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Myelodysplastic Syndromes

Summary of Key Points Etiology The myelodysplastic syndromes (MDS) are a group of clonal marrow failure syndromes originating in a hematopoietic progenitor or stem cell. Approximately 25% to 30% of MDS cases eventually progress to acute myeloid leukemia (AML), which is defined by 20% or more marrow blasts or an AML-restricted karyotype. Approximately 50% of MDS cases are associated with a karyotypic abnormality, often chromosomal aneuploidy…

Acute Leukemias in Adults

Summary of Key Points Incidence There were 19,950 new cases of acute myeloid leukemia (AML) and 6590 new cases of acute lymphocytic leukemia (ALL) in the United States in 2016, resulting in 10,430 deaths from AML and 1430 from ALL. Whereas the incidence of AML is relatively low until age 35 years and then rises almost exponentially, ALL peaks in incidence in young children. Risk factors…

Childhood Lymphoma

Summary of Key Points Incidence Malignant lymphoma, which comprises both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), is the third most common malignancy in childhood. Among children younger than age 15 years, there is a slight predominance of NHL; HL is more frequent among children up to age 18 years. There are approximately 500 to 750 newly diagnosed cases of pediatric NHL in the United States…

Childhood Leukemia

Summary of Key Points Incidence Leukemia is the most common childhood cancer, accounting for 30% of cancers occurring before age 15 years and 25% before age 20 years. Acute lymphoblastic leukemia (ALL) accounts for 75% to 80% of all cases of childhood leukemia; acute myeloid leukemia (AML) comprises 15% to 20%. Approximately 85% of ALL cases are B-lineage (B-ALL), and 15% are T-lineage (T-ALL). Myeloproliferative neoplasms,…

Pediatric Solid Tumors

Summary of Key Points Osteosarcoma The incidence of osteosarcoma is 5 new cases per 1 million population per year among children and adolescents (up to 19 years). Osteosarcoma is the most common bone tumor in children and adolescents. Other lytic bone lesions, including eosinophilic granuloma and giant cell tumor, must be excluded. At histopathological examination, tumors must be differentiated from fibrosarcoma and chondrosarcoma. Staging evaluation includes…

Carcinoma of Unknown Primary

Summary of Key Points Incidence Carcinoma of unknown primary is a diverse group of heterogeneous cancers that accounts for about 2% to 4% of all cancers. Evaluation There is not universal agreement on the extent of the appropriate initial evaluation to find a primary cancer; a focused evaluation is recommended. Early biopsy of a metastatic site is recommended to establish the diagnosis and help direct further…

Sarcomas of Soft Tissue

Summary of Key Points Incidence and Epidemiology Annually, 12,390 new cases occur in the United States—fewer than 1%–2% of cancer diagnoses. No specific etiologic agent is identifiable in the majority of cases. Occasional cases are related to previous radiation, chemical exposure, alkylating chemotherapeutic agents, or chronic lymphedema. Genetic conditions related to soft tissue sarcoma include Li-Fraumeni syndrome, neurofibromatosis, tuberous sclerosis, basal cell nevus syndrome, Gardner syndrome,…

Sarcomas of Bone

Summary of Key Points Incidence and Epidemiology More than 3000 new cases of bone sarcoma are diagnosed annually in the United States. No specific etiologic agents are identified in the majority of cases. Secondary neoplasms are related to known oncogenic factors (e.g., ionizing radiation, alkylating chemotherapy agents, combinations of both). Hereditary cancer syndromes (tumor suppressor genes) are responsible for some cases. Diagnosis and Radiographic Staging Plain…

Cancer of the Breast

Summary of Key Points Incidence and Epidemiology Breast cancer is the most frequently diagnosed cancer in women in the United States, accounting for an estimated 268,670 new cases of invasive breast carcinoma, 63,960 new cases of in situ carcinoma, and 41,400 deaths in 2018. In the United States, the age-specific incidence of breast cancer increases with age, to a lifetime risk of breast cancer of 1…

Gestational Trophoblastic Disease

Summary of Key Points Incidence and Epidemiology The incidence of complete hydatidiform mole is approximately 1 in 1200 pregnancies in the United States. The incidence of partial hydatidiform mole is approximately 1 in 650 pregnancies. Repeat moles occur in approximately 1 in 125 pregnancies, and third moles occur in approximately 1 in 5 pregnancies. Complete hydatidiform mole is usually caused by an androgenetic diploid conception in…

Carcinoma of the Ovaries and Fallopian Tubes

Summary of Key Points Ovarian cancer is the second most common gynecologic malignancy, but it is the leading cause of gynecologic cancer-related deaths in the United States. There are many different histologic subtypes of ovarian cancer. Among these, high-grade serous is the most common. The overall 5-year survival rate for all patients is approximately 45%. Risk factors vary depending on histologic subtype but in general include…

Uterine Cancer

Summary of Key Points Incidence 60,000 estimated new cases per year. Approximately 10,400 deaths per year from the disease. Endometrioid adenocarcinoma arises in the endometrium and accounts for approximately 90% of cases. Biological Characteristics Median age is 63 years. The most common presenting symptom is irregular vaginal bleeding. Risk factors include unopposed estrogen therapy, obesity, chronic anovulation, tamoxifen use, diabetes, and nulliparity. Staging Evaluation Staging is…

Cancers of the Cervix, Vulva, and Vagina

Summary of Key Points Cervical Cancer An estimated 12,990 new cases of invasive cervical cancer were anticipated in 2016 in the United States, with 4120 deaths projected. Seventy-five percent to 80% are squamous cell carcinomas. Since the advent of cytologic screening in the 1940s, the incidence of cervical cancer has been decreasing; however, a steady increase in the incidence of preinvasive disease of the cervix has…

Testicular Cancer

Summary of Key Points Incidence Testicular cancer comprises 1% of all male malignancies, accounting for over 8000 new cases a year in the United States. It is the most common malignancy in men aged 15 to 35 years. Germ cell tumors account for 95% of all testicular cancers. Pure seminoma accounts for 40% of all germ cell tumors. Nonseminoma accounts for 60% of all germ cell…

Cancer of the Penis

Summary of Key Points Incidence Penile cancer is rare in developed countries but is responsible for a large proportion of solid tumors in males where sanitation and medical care are poor. Biologic Characteristics Most penile cancers are squamous cell carcinomas, and many are associated with high-risk human papillomavirus (HPV) infection. Presentation is typically with localized disease with predictable spread to regional lymph nodes preceding widespread metastasis.…

Prostate Cancer

Summary of Key Points Incidence Prostate cancer is the most commonly diagnosed life-threatening cancer in men (180,890 cases and 26,120 deaths in 2016). Small prostate cancers are present in 29% of men between ages 30 and 40 and 64% of men between ages 60 and 70. The lifetime risk of a prostate cancer diagnosis is about 1 in 8, and the risk of dying from prostate…

Carcinoma of the Bladder

Summary of Key Points Incidence Worldwide, bladder cancer is diagnosed at a rate of approximately 429,800 cases each year and causes 165,100 deaths. In the United States, it is the fourth most common cancer in men. In 2018 there were an estimated 81,190 diagnoses and 17,240 deaths. Median age at diagnosis is 73 years. Many patients have comorbid illnesses such as cardiovascular disease at diagnosis. Cigarette…

Cancer of the Kidney

Summary of Key Points Renal cell carcinoma (RCC) accounts for 4% to 5% of malignancies in adults. Cigarette smoking (in more than 20% of cases) and obesity (in more than 30%) are established causal factors for RCC. Four percent of cases of RCC arise from hereditary syndromes. Different subtypes of RCC are characterized by distinct clinical behavior, genetic abnormalities, and molecular signatures. Clear cell RCC is…

Carcinoma of the Pancreas

Summary of Key Points Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death. The overall 5-year survival rate for all patients is less than 5%: 15% to 20% of patients present with resectable or borderline resectable disease with a median survival period of 20 to 24 months, 25% to 30% present with locally advanced or unresectable disease with a median survival period of 8 to…

Liver and Bile Duct Cancer

Summary of Key Points Liver Cancer There is a continued rise of hepatocellular carcinoma (HCC) incidence, especially in the Western hemisphere. HCC main risk factors are hepatitis B, hepatitis C, alcohol use, and nonalcoholic steatohepatitis. Screening programs continue to evolve but depend mainly on ultrasound and α-fetoprotein (AFP) evaluations. Staging of HCC depends on evaluating the two aspects of the disease: the cancer itself and the…