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Commentary (Bouda)-Opioids in Cancer Pain: Common Dosing ErrorsIread with pleasure this articlefrom the staff of the Harry R.Horvitz Center for Palliative Medicine,an institution with expertiseand experience to draw upon. Allmultidisciplinary cancer centersshould have an expertise in palliativemedicine if not a formalized program,as one of the most important jobs ofoncologists is to relieve pain and sufferingfor patients and their families.When pain is effectively addressed,the patient’s aggregate quality of lifeis optimized and time spent with familyand friends is more enjoyable.
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Invasive Aspergillosis in Cancer PatientsThe incidence of invasive aspergillosis is increasing parallel to the intensity of immunosuppressive and myelosuppressive anticancer treatments. Successful management is linked to an understanding of the
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CT Screening for Lung Cancer: How to Fulfill the PromiseRadiologic screening for lung cancer had a long and unsuccessful history until the advent of low-dose computed tomography (CT) screening and the completion of the National Lung Screening Trial, which demonstrated an improvement in lung cancer–specific mortality in a high-risk population.
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Chronic Inflammation and Cancer: The Role of the MitochondriaWe review the evidence implicating a strong association between chronic inflammation and cancer, with an emphasis on colorectal and lung cancer.
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Sentinel Lymph Node Mapping in Breast CancerAs Dr. Cody points out, sentinel lymph node mapping of axillary nodes in patients with invasive breast cancer will probably become the standard of care for patients with early breast cancer, and will replace standard axillary dissection for many of these patients. With mammography increasing the detection of small, nonpalpable breast cancers, which pose a very low risk of axillary metastases, it is difficult to justify the continued use of standard axillary dissection. To my mind, it is also difficult to justify omitting axillary dissection of any type in these settings.
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Commentary (Larson/Nelson)-Laparoscopic Surgery for Cancer: Historical, Theoretical, and Technical ConsiderationsSurgery for cancer carries concerns of tumor dissemination related to tumor manipulation, tumor violation, and wound seeding. Minimally invasive surgery is now standard for several benign conditions, such as symptomatic cholelithiasis and surgical therapy of gastroesophageal reflux. With the minimally invasive surgery explosion of the 1990s, virtually every procedure traditionally performed via laparotomy has been performed successfully with laparoscopic methods, including pancreaticoduodenectomy for cancer. Shortly after the first descriptions of laparoscopic-assisted colectomy, reports of port-site tumor recurrences surfaced, raising concerns of using pneumoperitoneum-based surgery for malignancy. This review covers the development of laparoscopic surgery for cancer. Historical perspectives elucidate factors that helped shape the current state of the art. Theoretical concerns are discussed regarding surgery-induced immune suppression and its potential effects on tumor recurrence with both open and laparoscopic approaches. The concerns of laparoscopic port-site wound metastases are addressed, with a critical evaluation of the literature. Finally, a technical discussion of laparoscopic-assisted resections of hepatic and pancreatic tumors details patient selection, operative approach, and existing data for these operations.
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Sentinel Lymphadenectomy: Accurate Histopathologic Staging of the AxillaWe agree with the need to reexamine the routine use of axillary dissection in the management of breast cancer patients, as advocated by Manjeet Chadha and Deborah Axelrod, in their article, "Is Axillary Dissection Always Indicated in Invasive
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Antiemetic Therapy: Much Progress, Much More to be DoneA review of "Chemotherapy-Induced Nausea and Vomiting: Which Antiemetic for Which 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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Changing Perspectives on Palliative CareIn their article, Drs. Choi and Billings address a number of strategic areas in palliative care. These topics include the definition and scope of the evolving field, the complexities involved in the use of modalities that carry burden or risk (such as artificial nutrition and bowel decompression), and the underappreciated importance of communication skills and a capacity for ethical reasoning.
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Gemcitabine in Combination With New Platinum Compounds: An UpdateCombinations of gemcitabine (Gemzar) with cisplatin (Platinol) are among the most active new chemotherapy regimens developed for advanced non-small-cell lung cancer. Carboplatin (Paraplatin) is a platinum analog
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Late Effects Clinic: Cardiovascular Late EffectsChronic or late cardiovascular effects are estimated to occur in less than 5% of patients who receive chemotherapy and mediastinal radiation for all types of cancer.
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Anthracycline Cardiotoxicity After Breast Cancer TreatmentAnthracyclines are among the most effective and widely prescribed anticancer agents. They were first isolated from cultures of Streptomyces peucetius by Dr. Federico Arcamone in the early 1960s.[1] Anthracyclines have since become an essential component of breast cancer treatment, and their use in combination regimens as adjuvant therapy is the standard of care for most women with early-stage disease.[2] Two commonly used anthracyclines in breast cancer are doxorubicin and epirubicin, a semisynthetic derivative of doxorubicin.
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The Role of Physical Activity in Cancer Prevention, Treatment, Recovery, and SurvivorshipThis article will review these intersections of exercise and oncology, discuss the known mechanisms by which exercise exerts its salutary effects, and touch upon the future directions of exercise research in the oncology setting. Finally, recommendations are provided for clinicians to help patients with and without cancer take advantage of the benefits of physical activity.
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ASCO: Biomarkers in Cancer PreventionDr. Brenner discusses the role of chemopreventives, biomarkers, and early detection for cancer prevention.
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Combined-Modality Therapy for Bladder CancerRadical cystectomy remains standard management for patients with locally advanced T2 through T4, N0, M0 transitional cell carcinoma of the urinary bladder.
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Biphasic Tumors of the Female Genital TractIn this installment of Second Opinion, we are presenting two cases of tumors of the female genital tract, specifically, the ovary and uterus, which contain both epithelial and mesenchymal components and therefore have unique diagnostic and therapeutic implications. The first has an unusually poor prognosis and the second is notoriously difficult to diagnose.
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Cardiotoxicities of Breast Cancer TreatmentOne of the potential side effects of chemotherapy is cardiac toxicity. The resulting damage to the heart can range from non–life-threatening events to devastating heart failure. The spectrum of these events can occur almost immediately, during a drug infusion, or as a delayed complication later in the patient’s life. Oncology nurses not only need to be familiar with identifying and intervening in acute cardiac events, but also in some instances will need to monitor for delayed cardiac toxicities during the continuum of the patient’s life.
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Commentary (Misra/Kimmick): Managing Early-Stage Breast Cancer in Your Older PatientsAs the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.
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Active Surveillance for African-American Men With Prostate Cancer: Proceed With CautionActive surveillance seems to be generally safe, yet African-American men tend to have more aggressive prostate cancers. Thus, it is imperative that we learn the characteristics and outcomes of African-American men considering surveillance.
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Managing Central Venous CathetersOver 5 million central venous catheters are inserted annually in the United States. Yet the ‘ideal’ access device does not exist. A host of issues preclude optimizing central line care.
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Unmet Needs During Extended SurvivorshipThe needs and challenges of cancer survivors and their family members do not vanish once treatment has been completed, although their follow-up care is often not addressed sufficiently.
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Treatment of Complications After Breast-Conservation TherapyOver the past 2 decades, breast-conservation therapy with lumpectomyand whole-breast radiotherapy has become a standard option for themajority of women with newly diagnosed breast cancer. Long-term localcontrol is achieved in approximately 85% of patients, and the therapy isgenerally well tolerated. There can, however, be long-term effects on thebreast and other nearby tissues that may range from asymptomaticfindings on examination to severe, debilitating problems. Infection, fatnecrosis, and severe musculoskeletal problems such as osteoradionecrosisor soft-tissue necrosis are uncommon, affecting less than 5% ofpatients. However, changes in range of motion, mild-to-moderate musculoskeletalpain, and arm and breast edema are much more common.As more women choose breast-conservation therapy for management oftheir breast cancer, physicians will encounter these problems, as well asin-breast tumor recurrence, with greater frequency. This review willfocus on the incidence, contributing factors, and management of thelate problems of infection, fat necrosis, musculoskeletal complications,and local recurrence following breast-conservation therapy.
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Lymph Node–Positive Prostate Cancer: The Benefit of Local TherapyAlthough high-level evidence is lacking, the existing literature indicates that select men with lymph node–positive prostate cancer benefit from local therapy.
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Is Axillary Dissection Always Indicated in Invasive Breast Cancer?In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as
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Metabolic Abnormalities in an Adult Survivor of Pediatric CraniopharyngiomaAdult survivors of childhood craniopharyngiomas, the second most common type of childhood brain tumor, face many challenges, including multiple life-threatening metabolic abnormalities. Serious metabolic deficits can result from injury to the pituitary gland or hypothalamus.
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Gastric CancerThis comprehensive guide for oncologists covers the diagnosis, staging, treatment, and management of gastric cancer.
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Tailoring Treatment for Multiple Myeloma Patients With Relapsed and Refractory DiseaseResponses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
