CA: A Cancer Journal for Clinicians最新文献

{"title":"Social determinants of health and US cancer screening interventions: A systematic review","authors":"Ariella R. Korn PhD, MPH,&nbsp;Callie Walsh-Bailey MPH,&nbsp;Margarita Correa-Mendez PhD, MPH,&nbsp;Peter DelNero PhD, MPH,&nbsp;Meagan Pilar PhD, MPH,&nbsp;Brittney Sandler MLIS,&nbsp;Ross C. Brownson PhD,&nbsp;Karen M. Emmons PhD,&nbsp;April Y. Oh PhD, MPH","doi":"10.3322/caac.21801","DOIUrl":"https://doi.org/10.3322/caac.21801","url":null,"abstract":"<p>There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8–18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"461-479"},"PeriodicalIF":254.7,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5897160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Tumor Board: Papillary thyroid carcinoma with nodal disease","authors":"Peter J. Abraham MD, MSPH,&nbsp;Rongzhi Wang MD,&nbsp;Deepti Bahl MD,&nbsp;Pradeep Bhambhvani MD,&nbsp;Sadie Ho,&nbsp;Jessica M. Fazendin MD,&nbsp;Herbert Chen MD,&nbsp;Brenessa M. Lindeman MD, MEHP","doi":"10.3322/caac.21802","DOIUrl":"10.3322/caac.21802","url":null,"abstract":"&lt;p&gt;The patient is a 19-year-old female who had an incidental thyroid nodule discovered on magnetic resonance imaging (MRI) in July 2020 during the work-up of a superficial, midline neck cellulitis. She reported having noticed a bulge in her neck a few years prior but had never been concerned about it. She began seeing an endocrinologist and underwent a thyroid ultrasound in July 2020, which revealed a solid, hypoechoic nodule in the left upper thyroid lobe measuring 2.2 cm in greatest dimension, classified as American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) 4 (Figure 1). Multiple, enlarged, abnormal-appearing lymph nodes were also noted in the left cervical lymph node chain in level IV (Figure 2). The lower pole of the left thyroid lobe was heterogeneous, with scattered calcifications and subcentimeter cystic areas, and no abnormal findings were noted in the isthmus or right lobe of the thyroid gland. Her thyroid function tests were normal, with a thyroid-stimulating hormone (TSH) level of 2.34 mU/L (reference range, 0.45–5.33 mU/L) and a T4 (thyroxine) level of 0.88 ng/dL (reference range, 0.58–1.64 μg/dL), with negative thyroid peroxidase antibodies and normal blood cell counts.&lt;/p&gt;&lt;p&gt;A fine-needle aspiration (FNA) of the left thyroid nodule was performed in September 2020 and revealed papillary thyroid cancer (PTC). The patient was then referred to the endocrine surgery clinic for evaluation and further management. An FNA biopsy of the concerning left lateral cervical lymph nodes (Figure 2) was conducted in the endocrine surgery clinic because it had not previously been performed. Given the concerning appearance of the lymph nodes on ultrasound, a total thyroidectomy with possible left central and lateral neck dissections was discussed as the likely operation pending pathology results from the lymph node biopsy. The patient agreed with the treatment plan, and FNA results from the lymph nodes returned as metastatic PTC.&lt;/p&gt;&lt;p&gt;Given the evidence of metastatic lymph node disease, the patient underwent a total thyroidectomy along with left central and lateral neck dissections in October 2020. Intraoperatively, a very firm nodule in the left lobe of the thyroid gland was encountered that was unable to be cleanly separated from the overlying sternothyroid muscle. Given concern for extrathyroidal extension, the muscle was resected en bloc with the thyroid specimen. During the dissection, there was concern for devascularization of the left superior parathyroid gland, so it was excised and re-implanted. However, there was significant lymphadenopathy low in cervical level VI surrounding the left inferior parathyroid gland, making clear identification of the inferior gland difficult. A frozen section was obtained that confirmed the identification of the left inferior parathyroid gland, so it was also re-implanted into the left sternocleidomastoid muscle. Bulky lymphadenopathy was found throughout the left central and ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"555-561"},"PeriodicalIF":254.7,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9999703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of cancer care at home: Findings from an American Cancer Society summit","authors":"Arif H. Kamal MD, MBA, MHS,&nbsp;Paul P. Thienprayoon MBA, MS,&nbsp;Marco H. M. Janssen MSc, PhD,&nbsp;Lisa A. Lacasse MBA,&nbsp;William L. Dahut MD,&nbsp;Justin E. Bekelman MD","doi":"10.3322/caac.21784","DOIUrl":"https://doi.org/10.3322/caac.21784","url":null,"abstract":"&lt;p&gt;In February 2022, the White House announced the reignition of the Cancer Moonshot Initiative with the goals of reducing the death rate from cancer by at least 50% over the next 25 years and improving the experience of people and their families living with and surviving cancer. A core component of the Cancer Moonshot Initiative is the facilitation of multisector partnerships to solve the compelling challenges faced in cancer care delivery. The American Cancer Society (ACS) has a longstanding tradition of convening partners across the cancer landscape, most notably through conferences, partner meetings, advocacy coalitions, and coalescing of thought leaders through roundtables. For example, the ACS and several patient advocacy organizations, scientific organizations, and pharmaceutical partners came together in October 2022 to launch the new ACS National Breast Cancer Roundtable and the ACS National Cervical Cancer Roundtable as “all-hands-on-deck” coalitions to reshape cancer care.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; These Roundtables aim to both (1) identify the leading challenges in detection and treatment within these cancers and (2) provide expert guidance to providers, patients, payers, and policy makers regarding evolutions needed to increase access and patient centricity of cancer care. Beyond disease-specific issues, the ACS and its partners have also explored topics that span the cancer care continuum.&lt;/p&gt;&lt;p&gt;Currently, much of the attention given to innovation in oncology is centered upon creating and delivering a rapidly expanding armamentarium of anticancer treatments. Efforts to develop more novel, personalized, and targeted therapies have been fruitful but also continue to further highlight issues related to access. How treatments are selected and delivered and how outcomes are monitored require additional focus. Furthermore, how such efforts align with increasing calls for patient centricity, meeting patients where they are both figuratively and literally, requires a national discussion. Herein, we describe the findings from the first effort of the ACS in convening national leaders across multiple stakeholders, including the provider, payer, government, and technology communities, to discuss cancer care delivery at home.&lt;/p&gt;&lt;p&gt;This ACS Cancer Care at Home Summit convened in Cambridge, Massachusetts, on October 26, 2022, using a “design-thinking” framework to identify the major issues in decentralized cancer care delivery and plan for the next steps forward. The Summit convened 30 national leaders at the Philips North America campus using Chatham House rules during which participants were guided in building a shared mental model, framing the challenges and ideating around barriers, defining opportunities, and sharing findings with each other to determine next steps. To ensure that the ACS optimally used the time dedicated by these senior leaders, untapping the immense potential of the combination of participants in the room, and really gettin","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 4","pages":"353-357"},"PeriodicalIF":254.7,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21784","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6026376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary approach for a high-risk, localized soft tissue sarcoma of the trunk after unplanned nononcological resection","authors":"Candace L. Haddox MD,&nbsp;Elizabeth H. Baldini MD, MPH,&nbsp;Jyothi P. Jagannathan MD,&nbsp;Jason L. Hornick MD, PhD,&nbsp;Chandrajit P. Raut MD, MS","doi":"10.3322/caac.21787","DOIUrl":"https://doi.org/10.3322/caac.21787","url":null,"abstract":"&lt;p&gt;A man aged 45 years with hypertension and hyperlipidemia presented to his primary care physician with a 3-month history of a golf ball-sized right upper back mass. Ultrasound was performed, revealing a well defined lesion with mixed echogenicity, thought to be consistent with a lipoma. Clinically, however, the mass rapidly enlarged and became painful. The patient was referred to dermatology and subsequently to a surgeon. He underwent surgery at his local institution 2 months after initial presentation.&lt;/p&gt;&lt;p&gt;The mass was excised in two fragments measuring 8 × 7 cm and 6 × 6 cm. Pathology revealed a high-grade pleomorphic liposarcoma (PLPS). Necrosis was observed, and the mitotic rate was 26 per 10 high-power fields. The tumor involved the margins of the piecemeal excision specimens. Computed tomography (CT) imaging of the chest, abdomen, and pelvis was notable for tiny, indeterminate pulmonary nodules and a 4.3 × 2.4 × 4.7 cm, well circumscribed area with central low density in the right posterolateral chest wall soft tissues, possibly reflecting a postoperative seroma (Figure 1A). The patient noted progressive enlargement of the operative site; therefore, repeat CT imaging of the chest was performed 3 weeks later and showed an enlarging soft tissue mass concerning for residual disease (Figure 1B). Magnetic resonance imaging (MRI) of the chest showed a 4.2 × 5.0 × 6.0 cm solid mass with enhancement and diffusion restriction contiguous with the latissimus dorsi muscle (Figure 1C,D). The patient was referred to our sarcoma specialty center and had a multidisciplinary evaluation with medical oncology, radiation oncology, and surgical oncology. Preoperative radiation therapy (RT) and surgery followed by adjuvant chemotherapy with doxorubicin and ifosfamide were recommended.&lt;/p&gt;&lt;p&gt;Ultrasonography (US) is often the first imaging examination performed to evaluate palpable, superficial soft tissue masses because of its wide availability, low cost, and ease of performance. US is most useful in distinguishing solid from cystic lesions without additional intravenous contrast, and it can identify specific benign lesions. However, the US findings of benign and malignant solid soft tissue tumors overlap, and accurate tissue diagnosis is not feasible in most instances.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; In this case, the US findings were reported as likely lipoma; therefore, the mass was resected because of rapid growth and pain. Findings concerning for malignancy are rapid growth, vascularity, and pain, which should prompt further workup with MRI or CT.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; MRI is the imaging modality of choice for soft tissue tumors or tumor-like masses because of its superior contrast, allowing for tissue characterization and multiplanar capability without radiation exposure. In cases of suspected myxofibrosarcoma, MRI can be helpful diagnostically because these tumors are often infiltrative and extend along the fascial planes, referred to on MRI as the &lt;i&gt;t","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"451-457"},"PeriodicalIF":254.7,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6026374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review","authors":"Allison J. L’Hotta PhD, OTD,&nbsp;Samantha B. Randolph MAOT,&nbsp;Ben Reader DPT,&nbsp;Kim Lipsey MLIS,&nbsp;Allison A. King MD, MPH, PhD","doi":"10.3322/caac.21783","DOIUrl":"https://doi.org/10.3322/caac.21783","url":null,"abstract":"<p>Increased attention to the rehabilitation needs of children with cancer is vital to enhance health, quality-of-life, and productivity outcomes. Among adults with cancer, rehabilitation recommendations are frequently incorporated into guidelines, but the extent to which recommendations exist for children is unknown. Reports included in this systematic review are guideline or expert consensus reports containing recommendations related to rehabilitation referral, evaluation, and/or intervention for individuals diagnosed with cancer during childhood (younger than 18 years). Eligible reports were published in English from January 2000 to August 2022. Through database searches, 42,982 records were identified; 62 records were identified through citation and website searching. Twenty-eight reports were included in the review: 18 guidelines and 10 expert consensus reports. Rehabilitation recommendations were identified in disease-specific (e.g., acute lymphoblastic leukemia), impairment-specific (e.g., fatigue, neurocognition, pain), adolescent and young adult, and long-term follow-up reports. Example recommendations included physical activity and energy-conservation techniques to address fatigue, referral to physical therapy for chronic pain management, ongoing psychosocial surveillance, and referral to speech-language pathology for those with hearing loss. High-level evidence supported rehabilitation recommendations for long-term follow-up care, fatigue, and psychosocial/mental health screening. Few intervention recommendations were included in guideline and consensus reports. In this developing field, it is critical to include pediatric oncology rehabilitation providers in guideline and consensus development initiatives. This review enhances the availability and clarity of rehabilitation-relevant guidelines that can help prevent and mitigate cancer-related disability among children by supporting access to rehabilitation services.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"524-545"},"PeriodicalIF":254.7,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21783","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6158402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why young patients with cancer refuse the human papillomavirus vaccine","authors":"Mike Fillon","doi":"10.3322/caac.21781","DOIUrl":"https://doi.org/10.3322/caac.21781","url":null,"abstract":"<p>Despite their elevated risk for developing cervical, oropharyngeal, and other human papillomavirus (HPV)–related cancers and the strong and consistent evidence for the HPV vaccine’s safety and efficacy, many young cancer survivors reject this vaccine. In a new study appearing in <i>Cancer</i>, researchers from Emory University School of Medicine and the Aflac Cancer &amp; Blood Disorders Center (both in Atlanta, Georgia), the University of Alabama at Birmingham, and St. Jude Children’s Research Hospital (Memphis, Tennessee) investigate the reasons that many young survivors are rejecting this vaccine (doi:10.1002/cncr.34521).</p><p>Senior study author Wendy Landier, PhD, a professor in the Division of Pediatric Hematology/Oncology and deputy director of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, says that this is the first study to systematically characterize reasons for HPV vaccine refusal by a large group of young cancer survivors (or their parents).</p><p>HPV vaccine–naive childhood, adolescent, and young adult cancer survivors were invited to participate in an open-label clinical trial conducted from January 12, 2013, and October 5, 2018, that evaluated the immunogenicity of the vaccine and safety of a quadrivalent HPV vaccine. According to Dr Landier, “We methodically recorded study refusal reasons in real time for those declining participation.”</p><p>Two researchers independently reviewed these reasons for refusal and developed coding lists for primary and secondary reasons for declining the vaccine. Four of the study researchers then developed the final categories of reasons for refusal. Associations of these various reasons with participant characteristics, including sex, race/ethnicity, cancer diagnosis, and age, were examined to help guide clinicians in improving adherence with vaccine guidelines.</p><p>Of the 755 survivors eligible to participate in the study of vaccine safety and efficacy, 301 (39.9%) declined to participate. Among those who declined, 86 survivors or their parents (28.6%) cited reasons unrelated to the HPV vaccine. For example,</p><p>some said that they simply were not interested or were uncomfortable with taking part in any research study or had concerns about the needle sticks required for study-related blood draws, or they mentioned “logistical concerns.”</p><p>The 215 survivors or their parents who refused clinical trial participation for vaccine-related reasons became the focus of this study. Approximately 75% (75.3%) were non-Hispanic White, 53.0% were male, and 54.9% had had leukemia or lymphoma. The ages of the survivors ranged from 9.0 to 26.9 years; the median age at which they were first offered study participation was 14.2 years. The survivors had completed cancer therapy 1–5 years (median, 2.8 years) before they were offered the study.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 3","pages":"225-227"},"PeriodicalIF":254.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5972494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better solutions needed to reduce suicides among patients with cancer","authors":"Mike Fillon","doi":"10.3322/caac.21782","DOIUrl":"https://doi.org/10.3322/caac.21782","url":null,"abstract":"&lt;p&gt;In light of these findings, the study authors suggest that better distress screening access and improved availability of psychosocial support for at least the most vulnerable high-risk patients with cancer, both before and after surgery, are urgently needed to reduce the risks of suicide in this patient population.&lt;/p&gt;&lt;p&gt;The study appears in JAMA Oncology (doi:10.1001/jamaoncol.2022.6549).&lt;/p&gt;&lt;p&gt;Study author Chi-Fu Jeffrey Yang, MD, a thoracic surgeon at Massachusetts General Hospital and an assistant professor of surgery at Harvard Medical School in Boston, says that previous studies reported that the risk of suicide is higher among patients diagnosed with cancer. “However, the risk of suicide among patients undergoing cancer operations was largely unknown.”&lt;/p&gt;&lt;p&gt;According to the researchers, the study had three goals: to determine how common suicide is among patients with cancer who have been treated with surgery, to discover when suicide is most likely relative to the time of cancer operations, and to identify clinical and demographic clues to help clinicians to recognize patients likely to commit suicide after surgery.&lt;/p&gt;&lt;p&gt;For the study, researchers culled cancer incidence, treatment, and cause-specific mortality data (including suicide data) between the years 2000 and 2016 from 18 population-based US registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Patients with more than one type of cancer were excluded, they wrote, “to avoid potential biases resulting from the&lt;/p&gt;&lt;p&gt;influence of past or future cancer diagnoses on suicide risk.”&lt;/p&gt;&lt;p&gt;They identified more than 1.8 million (1,811,397) adult patients with cancer who had surgery for one of 15 solid-organ cancers. Seventy-four percent of the subjects were women, and the median age was 62 years. The researchers calculated standardized mortality ratios (SMRs) to compare suicide rates of patients in the cohort with suicide rates in general in the United States.&lt;/p&gt;&lt;p&gt;In addition, they used both unadjusted analyses and multivariable Fine–Gray competing risk models to examine whether patients’ risk of suicide was associated with their year of death or with any clinical characteristics (cancer type and stage and cohort-level 5-year survivor for each cancer type) or demographic characteristics (gender, marital status, race, and age).&lt;/p&gt;&lt;p&gt;During a median follow-up period of 4.6 years (range, 1.7–9.0 years), the researchers found that 1494 patients (0.08%) committed suicide after undergoing surgery for cancer; this represents 14.5 suicides per 100 000 person-years, a rate much higher than the suicide rate in the general US population when it is adjusted by age, sex, race, and calendar year of death (SMR, 1.29). The 10 solid organ cancers examined in this study with suicide rates that are statistically significant relative to the general US population (adjusted by age, sex, race, and calendar year of death), in SMR result order, are as follows: la","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 3","pages":"228-230"},"PeriodicalIF":254.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5972495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer","authors":"Lauren M. Janczewski MD,&nbsp;Joseph Faski MS,&nbsp;Heidi Nelson MD,&nbsp;Marc J. Gollub MD,&nbsp;Cathy Eng MD,&nbsp;James D. Brierley MS, MB,&nbsp;Joel M. Palefsky MD,&nbsp;Richard M. Goldberg MD,&nbsp;M. Kay Washington MD, PhD,&nbsp;Elliot A. Asare MD, MS,&nbsp;Karyn A. Goodman MD, MS,&nbsp;the American Joint Committee on Cancer Expert Panel on Cancers of the Lower Gastrointestinal, Anus Disease Site","doi":"10.3322/caac.21780","DOIUrl":"https://doi.org/10.3322/caac.21780","url":null,"abstract":"<p>The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long-term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1–T2N1M0 disease, (2) redefined stage IIIA as T3N0–N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"516-523"},"PeriodicalIF":254.7,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5857886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma","authors":"Samantha M. Ruff MD,&nbsp;Dayssy A. Diaz MD,&nbsp;Kenneth L. Pitter MD,&nbsp;Bridget C. Hartwell NP,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA","doi":"10.3322/caac.21779","DOIUrl":"https://doi.org/10.3322/caac.21779","url":null,"abstract":"&lt;p&gt;A 63-year-old woman who was a former smoker with a past medical history of hypertension and gastroesophageal reflux disease initially presented with upper abdominal pain. Her family history was notable for breast cancer in her mother, lung cancer in her father, and renal cell carcinoma in her sister. An ultrasound showed a heterogenous mass in the left lobe of the liver measuring 8.7 × 7.0 × 5.1 cm that was abutting the common bile duct and concerning for a neoplasm (Figure 1A). On laboratory testing, her alpha fetoprotein (AFP) was elevated (15.7 ng/mL), carbohydrate antigen 19-9 (CA 19-9) was normal (&lt;15 U/ml), and carcinoembryonic antigen (CEA) was slightly elevated (0.6 ng/ml). She underwent an ultrasound-guided biopsy that demonstrated cytokeratin 7 (CK7)-positive, poorly differentiated adenocarcinoma with nonmucinous gland formation and papillary architecture within sclerotic stroma. Given that the biopsy was positive for CK7 with negative hepatocellular (hepatocyte-specific antigen, arginase, glypican), CDX2, TTF1, and synaptophysin markers, the mass was diagnosed as an intrahepatic cholangiocarcinoma (iCCA). A computed tomography (CT) scan of the chest, abdomen, and pelvis did not show any extrahepatic metastatic disease but did show a central left hepatic lobe mass in segment 4a/4b that measured 7.7 × 6.7 cm with calcifications suggestive of iCCA (Figure 1B,C). A CT scan also revealed potential tumor thrombus within the middle hepatic vein and distal left portal vein branches, extrahepatic (periportal, gastrohepatic, peripancreatic, portacaval) lymphadenopathy, left intrahepatic biliary ductal dilation, and common bile duct dilation.&lt;/p&gt;&lt;p&gt;The patient was started on gemcitabine, cisplatin, and nanoparticle albumin-bound paclitaxel (nab-paclitaxel). After 3 months of chemotherapy, the patient's AFP increased to 43.8 ng/ml and her CA 19-9 increased to 21.4 U/ml. On repeat CT scan, the size of the tumor was stable, but there was suspected intraductal extension toward the central inferior aspect of segment 4b. Given her suboptimal response to chemotherapy, radiation oncology was consulted. Approximately 4 months after starting chemotherapy, the patient underwent yttrium-90 radioembolization (Y90 RE) to the left hepatic hemiliver and subsequently was resumed on a gemcitabine, cisplatin, and nab-paclitaxel regimen (Figure 2A). A CT scan 5 months after starting treatment and 1 month after Y90 RE demonstrated a stable left hepatic lobe mass with interval necrosis. However, this effect was mostly seen in the tumor in the left lobe of the liver, whereas there was still some residual arterial enhancement along the right side of the mass because where the tumor extended into the right lobe was not treated given concern of toxicity to the remaining liver. After nine cycles of chemotherapy and the Y90 RE treatment, re-staging CT scans did not demonstrate any metastatic disease, and the tumor in the left lobe of the liver had a seemingly good res","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 4","pages":"346-352"},"PeriodicalIF":254.7,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6099643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From medical student to Editor: A note of thanks","authors":"Ted Gansler MD, MBA, MPH","doi":"10.3322/caac.21778","DOIUrl":"https://doi.org/10.3322/caac.21778","url":null,"abstract":"&lt;p&gt;I first encountered &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt; as a medical student. Back then, the American Cancer Society (ACS) printed hundreds of thousands of copies that were mailed (without any charge) to practicing physicians and dropped off by ACS volunteers at medical schools, with the goals of educating students about cancer and inspiring some of us to pursue careers in cancer-related specialties. I recall appreciating that the Society deemed medical students worthy of their attention. After carrying each issue in the pocket of my short white medical student coat for a few days (back when the journal was printed in a small, digest-sized format), I realized that I was unlikely to get beyond the first few pages anytime soon, so I carefully separated the journal pages and filed the articles in folders labeled by topic, wishing that someday I would be able to read them. (Note—foreshadowing alert).&lt;/p&gt;&lt;p&gt;After 2 decades of pathology residency, fellowship, academic pathology practice, and laboratory-based cancer research, this wish came true. A series of fortunate events led me to a staff position at the ACS national office, where one of my roles was reading &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt;. Every article. At least twice. For more than 20 years.&lt;/p&gt;&lt;p&gt;The first message of this editorial is my retirement from the position of Editor. This role has been tremendously fulfilling and enjoyable, but it's time for some new ideas from someone else. By the time you read this I will be almost completely retired from my work with the ACS and looking forward to some other pursuits that, until recently, I haven't had time for.&lt;/p&gt;&lt;p&gt;More importantly, this editorial also gives me an opportunity for some reflection about this journal, to thank the people who are responsible for its success, and to introduce the incoming editor, Don Dizon, MD. It would be difficult to name all the distinguished contributors to &lt;i&gt;CA&lt;/i&gt; during my tenure as Editor, so I apologize for any truncations in the lists below and for any omissions resulting from lapses in my memory. There are several individuals who have contributed to &lt;i&gt;CA&lt;/i&gt; in more than one capacity, and many of them are included below on only one list (the one for which their role seems most significant or most memorable to me). I appreciate them all and extend my utmost gratitude for their expertise and time.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CA&lt;/i&gt; reaches a heterogeneous audience of clinical and public health professionals to provide information relevant to the entire cancer continuum, from prevention through survivorship and end-of-life care. Content includes educational review articles; ACS guidelines for cancer prevention and early detection; ACS summaries of the most recent data on cancer incidence, mortality, risk factors, and screening prevalence; virtual tumor board discussions; and brief news stories that offer perspectives on recent research. &lt;i&gt;CA&lt;/i&gt; has always been free to access and remains free online witho","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 3","pages":"231-232"},"PeriodicalIF":254.7,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6113034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}