Open full size image Cancer drugs are a central part of cancer therapy and knowledge of their use, mode of action, and side effect profile is very important. This chapter is intended to provide an overview and to serve as a reference. With this intent, Table 54.1 lists the acronyms and components of a number of combination therapies and Tables 54.2 to 54.12 summarize the information…
Cardiac mass algorithm. (Adapted from Bruce CJ. Cardiac tumours: diagnosis and management. Heart . 2011;97(2):151–60; with permission.) Open full size image KEY POINTS Cardiac masses are uncommon, mostly encountered as an unexpected finding in clinical practice. The first step in the differential diagnosis is the question whether this mass could represent a normal variant. If not, the second step is to consider a vegetation (valvular lesions…
Open full size image KEY POINTS Carcinoid tumors are rare neuroendocrine tumors, arising from the small bowel (75% to 80%) or lung (20% to 30%). Carcinoid tumors secrete biologically active substances, including serotonin, histamine, tachykinins, kallikrein, and prostaglandins and they account for the presentation of carcinoid syndrome (flushing, diarrhea, and bronchospasm). Carcinoid syndrome typically occurs in patients with small-bowel primaries and hepatic metastases. Carcinoid syndrome therapy…
Unlike solid tumors, myeloma staging is a composite score based on the four tests: blood albumin, beta-2 microglobulin, lactate dehydrogenate (LDH), and bone marrow Fluorescent in situ hybridization (FISH). Stage I is albumin 3.5 g/dL or greater, beta-2 microglobulin is less than 3.5 mg/L, normal LDH, and no high-risk FISH. Stage III is beta-2 microglobulin 5.5 mg/L or greater and either high LDH or high-risk FISH.…
Open full size image Introduction The lymphomas represent 4% of all malignancies. In the 2017 World Health Organization (WHO) classification, there are approximately 106 subtypes of lymphoma ; a simplified overview is presented in Fig. 50.1 . The biology, natural history, management strategies, and outcomes of the histologic subtypes show notable differences. Diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma with MYC and/or BCL2 and BCL6…
Open full size image KEY POINTS Leukemias account for 0.3% to 1.2% of all malignancies with chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) being the most common (one-third of all leukemia cases each). Risk factors for leukemias are ill-defined, with the exception of a few well-documented risks, including exposure to alkylating agents or topoisomerase II inhibitors (AML) and ionizing radiation. Prognosis differs for each…
Open full size image KEY POINTS Sarcomas are an extremely heterogeneous group of mesenchymal cancers accounting for approximately 1% of all adult malignancies. Pathologic diagnosis should rely on specialized expertise of highly skilled pathologists in referral centers. Molecular pathology, including individual genetic profiling, is becoming an integral part of diagnosis and is a platform for future research to find new therapeutic options. A prevalent nihilistic approach…
Open full size image KEY POINTS Primary malignant brain tumors are rare, but glioblastoma is the most common type. Glioblastoma remains one of the deadliest malignancies, with a median overall survival of only 15 to 20 months. Standard treatment includes maximum surgical resection followed by radiation and concomitant temozolomide followed by adjuvant temozolomide with or without Optune therapy, and bevacizumab at the time of recurrence. Optune…
Open full size image Open full size image KEY POINTS Thyroid cancer is the most common endocrine malignancy accounting for 3% of all newly diagnosed cancers in the United States. The median age of diagnosis is 51 years (SEER statistics). Risk factors for thyroid cancer include genetics (MEN2-mutation of the RET protooncogene, Cowden syndrome, familial polyposis), gender (higher incidence in women), age (most cases occur at…
Open full size image KEY POINTS ABOUT HEAD AND NECK CANCER Worldwide, head and neck cancer accounts for 380,000 deaths annually. Major risk factors for head and neck cancers include smoking, heavy alcohol use, and infection with human papilloma virus (HPV). With treatment, 5-year survival rates are 70% to 90% for early stage disease (stages I and II) and 40% to 60% for advanced disease (stages…
Open full size image Cutaneous melanoma KEY POINTS ABOUT MELANOMA The incidence of melanoma is rising faster than for any other malignancy and shows regional variation (4% to 5% of women and men in the United States and 1% to 2% in Europe). The median age at diagnosis is around 50 years, but melanoma is not uncommon in young adults. The strongest risk factors are exposure…
Open full size image KEY POINTS ABOUT PANCREATIC CANCER Pancreatic cancer has the lowest survival rate among any solid tumors. , Median age at diagnosis is 70 years. Risk factors include smoking and obesity. Most patients are diagnosed at an advanced stage. , Prognosis and treatment options vary based on stage at diagnosis. Perioperative precautions must be taken for thromboembolic events after extended surgeries. Incidence As…
Open full size image Hepatocellular carcinoma KEY POINTS ABOUT HEPATOCELLULAR CARCINOMA (HCC) HCC is a relatively uncommon cancer in the United States (annual incidence 6/100,000), but the incidence is rising; it is the fourth leading cause of cancer-related death worldwide. Common risk factors include viral hepatitis, excessive alcohol consumption, environmental toxins (e.g., aflatoxin), nonalcoholic fatty liver disease, and iron overload (e.g., hemochromatosis). 5-year survival prognosis is…
Open full size image Open full size image Esophageal cancer Key Points About Esophageal cancer Relatively uncommon cancer (annual incidence 4.3/100,000) The median age at diagnosis is 68 years. The incidence of squamous cell cancer of the esophagus has declined substantially, whereas the incidence of adenocarcinoma of the distal esophagus and especially the gastroesophageal junction has increased in recent decades. The most common risk factors for…
Open full size image KEY POINTS: ABOUT COLORECTAL CANCER Colorectal cancer is the second leading cause of cancer death in the United States. Decreasing incidence in those over 50 years of age, but rising incidence in younger adults. Median age of diagnosis is 71 years. 5% to 10% of patients have well-defined genetic predisposition (e.g., Lynch syndrome) Postoperative adjuvant therapy routinely recommended for patients with stage…
Open full size image KEY POINTS Lung cancer is the most common cancer worldwide (12.3% of newly diagnosed cancers in 2018) with non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) accounting for 85% of the cases. Cigarette smoking is the primary risk factor for the development of lung cancer. Other risk factors include older age, family history of lung cancer, exposure to environmental…
Open full size image Open full size image KEY POINTS ABOUT BLADDER CANCER Smoking is the leading cause of bladder cancer in the United States. The median age at diagnosis is 73 years. Non-muscle invasive disease is treated with cystoscopic resection and intravesical therapy. Muscle invasive disease is treated with neoadjuvant cisplatin-based combination chemotherapy followed by cystectomy. If bladder preservation is desired or if the patient…
Open full size image Open full size image KEY POINTS ABOUT TESTICULAR CANCER Worldwide, testicular cancer is a relatively rare cancer, accounting for 1% to 2% of all cancers (>52,000 new cases and almost 10,000 deaths worldwide every year); however, it is the most common cancer among men 15 to 40 years of age. Major risk factors for testicular cancer include congenital anomaly (cryptorchidism), as well…
FIGO Staging System for Endometrial (Uterine) Cancer and Treatment by Stage. FIGO, International Federation of Gynecology and Obstetrics; LN, lymph node; MSI, microsatellite instability; CV, cardiovascular; VO, volume overload. Open full size image Open full size image Open full size image Endometrial cancer KEY POINTS ABOUT ENDOMETRIAL CANCER Most common gynecologic malignancy Median age at diagnosis is 62 years. Risk factors for typical endometrioid histology include…
Open full size image KEY POINTS Most common female cancer Median age at diagnosis is 62 years Risk factors for breast cancer include increased age, early age at menarche, late age at first birth, late age at menopause, family history, BRCA1/BRCA2 genes, alcohol use, hormone replacement therapy, and atypical hyperplasia on biopsy Early stage disease has 5-year overall survival of approximately 90%; stage IV metastatic disease…