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Hepatobiliary Cancer

Key Points Incidence Globally, hepatobiliary cancer is the sixth most common cause of cancer and the second most common cause of cancer death. In 2018, the expected incidence of hepatobiliary cancer in the United States was 54,410 cases, with 33,990 deaths. Biological Characteristics The primary risk factors for hepatocellular carcinoma (HCC) are chronic hepatitis B infection and hepatitis C infection, although liver cirrhosis from any cause…

Pancreatic Cancer

Key Points Incidence and Epidemiology In the United States in 2018, an estimated 55,440 patients will be diagnosed with pancreatic cancer (PCA) and 44,330 will die of the disease. PCA is the 12th most commonly diagnosed cancer and the 4th leading cause of cancer-related death in men and women in the United States. Incidence rates are highest in Western and developed countries, among the elderly, African…

Esophagus-Gastric Cancer

Key Points Incidence For 2019, the predicted incidence of esophageal and gastric cancers in the United States is projected to be 17,650 and 27,510 cases, respectively. The predicted number of deaths is 16,080 and 11,140, respectively. The site of origin is shifting to tumors localized in the distal esophagus, gastroesophageal junction (GEJ), and proximal stomach. Biological Characteristics The main prognostic factors relate to locoregional tumor extent,…

Overview

Gastrointestinal (GI) cancer continues to be a common health problem. Approximately 319,160 new cases of GI malignant disease were estimated to occur in the United States in 2018 with an associated 160,820 deaths. Although colorectal tumors account for almost 50% of the cases in the United States (140,250), cancers of the esophagus, stomach, liver, and pancreas continue to occur with regularity and have high mortality rates,…

Uncommon Thoracic Tumors

Key Points Incidence Three distinct neoplasms are discussed in this chapter: thymoma, bronchopulmonary carcinoid, and malignant pleural mesothelioma. The overall incidence of thymoma in the United States is 0.15 cases per 100,000 persons. Thymoma is the most common tumor of the anterior mediastinum, accounting for 30% of anterior mediastinal lesions and 20% of all mediastinal tumors in adults. The rate for bronchopulmonary carcinoids is 0.6 per…

Non–Small Cell Lung Cancer

Key Points Incidence In the United States, approximately 228,150 cases of lung cancer and approximately 142,670 deaths were projected from lung cancer in 2019. Incidence is decreasing in the United States while increasing worldwide, reflecting patterns in tobacco use. Routine lung cancer screening with low-dose computed tomography (CT) is recommended for patients with a significant tobacco history. Biological Characteristics The predominant histological classifications of NSCLC are…

Small Cell Lung Cancer

Key Points Incidence Small cell lung cancer (SCLC) represents about 15% of over 230,000 annual lung cancer diagnoses in the United States. Only about one-third present without metastatic disease. Biological Characteristics SCLC is a high-grade tumor of the lung, with ultrastructural characteristics consistent with its neuroendocrine differentiation. P53 and pRB are mutated in nearly all cases, and additional mutations are acquired, leading to the final metastatic…

Overview

Primary thoracic neoplasms are reviewed in detail in the chapters of this section. In this overview, we consider developments and controversies in the diagnosis and treatment of non–small cell lung cancer (NSCLC), small cell lung cancer (SCLC), thymic tumors, pulmonary carcinoid, and mesothelioma. Epidemiology Lung Cancer Lung cancer is the most common and deadliest thoracic malignancy, accounting for approximately 3000 deaths each week in the United…

Malignant Melanoma

Key Points Incidence It was estimated that in 2018 there would be 91,270 new cases of melanoma diagnosed and 9320 deaths in the United States. Biological Characteristics Sun exposure is clearly associated with the development of cutaneous melanoma. Inherited mutations may also play a role in some cases. The natural history of melanoma is usually characterized by early, stepwise dissemination from a primary tumor to regional…

Cutaneous Carcinoma

Key Points Incidence Cutaneous basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are the most frequent cancers worldwide. Caucasian populations residing in locations with high level exposure to ultraviolet (UV) radiation, such as Australia and New Zealand and the Southern United States, have a particularly high lifetime risk for developing skin cancer. Biologic Characteristics The natural history of skin cancers varies widely with the histologic…

Management of the Neck

Assessment and treatment of regional lymph nodes in the neck are of utmost importance in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The philosophy of treatment of the neck has evolved over the past several decades. Radiation oncologists and head and neck surgeons have progressively realized that extensive treatments are associated with more morbidity, but not always with a better oncologic…

Unknown Head and Neck Primary Site

Key Points Incidence Carcinoma of an unknown primary tumor (CUP) in the head and neck describes a patient with cervical node metastases without a physically or radiologically identifiable primary tumor site. Approximately 3% of patients with head and neck squamous cell carcinomas have a CUP. Biologic Characteristics Biologic characteristics are similar to head and neck mucosal squamous cell carcinomas with known primary sites. Most CUPs are…

Thyroid Cancer

Key Points Incidence Thyroid cancer incidence in the United States increased on average 3.6% per year during 1974 to 2013 (from 4.56 per 100,000 person-years in 1974 to 1977 to 14.42 per 100,000 person-years in 2010 to 2013) mainly owing to increases in papillary thyroid cancer (PTC). Biologic Characteristics Prognostic factors include patient age, histology, grade, tumor size, neoplastic extent, and completeness of initial surgical resection.…

Salivary Gland Malignancies

Key Points Incidence The overall incidence of salivary gland malignancies in the general population is about 0.9 to 4.0 new cases per 100,000 population per year. Biologic Characteristics Prognostic factors relate to histology, grade, primary tumor size and extent, lymph node involvement, gender, and age. Staging Evaluation Staging includes a thorough history and physical examination, chest radiography, contrast-enhanced computed tomography (CT) scan or magnetic resonance imaging…

Sinonasal Cancer

Key Points Incidence and Epidemiology Sinonasal cancers comprise less than 1% of all malignant neoplasms and the American Cancer Society estimates 2000 Americans develop cancers of the nasal cavity and paranasal sinuses annually. Men are 50% more likely to be affected. Approximately 40% to 50% occur within the nasal cavity, 30% to 40% within the maxillary sinus, 10% in the ethmoids, and less than 5% in…

Larynx and Hypopharynx Cancer

Key Points Incidence Laryngeal and hypopharyngeal cancers account for about one-third of all head and neck neoplasms, affecting approximately 13,000 Americans per year. Biological Characteristics Prognosis for all tumors is primarily dependent on extent of disease, although it is also influenced by the anatomic site of origin. Glottic tumors have the lowest incidence of metastases because they more commonly present with earlier-stage lesions and the true…

Nasopharyngeal Carcinoma

Key Points Incidence In the United States, nasopharyngeal carcinoma is uncommon, occurring at a rate of less than one case per 100,000 people. In contrast, in southern China and Hong Kong, the incidence is 25 to 50 per 100,000 people and among the Inuit in Alaska and Greenland, 15 to 20 per 100,000 people. Biology A potential link between Epstein-Barr virus (EBV) and nasopharyngeal cancer was…

Oropharyngeal Cancer

Key Points Incidence The estimated annual incidence of oropharyngeal cancer in the United States is more than 10,000 patients. The incidence of oropharyngeal cancer has gradually increased over the past several decades, particularly in younger patients. Biologic Characteristics Squamous cell carcinomas represent over 95% of all tumors arising within the oropharynx. Approximately 70% of patients present with nodal involvement and 10% to 15% of these have…

Oral Cavity

Key Points Incidence In 2017, there were an estimated 32,670 new cases of oral cavity cancer with an estimated 6650 deaths due to the disease. Biologic Characteristics Growth patterns depend on the oral cavity subsite of the cancer. Cancers can grow exophytically or endophytically. Due to the lack of anatomic barriers in the oral cavity, cancer can grow quickly and expand into nearby structures. Staging Evaluation…

Overview

Although representing about 4% of cancers, a variety of neoplasms with diverging natural histories arise in the relatively small body region of the head and neck. Essential basic physiological functions that are critical for expression, respiration, nutrition, and social interactions are all located within the head and neck region, including personal appearance. Depending on the site, size, and pattern of spread, head and neck cancers can…