Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Benign Diseases

Definition and Classification of Benign Diseases Many diseases that are pathologically benign (nonmalignant) do not act clinically benign and can cause significant symptoms or dysfunction. A number of these entities can be successfully treated with ionizing radiation. The use of radiation for benign diseases dates back centuries, with initial uses coming from results obtained using x-rays for experimental purposes. Sokoloff reported positive results in radiotherapy for…

Soft-Tissue Sarcoma

Key Points Epidemiology and Pathology Soft-tissue sarcomas (STS) account for approximately 1% of adult cancers in the United States. The estimated number of newly diagnosed cases in the year 2019 was projected to be 12,750, with a slightly higher male-to-female ratio and 5,270 deaths. The peak incidence of STS is the fifth decade of life, but histology such as rhabdomyosarcoma has a peak incidence in the…

Locally Advanced and Inflammatory Breast Cancer

Key Points Incidence Breast cancer is the most common cancer in women, with 252,710 new cases of invasive breast cancer diagnosed in 2017. The National Cancer Database (NCDB) reported that approximately 7% to 10% of all breast cancers (in situ and invasive) diagnosed annually between 2004 and 2015 were stage III. Biological Characteristics Locally advanced breast cancers (LABCs) are a heterogeneous group, ranging from indolent cancers…

Breast Cancer: Stages I-II

Key Points Patient Selection The majority of individuals with stages I-II invasive breast cancer are candidates for breast-conserving therapy (BCT). Treatment with conservative surgery (CS) and radiotherapy (RT) is absolutely or relatively contraindicated owing to toxicity concerns for only a few patients. The anticipated cosmetic results of CS and RT may be so poor for some individuals that mastectomy with immediate reconstruction is a more appealing…

Noninvasive Breast Cancer

Key Points Epidemiology Noninvasive breast cancers comprise more than 20% of all breast cancers. Lobular carcinoma in situ (LCIS) represents less than 15% of these noninvasive cancers, 0.5% to 5.0% are Paget disease, and 85% are ductal carcinoma in situ (DCIS). Biological Characteristics LCIS is a noninfiltrating lobular proliferation characterized by loose, noncohesive cells filling the acinar space. Lesions frequently stain for estrogen receptor (ER) and…

Overview

Key Points Incidence and Mortality Breast cancer is the most common cancer in women in both the developed and the developing world, with approximately 1.7 million new cases diagnosed in 2016. It accounts for 25% of all cancers in women and approximately 12% of all cancer cases. Its incidence is highest in North America, Australia, New Zealand, and western and northern Europe, and lowest in Asia…

Ovarian Cancer

Key Points Incidence and Etiology Ovarian cancer constitutes 3% of all cancer diagnosed in women and 5% of all cancer-related deaths. In 2018, the estimated incidence of ovarian cancer in the United States was 22,240 cases with an estimated 14,070 deaths. The lifetime risk in the general population is 1.3%. The molecular events involved in the carcinogenesis of ovarian cancer remain unclear; however, environmental, hormonal, and…

Cancers of the Vulva and Vagina

Incidence and Mortality Vulvar carcinoma accounted for an estimated 6190 cancer cases and 1200 deaths in the United States in 2018, comprising 0.70% of all cancers in women, 5.6% of gynecological malignancies, 0.42% of cancer deaths in women, and 3.6% of gynecological cancer deaths. The rarity of the disease has made it difficult to evaluate new treatment strategies in prospective randomized trials. Incidence has risen 0.6%…

Endometrial Cancer

Key Points Incidence Endometrial cancer is the most common gynecological malignancy, and the fourth most common cancer in women in the United States, with an estimated 61,880 new cases in 2019. The age-adjusted mortality rate is 4.7 deaths per 100,000 women per year, with an estimated 12,160 deaths in 2019. Biological Characteristics Historically, two prototypes of endometrial carcinoma have been distinguished: type 1, which was associated…

Cervical Cancer

Key Points Incidence Worldwide, cervical cancer is the most prevalent human papillomavirus (HPV)–related cancer, the fourth most common cancer in women, and the second most common cancer among women ages 15 to 44 years. In 2018, there were over 570,000 new cases and over 260,000 deaths. However, in the United States, the incidence of cervical cancer is quite low, accounting for approximately 13,000 cases annually and…

Overview

This overview provides an introduction to the chapters on cancers of the cervix, uterine corpus, vulva, vagina, and ovary. It highlights important clinical issues and novel developments as well as areas of controversy. Specific details of each of the disease sites are found in the relevant chapters. The recent publication of the cancer genome atlas for cervical and uterine cancer has created a new framework and…

Penile Cancer

Key Points Incidence Penile cancer occurs in 1 in 100,000 North American and European men (accounting for 0.4%-0.6% of all male cancers). It is 10% of male malignancies in parts of Asia, Africa, and South America. Biological Characteristics Human papillomavirus (HPV) types 16 and 18 are detected in 40% to 45% of penile cancers. Moderate or poor differentiation, invasion of the corpora, and the presence of…

Kidney and Ureteral Carcinoma

Key Points Incidence In 2018, an estimated 65,340 new cases of cancers arising from the renal pelvis and kidney proper are expected in the United States, with approximately 14,970 deaths. It represents the sixth most common cancer in men and the tenth most common cancer in women. Most of these cancers of the kidney are classified as renal cell carcinoma (RCC). By comparison, upper urinary tract…

Testicular Cancer

Key Points Incidence In men 15 to 35 years of age, testicular cancer represents the most frequently diagnosed malignancy, but overall only 1% of all malignant tumors. In 2012, 55,000 new cases and 10,000 deaths were estimated worldwide from this disease. Biologic Characteristics Isochromosome 12p is present in more than 80% of cases. Staging Evaluation After a history and physical examination has been taken, serum tumor…

Bladder Cancer

Key Points Incidence Bladder cancer is the sixth most common cancer in the United States, with over 80,000 new cases and 17,000 deaths estimated in 2019. Bladder cancer more commonly affects men, people of European heritage, and adults over age 65 years. Urothelial bladder cancer is associated with a number of modifiable environmental and occupational exposures, chief among them tobacco smoking. Biological Characteristics Bladder cancer is…

Prostate Cancer

Key Points Incidence It was predicted that there were an estimated 164,690 new cases of prostate cancer in the United States in 2018 and 29,430 deaths. Although the incidence of new cases has been relatively stable since 1994, owing to prostate-specific antigen (PSA) screening, the death rate has been declining because of earlier diagnosis and treatment. One in six American men will develop prostate cancer during…

Overview

The field of genitourinary oncology continues to evolve dramatically. With each new edition of this textbook, the management of patients with cancers of these sites has improved. It has truly become a field that is intensely multidisciplinary—radiation oncologists, often substantially outnumbered in the multidisciplinary clinic, must be masters of the published data. Genitourinary oncology has become one of the areas in which practicing radiation oncologists are…

Anal Carcinoma

Key Points Incidence In 2018, an estimated 8580 new cases and 1160 deaths were attributed to anal cancer, representing approximately 3% of gastrointestinal malignancies in the United States. Biologic Characteristics Prognostic factors predictive for local control and survival are primary tumor extent and size, regional lymph node involvement, and association with human papilloma virus (HPV) infection. Staging Evaluation Staging should generally include a complete history and…

Rectal Cancer

Key Points Incidence Colorectal cancer is the fourth most common form of cancer worldwide, with an estimated 800,000 new cases diagnosed each year, accounting for roughly 10% of all cancers. Approximately two-thirds of cases occur in the colon and one-third in the rectum. The incidence of rectal cancer in the United States and in the European Union is currently approximately 40,000 and 125,000 per year, respectively…

Colon Cancer

Key Points Epidemiology/Etiology In 2018, it is estimated that nearly 140,000 patients will be diagnosed with colon or rectal cancer and 50,000 deaths will occur in the United States. Linkage between diet and environmental factors with colon cancer is supported by epidemiological studies. Risk factors include advanced age, race, male sex, family history of colorectal cancer, increasing body mass index, low physical activity level, and red…