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Colorectal Cancer ScreeningWe discuss colorectal cancer screening with two gastroenterologists, including results from two recently published studies showing long-term effects of screening.
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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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The Quest for an Evidence-Based Approach to Intermediate-Risk Prostate CancerWe must now come to a uniform consensus regarding the descriptions of these risk groups in order to truly determine which treatments have the best oncologic efficacy, while minimizing overtreatment and optimizing patients’ quality of life.
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ACR Appropriateness Criteria® Resectable Stomach CancerFor resectable gastric cancer, perioperative chemotherapy or adjuvant chemoradiation with chemotherapy are standards of care. The decision making for adjuvant therapeutic management can depend on the stage of the cancer, lymph node positivity, and extent of surgical resection.
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Radiation Sensitizers and Targeted TherapiesChemotherapeutic agents that are highly responsive to ionizing radiationand enhance the effectiveness of radiation treatment are termedradiation sensitizers. Radiation sensitizers act in a number of ways tomake cancer cells more susceptible to death by radiation than surroundingnormal cells, and several such compounds are now available forthe treatment of solid tumors. This review discusses the biology thatunderlies chemotherapy and radiation interactions for oneradiosensitizerSMQ-8212-SMQgemcitabine (Gemzar). It also provides a brief assessmentof how to modify treatment regimens for various cancers to maximizethe radiosensitization potential of gemcitabine in order to furtherincrease efficacy. Newer molecularly targeted agents and their antitumorpotential as monotherapy or in combination with radiation arealso reviewed.
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Nursing Challenges of Caring for Patients with HIV-Related MalignanciesAs many as 40% of individuals infected with HIV will be diagnosed with a malignancy during the course of their illness. Although neoplasms of all organ systems have been reported in infected patients, Kaposi's sarcoma (KS),
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Genetic Testing and Counseling in Familial Adenomatous PolyposisThe authors provide a timely introduction to the use of predictive testing as an adjunctive service in the management of a precancerous chronic disease, familial adenomatous polyposis (FAP). As they point out, this new technology carries a significant burden for both the caregiver and affected family since it will alter the genetic counseling process, as well as the clinical recommendations for managing FAP. The unique perspective of registry-based research illustrates the value of generational study of a genetic anomaly over a 22-year-period.
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Genetic Variations Linked to Post-Transplant Outcomes in Leukemia PatientsThis video examines research that found that certain genetic variations of both leukemia patients undergoing bone marrow transplant and their unrelated donors were associated with poor outcomes.
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Facing Forward: Meeting the Rehabilitation Needs of Cancer SurviviorsThe 5-year survival rate of cancer patients in the United States is about 66%, and today there are approximately 12 million cancer survivors in the US.
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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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Adjuvant or Induction Cisplatin-Based Chemotherapy for Operable Lung CancerDespite aggressive surgical management, 5-year survival rates of non–small-cell lung cancer (NSCLC) patients range from 73% for those with pathologic stage IA to 25% for those with stage IIIA.[1] Clinical or preoperative staging often underestimates the extent of the disease (particularly if positron-emission tomography and mediastinoscopy are not used), and the estimated survival rates for a given clinical stage are much lower than those for the corresponding surgical/pathologic stage.[1]
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Differentiated Thyroid Carcinoma: Risk Group Assignment and Management ControversiesIn this review, we provide a framework for clinical decision-making in the treatment of differentiated thyroid cancer. The clinical discussion and treatment recommendations are relevant to an adult population (more than 16
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Lung Cancer Screening: A New EraScreening is always an issue that generates a great deal of emotion, as recently seen with the controversies surrounding mammography and prostate-specific antigen (PSA) testing.
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Non-Small-Cell Lung Cancer Adjuvant Therapy: Translating Data Into RealitySurgery remains the initial treatment for patients with early-stage non-small-cell lung cancer (NSCLC). Additional therapy is necessary because of high rates of distant and local disease recurrence after surgical resection. Early trials of adjuvant chemotherapy and postoperative radiation were often plagued by small patient sample size, inadequate surgical staging, and ineffective or antiquated treatment. A 1995 meta-analysis found a nonsignificant reduction in risk of death for postoperative cisplatin-based chemotherapy. Since then, a new generation of randomized phase III trials have been conducted, some of which have reported a benefit for chemotherapy in the adjuvant setting. The role of postoperative radiation therapy remains to be defined. It may not be beneficial in early-stage NSCLC but still may have utility in stage IIIA disease. Improvement in survival outcomes from adjuvant treatment are likely to result from the evaluation of novel agents, identification of tumor markers predictive of disease relapse, and definition of factors that determine sensitivity to therapeutic agents. Some of the molecularly targeted agents such as the angiogenesis and epidermal growth factor receptor inhibitors are being incorporated into clinical trials. Preliminary results with gene-expression profiles and lung cancer proteomics have been promising. These techniques may be used to create prediction models to identify patients at risk for disease relapse. Molecular markers such as ERCC1 may determine response to treatment. All of these innovations will hopefully increase cure rates for lung cancer patients by maximizing the efficacy of adjuvant therapy.
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Limited-Field and Whole-Breast Hypofractionated RadiotherapyWith the publication of mature experiences using accelarated partial breast irradiation (APBI) and accelerated whole breast irradiation (AWBI), the use of shortened courses of radiotherapy has become increasingly popular.
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ALL in Adults: How Can We Do Better?The most interesting developments in drug therapy for adult ALL are occurring in two fields: (1) molecularly targeted therapies and (2) the use of antibodies, conjugated antibodies, or antibody constructs.
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Management of Brain Metastases: Neurosurgical ConsiderationsMetastatic lesions to the brain occur commonly in oncology patients and portend a very poor outcome, as they often occur in the setting of progressive systemic metastatic disease and can result in neurologic deterioration that may preclude therapy. Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis (eg, with surgical resection or radiosurgery) and to reduce the subsequent risk of recurrences elsewhere in the brain (eg, with whole-brain radiation). Successful therapy of extracranial systemic metastases is required for optimal outcomes. Clinical trials are currently underway to define the optimal role of whole-brain radiation and radiosurgery in different subsets of patients. Novel therapies to enhance radiation responsiveness are also under investigation. In the current review, we discuss recent developments in the management of patients with brain metastases.
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Management of Intestinal Obstruction in the Patient With Ovarian CancerIntestinal obstruction in the patient with ovarian cancer is a difficult situation for both patient and physician. In women presenting with ovarian cancer, obstruction is almost never complete.
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Nutritional Implications of Dental and Swallowing Issues in Head and Neck Cancerhe authors are to be commended for providing an overview of several important, though often overlooked, management issues in head and neck cancer. In their overview of nutrition, they correctly state that the nutritional status of head and neck cancer patients is frequently compromised even before cancer diagnosis and treatment. Documented reasons for this include poor oral hygiene, ill-fitting dentures, and a high incidence of alcoholism.[1] Consequently, it is imperative that patients’ pretreatment nutritional status be determined so that necessary dietary modifications can be made prior to therapy. As the authors emphasize, nutritional reassessment and intervention should continue during and after treatment.
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The Costs of Cancer Care in the United States: Implications for ActionThe total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high
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Dealing With Ethical Dilemmas in Oncological Communication Involving Issues of Culture and AutonomyBeginning with its provocative opening case vignette, Nathan Cherny's article provides an opportunity for us to reflect on and possibly redirect our own attitudes and habits regarding difficult ethical issues in communication with our patients and their families, especially in the setting of cultural and religious diversity.
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Pancreatic Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in
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A Rare Case of Metastatic Renal Epithelioid AngiomyolipomaThe patient is a 43-year-old man who was initially evaluated at an outside institution for unexplained anemia and who was found to have a large right kidney mass. He underwent a radical nephrectomy for a 19-cm large-cell, poorly differentiated neoplasm, consistent with pleomorphic, epithelioid angiomyolipoma (EAML) with extensive necrosis and cytologic atypia.
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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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Perioperative Chemotherapy for Colorectal Cancer Liver MetastasesThere is limited data available to guide decision making in the management of colorectal liver metastases. Despite a trend toward increased use of perioperative chemotherapy, others have questioned the role of this approach in patients with solitary lesions and a longer disease-free interval.
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Sociobiology and Cervical CancerThe April 1995 issue of Oncology featured an article that presented sound information on the state of viral interactions and cervical cancer, along with several excellent reviews. Cancer of the uterine cervix is a significant health and emotional
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Four-Year Follow-Up Confirms Lenvatinib/Pembrolizumab Safety in RCCCommon adverse effects following treatment with lenvatinib plus pembrolizumab in the phase 3 CLEAR study include diarrhea, hypertension, and fatigue, according to Thomas E. Hutson, DO, PharmD, FACP.
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Need for Mature Evidence to Validate HIFUThe use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
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Commentary (Merchant)-Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and TreatmentDrs. Jubran and Finlay havewritten a timely review thatarticulates the trials and tribulationsof treating central nervous system(CNS) germ cell tumors. Theirreview comes on the heels of the Children’sOncology Group (COG) nongerminomatousgerm cell tumor study(ACNS0122) that opened January 26,2004, and in anticipation of the COGgerminoma study (ACNS0232) thatmay open in 2005.
