Rate?Although vulvar cancer is relatively rare, accounting for less than 5% of all cancers of the female genital organs, lymph node metastasis associated with vulvar carcinoma is a common event and occurs in about 25% of cases.[1] The presence and number of lymph node metastases is the single most important prognostic factor in vulvar cancer and a critical component to the International Federation of Gynecology and Obstetrics (FIGO) staging system, as well as a major determinant in the need for adjuvant therapy
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Commentary (Sendowski/Segal): Management of Health-Care–Associated Infections in the Oncology PatientInfections are major causes of morbidityand mortality in patientswith cancer. In certain instances,the malignancy itself can predisposepatients to severe or recurrent infections.For example, acute leukemiamay cause neutropenia and ensuingbacterial or fungal infection. Hypogammaglobulinemiaof chroniclymphocytic leukemia may be complicatedby infections due to encapsulatedbacteria. Patients withHodgkin’s lymphoma may sufferfrom recurrent varicella-zoster infections.Solid tumors may obstruct thelumens of respiratory, digestive, andurinary tracts, leading to bacterial infections.Nevertheless, the principalrisk of infectious complications is relatedto the intensity and duration ofimmunosuppressive chemotherapy.Patients with cancer constitute ahighly varied population, both interms of the underlying malignancyand in terms of their immunosuppression.In addition, a single patientmay have multiple predisposing factors,thus increasing the spectrum oflikely pathogens. When evaluating apatient with cancer for a possible infection,it is essential to develop aconceptual framework of quantitativeand qualitative immune defectsthe patient is likely to have, and thento stratify the risk for specific pathogensin the context of the history,physical exam, and laboratorydata.[1]
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Neoadjuvant Treatment for Surgically Resectable Metastatic Colorectal CancerHere, we review the studies that have explored different treatment regimens, therapeutic sequencing, and biologic inclusions for the treatment of these patients, with neoadjuvant intent. We also describe how we have established our own treatment paradigm for the management of potentially curable metastatic colorectal cancer.
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Targeted Therapy in Advanced Urothelial CarcinomaThis review focuses on targeted therapies related to these pathways of interest for the treatment of advanced urothelial carcinoma, describing the evidence to support further investigation of these approaches.
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Managing Prostate Cancer Surgical Patients during the COVID-19 Pandemic: A Brief Report of the Duke Cancer Institute’s Initial ExperienceExperts from the Duke Cancer Institute outline their current approach to stratifying surgical management of patients with prostate cancer.
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Thromboembolism and Bleeding in Bladder CancerOverall, approximately 2% of patients with bladder cancer will experience a venous thromboembolism event, a rate five times higher than that in the overall population; also, such an event results in a threefold increased risk of death in patients with cancer.
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Disorders of Sex Development and Malignant Germ Cell TumorsKey points: Patients with disorders of sex development (DSDs) are at an increased risk of malignant germ cell tumors (GCTs). In adulthood, the partial form of androgen insensitivity syndrome confers the greatest risk of developing malignant GCTs. Gonadoblastoma is the most common gonadal GCT arising in patients with DSDs. Despite being a benign neoplasm, it can undergo malignant transformation in up to 60% of patients with a DSD. Oncologic treatment in patients with disorders of sex development and malignant GCTs does not differ from the standard treatment for testicular GCTs. Treatment of patients with DSDs requires a multidisciplinary team, including a psychiatric, genetic, and reproductive assessment as well as the involvement of an ethics committee. An early diagnosis of DSDs is crucial to avoid the development of potentially serious complications in adulthood.
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Early Palliative Care: Moving From ‘Why’ to ‘How’Integrating palliative care from the time of diagnosis can support both patients and families through difficult periods and prepare them for the journey ahead. It can improve quality of life while curtailing healthcare spending and increasing satisfaction with oncology care.
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Human Papillomavirus and Head and Neck CancerAs outlined by Leslie Kim and colleagues in this issue of ONCOLOGY,[1] almost 650,000 new cases of head and neck cancer are identified and approximately 350,000 individuals die from this disease worldwide each year. Most cancers of the head and neck are squamous cell carcinomas and originate from one of five major sites: oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx. Traditionally, tobacco smoking and alcohol consumption have been considered to be the main risk factors for head and neck squamous cell carcinoma (HNSCC) and, thus far, most prevention strategies and public health messages have focused on these two factors. However, as described in the review by Kim et al., there is increasing evidence that, independent of tobacco and alcohol exposure, oral human papillomavirus (HPV) infection is a major risk factor for a specific subset of HNSCCs. We agree with the authors that this is an important public health concern, especially given the increasing prevalence of HPV infection in the US and Western Europe and our limited knowledge about the natural history of oral HPV infection. Here we summarize the role of HPV in HNSCC and discuss clinical implications.
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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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Paclitaxel, UFT, and Calcium Folinate in Metastatic Breast CancerThis is a phase I dose-escalation study of uracil and tegafur (in a molar ratio of 4:1 [UFT]) administered in combination with calcium folinate and paclitaxel in metastatic breast cancer. This trial was initiated to 1)
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Brachytherapy in the Treatment of Breast CancerThe article by Nag and colleagues of the American Brachytherapy Society is a well-intentioned effort to establish guidelines
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Clinical Issues in the Surgical Management of Screen-Identified Lung CancersThis review outlines the diagnostic and therapeutic challenges associated with the increased number of screen-identified indeterminate lung nodules, highlighting currently recommended follow-up and management algorithms, as well as the various methods of nodule localization, tissue diagnosis, and definitive local therapeutic modalities.
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Younger Thyroid Cancer Survivors at Higher Risk for Late EffectsIn this interview we discuss a study that found that survivors of thyroid cancer diagnosed with the disease at a young age had an increased risk of late effects from therapy.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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Mohs Micrographic Surgery: Established Uses and Emerging TrendsMohs surgery has been well-established as the gold standard for the treatment of BCCs and SCCs. And, as described in this article, preliminary reports suggest that it may play an equally important role in the management of several other cutaneous malignancies.
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Cancers of the Gallbladder and Biliary DuctsNeoplasms of the biliary tract tree are uncommon and have a poor overall prognosis. Although numerous risk factors have been identified, little is known about the pathogenesis of these tumors, and no effective screening
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Primary Cutaneous and Systemic Anaplastic Large Cell LymphomaAnaplastic large cell lymphoma (ALCL) is a biologic and clinically heterogenous subtype of T-cell lymphoma. Clinically, ALCL may present as localized (primary) cutaneous disease or widespread systemic disease. These two forms of ALCL are distinct entities with different clinical and biologic features. Both types share similar histology, however, with cohesive sheets of large lymphoid cells expressing the Ki-1 (CD30) molecule. Primary cutaneous ALCL (C-ALCL) is part of the spectrum of CD30+ lymphoproliferative diseases of the skin including lymphomatoid papulosis. Using conservative measures, 5-year disease-free survival rates are>90%. The systemic ALCL type is an aggressive lymphoma that may secondarily involve the skin, in addition to other extranodal sites. Further, systemic ALCL may be divided based on the expression of anaplastic lymphoma kinase (ALK) protein, which is activated most frequently through the nonrandom t(2;5) chromosome translocation, causing the fusion of the nucleophosmin (NPM) gene located at 5q35 to 2p23 encoding the receptor tyrosine kinase ALK. Systemic ALK+ ALCLs have improved prognosis compared with ALK-negative ALCL, although both subtypes warrant treatment with polychemotherapy. Allogeneic and, to a lesser extent, autologous stem cell transplantation play a role in relapsed disease, while the benefit of upfront transplant is not clearly defined. Treatment options for relapsed patients include agents such as pralatrexate (Folotyn) and vinblastine. In addition, a multitude of novel therapeutics are being studied, including anti-CD30 antibodies, histone deacetylase inhibitors, immunomodulatory drugs, proteasome inhibitors, and inhibitors of ALK and its downstream signaling pathways. Continued clinical trial involvement by oncologists and patients is imperative to improve the outcomes for this malignancy.
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Current Therapy in Cancer, Second EditionIn their new book entitled Current Therapy in Cancer, Drs. Foley, Vose, and Armitage endeavor to provide a short and concise presentation of various cancers. Their purpose is to aid clinicians in presenting a succinct overview of individual
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Individualizing Therapeutic Strategies in Acute Myeloid Leukemia: Moving Beyond the ‘One-Size-Fits-All’ ApproachWe are ready to move beyond a “one-size-fits-all” approach in AML and join our colleagues treating other malignancies, such as lung cancer, in moving towards a personalized medicine approach.
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Topotecan in Combination With Cisplatin for the Treatment of Stage IVB, Recurrent, or Persistent Cervical CancerTopotecan, a camptothecin analog previously approved for the treatment of ovarian cancer and small-cell lung cancer, was granted regular approval by the US Food and Drug Administration (FDA) on June 14, 2006, for use in combination with cisplatin to treat women with stage IVB, recurrent, or persistent carcinoma of the cervix not amenable to curative treatment with surgery and/or radiation therapy. The purpose of this summary is to review the database supporting this approval.
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Topoisomerase I Inhibitors in the Treatment of Head and Neck CancerTraditionally, the role of chemotherapy in the treatment ofsquamous carcinoma of the head and neck has been confined to patients with
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Non-Hodgkin LymphomaThis management guide covers the risk factors, screening, diagnosis, staging, and treatment of non-Hodgkin lymphoma.
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Pancreatic Metastases From Renal Cell Carcinoma Treated With Stereotactic Body Radiation TherapyIn this edition of our ongoing series, the authors present two cases involving renal cell carcinoma patients treated with SBRT for pancreatic metastases.
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Quackery, Placebos, and Other Thoughts: An Integrative Oncologist’s PerspectiveAs they say, “absence of evidence is not evidence of absence.” Many alternative therapies, once believed by conventional medical practitioners to be merely placebos, have now been shown to have proven therapeutic value (eg, acupuncture, numerous botanical extracts, meditation).
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The "Epidemic" of Breast Cancer in the U.S.--Determining the FactorsIt is widely accepted that the causation of cancer is the result of environmental exposures (including endogenous hormone exposure) and genetic susceptibility. Ultimately, to prevent breast cancer, we must understand both the environmental and genetic components.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Role of Radiation Therapy in Patients With Resectable Pancreatic CancerIn this article, we review the data surrounding the use of chemotherapy (CT) and chemoradiotherapy (CRT) in patients with resectable pancreatic cancer.
