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Pancreatic Ductal Adenocarcinoma

Introduction Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival rate of less than 10%, and accounts for 90% of all pancreatic tumors. It remains one of the most difficult challenges in oncology because patients are typically asymptomatic until the disease is in an advanced stage. It is also not unusual to present with symptomatic metastases in the presence of a small primary…

Cholangiocarcinoma

Introduction Cholangiocarcinoma (CCA) refers to cancers that arise from biliary epithelium. These tumors can occur anywhere along the biliary tree and are divided into extrahepatic cholangiocarcinoma (ECC) and intrahepatic cholangiocarcinoma (ICC), with ECC lesions subclassified into perihilar and distal lesions. This practical classification is based on anatomy and surgical management. Cancers of the gallbladder (GB) are part of the CCA family but have a different clinical…

Liver Cancer: Hepatocellular and Fibrolamellar Carcinoma

Hepatocellular Carcinoma Introduction Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fifth most common cancer in the world. HCC typically develops in patients with background liver disease. Screening patients at risk with ultrasound (US) and for α-fetoprotein (AFP) levels every 5 months improves early detection rates. HCC can be diagnosed with multiphase computed tomography (CT) or magnetic resonance imaging (MRI) without the…

Pleural Tumors

Introduction Neoplasms of the pleura are a diverse group of benign and malignant pathologic entities that include both primary and secondary malignancies. Most neoplasms of the pleura are metastases, typically from lung cancer, although extrathoracic neoplasms such as breast and ovarian cancer have a predilection for spread to the pleura. This chapter discusses the most common primary malignant neoplasm to arise from the pleura, diffuse malignant…

Primary Mediastinal Neoplasms

Introduction The mediastinum can be the site of a variety of neoplastic conditions that can include both benign and malignant entities. Most neoplasms of the mediastinum are metastases, typically from lung cancer, although extrathoracic neoplasms such as breast cancer and melanoma have a predilection for spread to the mediastinum. Primary neoplasms of the mediastinum are uncommon, and whereas the majority in adults are benign, those in…

Lung Cancer

Introduction Lung cancer is a common malignancy, and imaging is an integral part of the detection, diagnosis, and staging of the disease, as well as assessing response to therapy and monitoring for tumor recurrence after treatment. This chapter will review the appropriate use of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) imaging and management in patients with nonsmall cell lung carcinoma…

Head and Neck Cancer

Introduction Head and neck cancer is a topic that at first glance can be somewhat formidable, but has considerable shared risk factors as other tumors, and is often found synchronously or incidentally on workup for other lesions. Recognizing that many radiologists prefer to keep their focus at or below the level of the clavicles, we aim to make head and neck cancer less of an enigma.…

Assessing Response to Therapy

Introduction Cancer continues to be a major health problem, as one in four deaths in the United States is attributed to cancer. However, we continue to see incremental improvements over time, with the relative 5-year survival rate for cancer in the United States at 68%, up from 50% in the mid-1970s. Cancer death rates fell 21.0% among men and 12.3% among women from 1991 to 2006…

A Multidisciplinary Approach to Cancer: A Radiation Oncologist’s View

Radiation therapy forms an integral part of the care of 50% to 60% of cancer patients in the United States. It plays a key role in the multidisciplinary curative treatment of many patients with head and neck, thoracic, genitourinary, gynecologic, and gastrointestinal cancers, lymphoma, sarcoma, brain tumors, and other malignancies. Radiation therapy also provides highly effective palliation of cancer symptoms, including pain, bleeding, and other symptoms…

A Multidisciplinary Approach to Cancer: A Medical Oncologist’s View

Introduction As our understanding of cancer has grown, medical oncology has evolved as a subspecialty of internal medicine since the 1960s. Initially, few treatments beyond surgery and a handful of toxic chemotherapy agents were available to cancer patients. Medical oncologists now have hundreds of chemotherapeutic agents and hundreds of targeted agents ranging from small molecules to monoclonal antibodies to genetically engineered cellular therapy to choose from…

A Multidisciplinary Approach to Cancer: A Surgeon’s View

Introduction Surgery remains a pillar of multimodality therapy for long-term survival in virtually all patients with solid tumors. For surgery to be effective, however, patients must be selected properly so that nontherapeutic surgery is avoided. In the current era of cancer surgery and imaging, “exploratory surgery” should, with the rarest of exceptions, not exist as a diagnostic modality. Both survival and resectability rates are rising based…

A Multidisciplinary Approach to Cancer: A Radiologist’s View

Introduction Multidisciplinary care teams are those that are composed of members from multiple different medical specialties working together to achieve the highest quality of care for the patient. Such teams are particularly needed in complex environments such as cancer hospitals. Frequently patients and their physicians are faced with different options for workup and therapy that cross the boundaries of specialties. These multidisciplinary teams may be comprised…

Telemedicine in Lung Cancer Rehabilitation

Telemedicine refers to the use of telecommunication technologies to deliver healthcare services at a distance. The concept of telehealth refers to the broader scope of healthcare services, including nonclinical services. In contrast, telemedicine, a subset of telehealth, refers to the delivery of clinical services by a practicing healthcare provider (physician, nurse practitioner, or physician assistant). Throughout this chapter, the terms telehealth and telemedicine will be used…

Functional Outcomes in Lung Cancer Rehabilitation

Introduction While lung cancer is the third most common cancer in males and females (behind breast and prostate cancer), it is the leading cause of cancer related death in the United States. , The 2-year survival rate ranges from 15% to 42% depending on the type of lung cancer. Risk factors for developing lung cancer include age >50 years, tobacco smoke exposure, and male gender. Smoking…

Musculoskeletal and Neurological Complications of Check Point Inhibitors

Introduction For decades, the standard of care for lung cancer, especially advanced disease, has been chemotherapy. However, the identification of specific genetic mutations and molecular mechanisms by which cancerous cells evade T cell-mediated cytotoxic damage has facilitated the development of immunotherapy. Since 2015, the Food and Drug Administration (FDA) has approved using multiple immunotherapy agents to be used in combination or as monotherapy for lung cancer…

Complications and Rehabilitation Challenges of Lung Cancer Surgeries

Surgical Techniques Tumor resection is the mainstay treatment of early stages of lung cancer (stage I, II, and some stage III). The first total pneumonectomy reported in the United States was performed in the 1940s by Dr. Evarts Graham, in Saint Louis, Missouri Graham . Since then, advances in technology have been developed to decrease morbidity and mortality associated with the procedure. Less invasive surgical techniques…

Neuropathy in Lung Cancer

Introduction There is a wide variety of neuromuscular diseases that impact patients with lung cancer and patients undergoing treatment for lung cancer. Neuropathy is a disease of peripheral nerves, with multiple primary, secondary, and tertiary consequences that can be debilitating for a patient's function and overall quality of life. For the purposes of this chapter, we will review the relationship of the neuropathic disease and function,…

Cognitive Impairment in Lung Cancer and Brain Metastases

Introduction Over the past few decades, advances in cancer treatments have significantly extended survival. With an increase in the number of cancer survivors, there has been a greater appreciation for potential adverse side effects of cancer treatments. Cognitive functioning in cancer patients has increasingly received research attention, particularly with the side effects of chemotherapy on cognition, which are often referred to by patients as “chemo brain”…

Pain Management in Lung Cancer Rehabilitation

Introduction Pain Definition In June 2020, the International Association for the Study of Pain (IASP) revised the definition of pain for the first time since 1979, after 2 years of development. The revised pain definition from the IASP reads as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Six additional notes were added to this revised…

Nutritional Considerations in Lung Cancer Rehabilitation

Introduction It has been estimated that about 235,760 people (119,100 men and 116.660 women) will be diagnosed with lung cancer in the United States in 2021. , 1 in 15 men and 1 in 17 women will be diagnosed with lung cancer in their lifetime with smokers having an increased risk compared to nonsmokers. , 541, 000 people in the United States have at some point…