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Metastases to Abdominal-Pelvic Organs

Introduction Metastasis is a complex process in which tumor cells leave the original site of disease, called the primary tumor, to spread to other parts of the body. Cancer cells can break away from a primary tumor, enter the blood vessels, circulate through the bloodstream, and be deposited in other organs far from the primary tumor. When tumor cells metastasize to distant organs, the new tumor…

Thoracic Metastatic Disease

Introduction Metastatic disease is the most common chest malignancy, and the chest acquires more metastases than any system. In autopsy series, pulmonary metastases are present in 20% to 54% of patients with a primary malignancy. The most common extrathoracic malignancies to metastasize to the chest include breast cancer, gastrointestinal (GI) malignancies (colon, pancreatic, and gastric cancer), melanoma, head and neck tumors, and renal cell cancer. Rarely,…

Hematologic Malignancy: The Lymphomas

Introduction The lymphomas are a diverse group of hematologic neoplasms arising primarily from lymph nodes. They vary widely in affected age group, clinical course, and prognosis. Hodgkin lymphoma (HL) was first described by Thomas Hodgkin in 1832, and since the early 1990s advances in therapy have been so great that HL is now curable in most patients. The non-Hodgkin lymphomas (NHLs) are far more variable in…

Myeloma and Leukemia

Introduction Myeloma and leukemia share a common origin as hematologic malignancies. Both are usually systemic at the time of the diagnosis, although occasionally a plasmacytoma may exist as an isolated collection of plasma cells without systemic involvement. Both also have unclear boundaries from each other and from other related malignancies. For example, plasma cell leukemia is usually considered to be in the myeloma family rather than…

Breast Cancer

Introduction The management of breast cancer has evolved into a highly multidisciplinary endeavor that includes specialists from medical and radiation oncology, surgery, radiology, and cancer prevention services. Despite advances in the knowledge and technology associated with diagnosis and treatment, breast cancer continues to be a substantial source of morbidity in women, and efforts to improve proper staging and effective treatment of advanced disease are ongoing. However,…

Ovarian Cancer

Introduction In general, the role of imaging in ovarian cancer screening is limited, because gynecologic oncologists depend more on the clinical examination and tumor markers cancer antigen 125 (CA125) to make the diagnosis. Ovarian cancers are usually detected when patients become symptomatic and are often quite large and disseminated throughout the abdomen and pelvis at the time of diagnosis. Ovarian cancers comprise a wide variety of…

Cervical Cancer

Introduction Cervical cancer is the third most common gynecologic malignancy in the United States. In 2019, 13,170 new cases and 4250 deaths are expected in the United States. Across the world cervical cancer is the fourth most common cancer in women, with 575,000 cases and 311,000 deaths in 2018. However, the incidence varies widely across developed and underdeveloped countries, ranging from 2 to 75 per 100,000…

Tumors of the Uterine Corpus

Malignant tumors of the uterine corpus can be divided into epithelial and mesenchymal types (sarcomas). In 2019, there were an estimated 61,880 cases of cancer involving the uterine corpus in the United States, of which 3% were uterine sarcomas, with an estimated 12,160 deaths. I Endometrial Cancer Introduction The most common epithelial tumor of the uterine corpus is endometrial cancer, representing more than 95% of uterine…

Primary Retroperitoneal Tumors

Introduction Primary retroperitoneal tumors are exceedingly rare. Primary masses in the retroperitoneum can be categorized as one of three entities: lymphomas, extragonadal germ cell tumors, and sarcomas. Although gastrointestinal stromal tumors (GISTs) arise in the intraperitoneal compartment, they can also mimic these retroperitoneal masses because of their large size. This chapter reviews primary retroperitoneal sarcomas (RPSs), which form about one third of all primary retroperitoneal tumors.…

Prostate Cancer

Introduction Prostate cancer is the most commonly diagnosed cancer among American men. For prostate cancer, imaging is crucial in assessing both primary disease and metastasis. Imaging is used in diagnosis, staging, pretreatment planning, disease surveillance, and monitoring response to treatment. Imaging is playing an increasing role in disease detection, including location within the gland, and guiding biopsies. Traditional roles continue to include defining intra- versus extraprostatic…

Primary Adrenal Malignancy

Introduction Adrenal masses are found in 2% to 9% of adults. In patients with a known history of malignancy, incidentally detected adrenal masses may be either benign or metastastic (the incidence of metastasis in this scenario varies from 25% to 72%, depending upon the type of primary tumor). In patients with no history of malignancy, the vast majority of adrenal masses tend to be benign adenomas,…

Testicular Germ Cell Tumors

Introduction Testicular cancer is the most common malignancy in males ranging from puberty to the fourth decade of life. The vast majority of testicular cancers (95%) are gonadal germ cell tumors (GCTs). The remaining 5% of GCTs in males are extragonadal germ cell tumors (EGGCTs). Female gonadal GCTs of the ovary, which account for 30% of ovarian tumors, are not discussed in this chapter. Although the…

Urothelial Carcinoma (Bladder Cancer and Upper Tracts)

Introduction Carcinoma of the urothelium is ’one of the most common tumor to affect the genitourinary system in the United States. The urothelium is the normal epithelium that lines the entire urinary collecting system from the calyces to the prostatic urethra. We will divide the urinary tract into a lower tract (bladder and prostatic urethra) and upper tract (pyelocaliceal system and ureters). Urothelial cancer is considered…

Renal Tumors

Introduction Cancer of the kidneys constitutes nearly 2% of the total human cancer burden worldwide, with a slightly increased incidence in developed countries. Renal neoplasms represent several histologic subtypes that show a characteristic pattern of somatic mutations, which, along with histopathology, constitute the major criteria for their classification. The 2016 World Health Organization (WHO) classification of adult renal neoplasms is based on cytologic, architectural, genetic, and…

Colorectal Cancer

Introduction Colorectal cancer (CRC) is one of the most common adult cancers. Imaging plays an important role in the management of CRC, including screening, staging, and surveillance. Understanding the anatomy of the colon and rectum is important when interpreting radiologic examinations pertaining to CRC. This especially applies when evaluating for the pattern and extent of disease spread. Computed tomographic colonography (CTC) is one of the recommended…

Small Bowel Malignant Tumors

Introduction Small bowel (SB) malignancies account for only 3% of all gastrointestinal (GI) neoplasms and 0.6% of all cancers in the United States. Common primary malignant tumors include carcinoid (40%), adenocarcinoma (31%), lymphoma (17%), and sarcoma (9%). The risk of a specific SB tumor type depends on the exact location in the SB, with adenocarcinomas the most common duodenal tumor and carcinoids the most common ileal…

Gastric Carcinoma

Introduction Over the past several decades, the incidence of gastric carcinoma in the world has been on a decline, but it remains the second most common cause of cancer-related death worldwide. There are differences in the geographic distribution, epidemiologic trends, presentation, and location of gastric carcinoma that have been studied in detail recently. Gastric carcinoma tends to be diagnosed at an advanced stage, particularly in the…

Esophageal Cancer

Introduction Esophageal cancer (EC) is a devastating diagnosis with a high morbidity and mortality. The overall 5-year survival rate for all combined stages remains dismally low, at approximately 17%. Although it is a relatively uncommon malignancy, accounting for less than 1% of all malignancies, it has been steadily increasing in incidence since the 1980s. Approximately 17,650 new cases were reported in the United States in 2019…

Pancreatic Neuroendocrine Tumors

Introduction Pancreatic neuroendocrine tumors (PNETs) are a heterogeneous subgroup of gastroenteropancreatic neuroendocrine tumors (NETs). The term neuroendocrine is derived from the similarity to neural cells in the expression of proteins such as synaptophysin, neuron-specific enolase, and chromogranin A. PNETs are thought to arise from a common precursor neuroendocrine cell that shares features with similar cells throughout the body that constitute the “neuroendocrine system.” The embryologic origin…

Cystic Pancreatic Lesions

Introduction Cystic lesions of the pancreas include malignant and benign processes and may or may not cause clinical symptoms. The risk of malignancy in symptomatic cyst can be high, whereas asymptomatic cysts can be benign, malignant, or premalignant. Pancreatic cystic neoplasms account for 10% to 15% of pancreatic cysts, and less than 1% of primary pancreatic malignancies. Currently, CT and magnetic resonance imaging (MRI) are used…