Items in AFP with MESH term: Neoplasm Staging

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Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment - Article

ABSTRACT: The treatment of osteosarcoma requires a multidisciplinary approach involving the family physician, orthopedic oncologist, medical oncologist, radiologist and pathologist. Osteosarcoma is a mesenchymally derived, high-grade bone sarcoma. It is the third most common malignancy in children and adolescents. The most frequent sites of origin are the distal femur, proximal tibia and proximal humerus. Patients typically present with pain, swelling, localized enlargement of the extremity and, occasionally, pathologic fracture. Most patients present with localized disease. Radiographs commonly demonstrate a mixed sclerotic and lytic lesion arising in the metaphyseal region of the involved bone. Computed tomography and bone scanning are recommended to detect pulmonary and bone metastases, respectively. Before 1970, osteosarcomas were treated with amputation. Survival was poor: 80 percent of patients died from metastatic disease. With the development of induction and adjuvant chemotherapy protocols, advances in surgical techniques and improvements in radiologic staging studies, 90 to 95 percent of patients with osteosarcoma can now be treated with limb-sparing resection and reconstruction. Long-term survival and cure rates have increased to between 60 and 80 percent in patients with localized disease.


Vulvar Cancer - Article

ABSTRACT: Vulvar cancer was reported in 3,200 women in 1998, resulting in 800 deaths. Recent evidence suggests that vulvar cancer comprises two separate diseases. The first type may develop from vulvar intraepithelial neoplasia caused by human papillomavirus infection and is increasing in prevalence among young women. The second type, which more often afflicts older women, may develop from vulvar non-neoplastic epithelial disorders as a result of chronic inflammation (the itch-scratch-lichen sclerosus hypothesis). Although vulvar cancer is relatively uncommon, early detection remains crucial given its significant impact on sexuality. Diagnosis is based on histology; therefore, any suspicious lesions of the vulva must be biopsied. Excisional or punch biopsy can be performed in the physician's office. Clinicians must closely monitor suspicious lesions because delayed biopsy and diagnosis are common. Once diagnosed, vulvar cancer is staged using the TNM classification system. Treatment is surgical resection, with the goal being complete removal of the tumor. There has been a recent trend toward more conservative surgery to decrease psychosexual complications.


Gastric Cancer: Diagnosis and Treatment Options - Article

ABSTRACT: Although the overall incidence of gastric cancer has steadily declined in the United States, it is estimated that more than 12,000 persons died from gastric cancer in 2003. The incidence of distal stomach tumors has greatly declined, but reported cases of proximal gastric carcinomas, including tumors at the gastroesophageal junction, have increased. Early diagnosis of gastric cancer is difficult because most patients are asymptomatic in the early stage. Weight loss and abdominal pain often are late signs of tumor progression. Chronic atrophic gastritis, Helicobacter pylori infection, smoking, heavy alcohol use, and several dietary factors have been linked to increased risks for gastric cancer. Esophagogastroduodenoscopy is the preferred diagnostic modality for evaluation of patients in whom stomach cancer is suspected. Accurate staging of gastric wall invasion and lymph node involvement is important for determining prognosis and appropriate treatment. Endoscopic ultrasonography, in combination with computed tomographic scanning and operative lymph node dissection, may be involved in staging the tumor. Treatment with surgery alone offers a high rate of failure. Chemotherapy and radiotherapy have not improved survival rates when used as single modalities, but combined therapy has shown some promise. Primary prevention, by control of modifiable risk factors and increased surveillance of persons at increased risk, is important in decreasing morbidity and mortality.


Esophageal Cancer: A Review and Update - Article

ABSTRACT: Although significant advancements have been made in the treatment of esophageal cancer, this aggressive malignancy commonly presents as locally advanced disease with a poor prognosis. Despite improvements in the detection of premalignant pathology, newer preventative strategies, and the development of more effective combination therapies, the overall incidence of esophageal carcinomas has risen. A clear association has been established between the development of esophageal cancer and Helicobacter pylori infection, gastroesophageal reflux disease, smoking, and heavy alcohol use. However, the growing number of newly diagnosed esophageal adenocarcinomas, despite widespread treatments with proton pump inhibitors and the eradication of H. pylori, leaves the medical community searching for more answers. There is a potential link between esophageal adenocarcinoma and obesity. Common presenting symptoms of esophageal cancer are dysphagia, odynophagia, and progressive weight loss. The initial assessment for patients with these symptoms is made with double-contrast barium esophagraphy. Treatment modalities include surgery, chemotherapy, radiation therapy, or a combination of modalities. Prevention strategies include smoking and alcohol cessation.


Pancreatic Cancer: Diagnosis and Management - Article

ABSTRACT: Although only 32,000 new cases of adenocarcinoma of the pancreas occur in the United States each year, it is the fourth leading cause of cancer deaths in this country. The overall five-year survival rate is 4 percent, and localized, resectable disease has only a 17 percent survival rate. Risk factors include smoking, certain familial cancer syndromes, and familial chronic pancreatitis. The link between risk of pancreatic cancer and other factors (e.g., diabetes, obesity) is less clear. Most patients present with obstructive jaundice caused by compression of the bile duct in the head of the pancreas. Epigastric or back pain, vague abdominal symptoms, and weight loss also are characteristic of pancreatic cancer. More than one half of cases have distant metastasis at diagnosis. Computed tomography is the most useful diagnostic and staging tool. Ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography may provide additional information. The majority of tumors are not surgically resectable because of metastasis and invasion of the major vessels posterior to the pancreas. Resectable tumors are treated with the Whipple procedure or the pylorus-preserving Whipple procedure. Adjuvant fluorouracil-based chemotherapy may prolong survival. For nonresectable tumors, chemotherapy with gemcitabine prolongs survival. Other agents are being studied. Radiation combined with chemotherapy has slowed progression in locally advanced cancers. Throughout the illness and during end-of-life care, patients need comprehensive symptom control.


Diagnosis and Treatment of Testicular Cancer - Article

ABSTRACT: Testicular cancer is the most common malignancy in men 20 to 35 years of age and has an annual incidence of four per 100,000. If diagnosed early, the cure rate is nearly 99 percent. Risk factors for testicular cancer include cryptorchidism (i.e., undescended testicles), family history, infertility, tobacco use, and white race. Routine self-examination and physician screening have not been shown to improve outcomes, and the U.S. Preventive Services Task Force and American Cancer Society do not recommend them in asymptomatic men. Patients presenting with a painless testicular mass, scrotal heaviness, a dull ache, or acute pain should receive a thorough examination. Testicular masses should be examined with scrotal ultrasonography. If ultrasonography shows an intratesticular mass, the patient should be referred to a urologist for definitive diagnosis, orchiectomy, and further evaluation with abdominal computed tomography and chest radiography. The family physician's role after diagnosis of testicular cancer includes encouraging the patient to bank sperm because of possible infertility and evaluating for recurrence and future complications, especially cardiovascular disease.


Breast Cancer in Older Women - Article

ABSTRACT: The American Geriatric Society currently recommends screening mammography for women up to 85 years of age whose life expectancy is three years or longer. The value of clinical breast examinations in older women needs further study. Total mastectomy and partial mastectomy with postoperative radiation therapy yield similar results in localized breast cancer. Postoperative irradiation may be avoided in women with small tumors (2.5 cm or less in diameter) who have undergone quadrantectomy. Lymph node dissection is important for tumor staging but significantly increases the risks and morbidity of surgery. Lymph node mapping may obviate the need for lymphadenectomy in many older women. Adjuvant hormonal therapy for at least two years appears to be beneficial in all women with hormone-receptor-rich tumors. Adjuvant chemotherapy is indicated in women with lymph node involvement or high-risk tumors with no lymph node involvement. Unless life-threatening metastases are present, hormonal therapy is the first approach to metastatic cancer. Chemotherapy is indicated if endocrine therapy is unsuccessful or life-threatening metastases are present. Most chemotherapy regimens appear to be well tolerated, even by women over 70 years of age. Special treatment should be employed for metastases to tumor sanctuaries (i.e., brain, eyes), the long bones, the spine and the chest wall.


Endometrial Cancer - Article

ABSTRACT: Endometrial cancer is the fourth most common cancer in women, accounting for approximately 6,000 deaths per year in the United States. It is more common in women who are older, white, affluent obese and of low parity. Hypertension and diabetes mellitus are also predisposing factors. Because any condition that increases exposure to unopposed estrogen increases the risk of endometrial cancer, tamoxifen therapy, estrogen replacement therapy without progestin and the presence of estrogen-secreting tumors are all risk factors. Smoking and the use of oral contraceptives appear to decrease the risk. Women with an increased risk and those with postmenopausal bleeding should be screened for endometrial cancer. Endometrial sampling is currently the most accurate and widely used screening technique, but ultrasonographic measurement of endometrial thickness and hysteroscopy have also been studied. Patients with endometrial specimens that show atypia have about a 25 percent likelihood of progressing to carcinoma, compared with less than 2 percent in patients without atypia. Endometrial cancer is usually treated surgically, but in patients with appropriate pathologic findings who decline surgical treatment, progestin therapy may be satisfactory.


Testicular Cancer - Article

ABSTRACT: Although testicular cancer accounts for only 1 percent of all tumors in males, it is the most common malignancy in males between 15 and 34 years of age. Cryptorchidism is the most significant risk factor for testicular cancer, increasing the risk up to 11-fold. A painless testicular mass is the classic presentation for testicular cancer, although a number of patients present with diffuse pain or swelling. Ultrasonography may be helpful in confirming the presence of a scrotal mass within the testicle. Intratesticular masses are considered malignant until proved otherwise. Radical orchiectomy is the treatment for the primary tumor. Staging of disease is based on tumor histology, serum tumor markers and presence of lymph-node or other metastatic disease. Depending on the stage of disease, further treatment may include observation, radiotherapy, chemotherapy or surgery. Survival rates in patients with testicular cancer have improved dramatically in the past 20 years and now exceed 90 percent overall.


Soft Tissue Sarcomas: Integrating Primary Care Recognition with Tertiary Care Center Treatment - Article

ABSTRACT: Soft tissue sarcomas account for fewer than 1 percent of malignancies diagnosed annually in the United States. These tumors usually present as an asymptomatic mass. Any lesion larger than 5 cm in diameter should be considered suspicious. Radiographs should be obtained as the initial step in assessing a suspicious lesion. Magnetic resonance imaging has become the preferred diagnostic examination for tumors involving the extremities, and computed tomographic scanning may be the best technique for imaging lesions in the thoracic, abdominal, and head and neck areas. In general, the patient with a suspicious soft tissue mass located in a surgically difficult area should be referred to a regional center for biopsy and multidisciplinary consultation before resection is attempted. Careful preoperative planning is necessary for a good outcome. The prognosis for the patient with a soft tissue sarcoma is primarily determined by the grade, size and depth of the tumor and the presence of tumor at the surgical margins.


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