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Cancer of the Anal Canal

Summary of Key Points Incidence It was estimated that there were 8580 anal squamous cell carcinomas diagnosed and 1160 deaths from this disease in the United States in 2018. The age-adjusted incidence rate is 1.7 per 100,000 men and women per year with a female predominance. Biologic Characteristics Anal cancer is associated with human papillomavirus (HPV) infection, which mediates transformation of the anal squamous epithelium through…

Cancer of the Rectum

Summary of Key Points Incidence Approximately 43,030 cases of rectal cancer will be diagnosed in the United States in 2018. The lifetime risk of developing colorectal cancer is roughly 4.5%. Higher rates of rectal cancer are noted in industrialized nations. Incidence has continued to decline over the past 20 years. Since 2001, rectal cancer in patients younger than 50 years has increased at an average annual…

Colorectal Cancer

Summary of Key Points Epidemiology Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men worldwide. Within economically developed countries, the lifetime risk of developing CRC varies among countries; for instance, it is 4.3% in the United States, but in the United Kingdom it is 6.4% for men and significantly lower for women (5%). CRC incidence is…

Cancer of the Small Bowel

Summary of Key Points Incidence Small bowel tumors are rare, with an incidence of less than 10% of new gastrointestinal (GI) cancer diagnoses and less than 1% of all newly diagnosed cancers each year. Genes involved include APC, KIT, and mismatch repair genes. Biologic Characteristics Malignant primary small bowel tumors consist of carcinoid (37%–39%), adenocarcinoma (31%–37%), lymphomas (17%–18%), and gastrointestinal stromal tumors (GISTs) (8%–10%). Staging Evaluation…

Cancer of the Stomach

Summary of Key Points Epidemiology and Pathology In the United States, it was predicted that there would be 28,000 patients diagnosed with gastric cancer in 2017, with an estimated 10,960 deaths. In the United States, the site of origin is shifting as more proximal lesions are diagnosed. Biological Characteristics Prognostic factors relate to tumor extent and include nodal involvement and extension beyond the gastric wall. Chronic…

Cancer of the Esophagus

Summary of Key Points Classification Adenocarcinomas and squamous cell carcinomas (SCCs) comprise 98% of esophageal tumors. The Siewert classification is now commonly used to categorize gastroesophageal junction (GEJ) tumors, although many studies, especially those for advanced disease, have enrolled patients with esophageal, GEJ, and gastric cancers. Incidence In the United States, approximately 17,290 patients will be diagnosed with esophageal cancer in 2018, with 15,850 deaths. Historically…

Diseases of the Pleura and Mediastinum

Summary of Key Points Malignant Pleural Mesothelioma Malignant pleural mesothelioma (MPM) is a rare disease with 2000 to 3000 cases occurring annually in the United States. Approximately 90% of the cases are attributed to prior asbestos exposure, with a latency period of more than 20 years. Other risk factors include smoking and prior chest radiation. There is a male predominance, with a peak age of 60…

Cancer of the Lung : Non–Small Cell Lung Cancer and Small Cell Lung Cancer

Summary of Key Points Non–Small Cell Lung Cancer Non–small cell lung cancer (NSCLC) constitutes 80% to 85% of new cases of lung cancer in North America. The most frequent histologic types are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. NSCLC is the leading cause of cancer-related death in the United States for both men and women; it is one of the most preventable forms of…

Cancer of the Endocrine System

Summary of Key Points Thyroid Cancer The incidence of thyroid cancer is increasing, and there are approximately 33,500 new cases per year in the United States. The incidence of differentiated thyroid cancer is 14.3 per 100,000 people per year, with a female-to-male ratio of more than 3 : 1. Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC), which accounts for 80% of all thyroid cancers; follicular thyroid…

Nonmelanoma Skin Cancers: Basal Cell and Squamous Cell Carcinomas

Summary of Key Points Incidence More than 5 million new cases of nonmelanoma skin cancer (NMSC) occur annually in the United States, including 80% basal cell carcinomas (BCCs), 20% squamous cell carcinomas (SCCs), and a few rarer types. Annual incidence is increasing by 4% for SCC and 1% for BCC in the United States. Of solid organ transplant recipients, 15% to 43% will develop NMSC within…

Melanoma

Summary of Key Points Incidence The incidence of melanoma continues to dramatically increase in the United States and worldwide. Approximately 87,110 new cases of invasive melanoma are estimated to be diagnosed anually in the United States, and it is estimated that 1 in 28 men and 1 in 44 women in the United States will be diagnosed with melanoma in their lifetime. Biologic Characteristics The risk…

Cancer of the Head and Neck

Summary of Key Points In the United States it is estimated that there will be 51,540 new cases of head and neck cancer in 2018, accounting for 3% of all cancer cases and 1.5% of all cancer deaths. The three major risk factors for head and neck cancer are tobacco use, human papillomavirus (HPV) infection, and alcohol use. Management of head and neck cancers requires a…

Ocular Tumors

Summary of Key Points Incidence The most common primary intraocular tumors are choroidal melanoma and retinoblastoma. The most common affecting the ocular adnexa are lymphoma, rhabdomyosarcoma, optic nerve glioma, and epithelial and melanocytic malignancies of the eyelid and conjunctiva. Many systemic neoplasms can involve the eye and adnexa, especially breast and lung cancer, lymphoma, and leukemia. Etiology Retinoblastoma is the prototypical model of a genetically transmissible…

Cancer of the Central Nervous System

Summary of Key Points Incidence 78,980 new primary brain tumors will be diagnosed in the United States in 2018, of which approximately one-third will be malignant. 3,560 new childhood (ages 0–19 years) primary benign and malignant CNS tumors will be diagnosed in 2018. Brain tumors are now the most commonly diagnosed malignancy among children at a rate of 5.47 per 100,000 population, surpassing leukemia (5.0 per…

Human Immunodeficiency Virus (HIV) Infection and Cancer

Summary of Key Points Nearly 37 million people were living worldwide with human immunodeficiency virus (HIV) infection in 2016, and about 2 million become infected every year. HIV testing is recommended as a component of routine medical care, not just in individuals with known risk factors, including patients with cancer. Acquired immunodeficiency syndrome (AIDS) is defined as HIV infection associated with an absolute CD4 count below…

Special Issues in Pregnancy

Summary of Key Points Cancer complicates 1 in 1000 pregnancies; the most common malignancies in pregnant women are breast cancer, cervical cancer, Hodgkin lymphoma, malignant melanoma, and acute leukemia. No evidence exists that pregnancy alters the clinical behavior of cancer, but cancer often is advanced at diagnosis because of the overlap of symptoms with those of a normal pregnancy. Important factors in management include assessment of…

Cancer in the Elderly: Biology, Prevention, and Treatment

Summary of Key Points Physiologic Changes of Aging Cancer and aging share common biologic and cellular mechanisms such as genomic instability, deregulated energetics, and cellular senescence. † Deceased. Older adults have age-related changes in all organ systems that decrease the tolerance to both cancer and its treatments. Geriatric Assessment in Oncology The geriatric assessment is a multidimensional evaluation of an older adult's physical function, cognition, comorbidity,…

Malignancy-Related Effusions

Summary of Key Points Malignancy-Related Ascites Malignancy-related ascites is a common complication of advanced cancer. Malignancy-related ascites accounts for 10% of all cases of ascites, with a majority of these cases related to carcinomatosis. Malignancy-related ascites most commonly occurs in patients with ovarian cancer, gastrointestinal malignancies, and carcinoma of unknown primary location. Malignancy-related ascites is rarely life threatening, but its occurrence signals advanced cancer and may…

Liver Metastases

Summary of Key Points Etiology The liver is a common site of metastatic disease in most gastrointestinal cancers owing to hepatic portal venous drainage. Diagnostic and Preoperative Evaluation Clinical risk scores, which predict prognosis for metastatic liver disease, are less frequently used clinically in the current era of improved chemotherapy and more aggressive surgical decision making. Contrast-enhanced computed tomography is the most widely used imaging modality…

Lung Metastases

Summary of Key Points Background and Etiology Lung metastases may develop in the lung parenchyma, lymph nodes, or pleura of the lung, and may occur because of genetic or immunologic changes and/or the co-opting of normal cellular processes to assist with metastatic spread. Dietary factors such as increasing omega-3 and decreasing omega-6 fatty acid levels in the diet may modulate the risk of lung metastasis. Patients…