CA: A Cancer Journal for Clinicians最新文献

{"title":"Cancer risk among World Trade Center rescue and recovery workers: A review","authors":"Paolo Boffetta MD,&nbsp;Charles B. Hall PhD,&nbsp;Andrew C. Todd PhD,&nbsp;David G. Goldfarb MPH,&nbsp;Maria J. Schymura PhD,&nbsp;Jiehui Li MBBS, MS,&nbsp;James E. Cone MD, MPH,&nbsp;Rachel Zeig-Owens DrPH, MPH","doi":"10.3322/caac.21723","DOIUrl":"https://doi.org/10.3322/caac.21723","url":null,"abstract":"<p>Twenty years after the September 11th, 2001 terrorist attacks, the association between exposures present at the World Trade Center (WTC) site and the risk of several specific types of cancer has been reported among rescue and recovery workers. The authors' objective was to conduct an updated review of these data. Most studies have found elevated rates of both prostate and thyroid cancers compared with rates in the general population, and some have reported statistically significant differences for the rates of all cancers as well. Studies including a larger combined cohort of WTC-exposed rescue and recovery workers from 3 main cohorts have since replicated findings for these cancers, with additional years of follow-up. Among this combined cohort, although a lower-than-expected standardized incidence ratio for all cancers was observed, WTC exposure was also related to an increased risk of cutaneous melanoma and tonsil cancer. Importantly, another study found that WTC-exposed rescue and recovery workers who are enrolled in the federally funded medical monitoring and treatment program experienced improved survival post-cancer diagnosis compared with New York state patients with cancer. On the basis of these combined cohort studies, the full effect of WTC exposure on cancer risk is becoming clearer. Consequently, the authors believe that surveillance of those with WTC exposure should be continued, and in-depth analysis of epidemiologic, molecular, and clinical aspects of specific cancers in these workers should be pursued.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 4","pages":"308-314"},"PeriodicalIF":254.7,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5806169","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":"Modern developments in germline pharmacogenomics for oncology prescribing","authors":"Natalie M. Reizine MD,&nbsp;Peter H. O’Donnell MD","doi":"10.3322/caac.21722","DOIUrl":"https://doi.org/10.3322/caac.21722","url":null,"abstract":"<p>The integration of genomic data into personalized treatment planning has revolutionized oncology care. Despite this, patients with cancer remain vulnerable to high rates of adverse drug events and medication inefficacy, affecting prognosis and quality of life. Pharmacogenomics is a field seeking to identify germline genetic variants that contribute to an individual's unique drug response. Although there is widespread integration of genomic information in oncology, somatic platforms, rather than germline biomarkers, have dominated the attention of cancer providers. Patients with cancer potentially stand to benefit from improved integration of both somatic and germline genomic information, especially because the latter may complement treatment planning by informing toxicity risk for drugs with treatment-limiting tolerabilities and narrow therapeutic indices. Although certain germline pharmacogenes, such as <i>TPMT</i>, <i>UGT1A1</i>, and <i>DPYD</i>, have been recognized for decades, recent attention has illuminated modern potential dosing implications for a whole new set of anticancer agents, including targeted therapies and antibody-drug conjugates, as well as the discovery of additional genetic variants and newly relevant pharmacogenes. Some of this information has risen to the level of directing clinical action, with US Food and Drug Administration label guidance and recommendations by international societies and governing bodies. This review is focused on key new pharmacogenomic evidence and oncology-specific dosing recommendations. Personalized oncology care through integrated pharmacogenomics represents a unique multidisciplinary collaboration between oncologists, laboratory science, bioinformatics, pharmacists, clinical pharmacologists, and genetic counselors, among others. The authors posit that expanded consideration of germline genetic information can further transform the safe and effective practice of oncology in 2022 and beyond.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 4","pages":"315-332"},"PeriodicalIF":254.7,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5692012","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":"Female erectile tissues and sexual dysfunction after pelvic radiotherapy: A scoping review","authors":"Deborah C. Marshall MD, MAS,&nbsp;Elizabeth S. Tarras MD,&nbsp;Ayesha Ali MD,&nbsp;Julie Bloom MD,&nbsp;Mylin A. Torres MD,&nbsp;Jenna M. Kahn MD","doi":"10.3322/caac.21726","DOIUrl":"https://doi.org/10.3322/caac.21726","url":null,"abstract":"<p>Sexual function is a vital aspect of human health and is recognized as a critical component of cancer survivorship. Understanding and evaluating the impacts of radiotherapy on female sexual function requires precise knowledge of the organs involved in sexual function and the relationship between radiotherapy exposure and sexual tissue function. Although substantial evidence exists describing the impact of radiotherapy on male erectile tissues and related clinical sexual outcomes, there is very little research in this area in females. The lack of biomedical data in female patients makes it difficult to design studies aimed at optimizing sexual function postradiotherapy for female pelvic malignancies. This scoping review identifies and categorizes current research on the impacts of radiotherapy on normal female erectile tissues, including damage to normal functioning, clinical outcomes of radiation-related female erectile tissue damage, and techniques to spare erectile tissues or therapies to treat such damage. An evaluation of the evidence was performed, and a summary of findings was generated according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. Articles were included in the review that involved normal female erectile tissues and radiotherapy side effects. The results show that little scientific investigation into the impacts of radiotherapy on female erectile tissues has been performed. Collaborative scientific investigations by clinical, basic, and behavioral scientists in oncology and radiotherapy are needed to generate radiobiologic and clinical evidence to advance prospective evaluation, prevention, and mitigation strategies that may improve sexual outcomes in female patients.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 4","pages":"353-359"},"PeriodicalIF":254.7,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6186502","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":"American Cancer Society nutrition and physical activity guideline for cancer survivors","authors":"Cheryl L. Rock PhD, RD,&nbsp;Cynthia A. Thomson PhD, RD,&nbsp;Kristen R. Sullivan MS, MPH,&nbsp;Carol L. Howe MD, MLS,&nbsp;Lawrence H. Kushi ScD,&nbsp;Bette J. Caan DrPH,&nbsp;Marian L. Neuhouser PhD, RD,&nbsp;Elisa V. Bandera MD, PhD,&nbsp;Ying Wang PhD,&nbsp;Kimberly Robien PhD, RD,&nbsp;Karen M. Basen-Engquist PhD, MPH,&nbsp;Justin C. Brown PhD,&nbsp;Kerry S. Courneya PhD,&nbsp;Tracy E. Crane PhD, RDN,&nbsp;David O. Garcia PhD, FACSM,&nbsp;Barbara L. Grant MS, RDN, CSO, FAND,&nbsp;Kathryn K. Hamilton MA, RDN, CSO, CDN, FAND,&nbsp;Sheri J. Hartman PhD,&nbsp;Stacey A. Kenfield ScD,&nbsp;Maria Elena Martinez PhD,&nbsp;Jeffrey A. Meyerhardt MD, MPH,&nbsp;Larissa Nekhlyudov MD, MPH,&nbsp;Linda Overholser MD,&nbsp;Alpa V. Patel PhD,&nbsp;Bernardine M. Pinto PhD,&nbsp;Mary E. Platek PhD, RD, CDN,&nbsp;Erika Rees-Punia PhD, MPH,&nbsp;Colleen K. Spees PhD, MEd, RD, LD, FAND,&nbsp;Susan M. Gapstur PhD,&nbsp;Marjorie L. McCullough ScD, RD","doi":"10.3322/caac.21719","DOIUrl":"https://doi.org/10.3322/caac.21719","url":null,"abstract":"<p>The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 3","pages":"230-262"},"PeriodicalIF":254.7,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21719","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5882209","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":"Nutrition and Physical Activity Guideline for Cancer Survivors","authors":"","doi":"10.3322/caac.21721","DOIUrl":"https://doi.org/10.3322/caac.21721","url":null,"abstract":"&lt;p&gt;There are nearly 17 million cancer survivors living in the United States. Research suggests that lifestyle factors, such as a person's body weight, how physically active they are, what they eat, and whether they drink alcohol, may affect their survival and wellness following a cancer diagnosis. The American Cancer Society (ACS) recently reviewed the research on how these factors may influence cancer outcomes and published a detailed update of its &lt;i&gt;Nutrition and Physical Activity Guideline for Cancer Survivors&lt;/i&gt;. Here is a summary of the guideline's evidence-based advice about these lifestyle factors for cancer survivors and their families as well as some related tips from experts at the ACS.&lt;/p&gt;&lt;p&gt;Your outlook for survival and for a return to good health after being diagnosed with cancer depends on many factors. The type of cancer you have, how advanced it is, what treatments you get, and whether you have any other health problems can all affect your outlook.&lt;/p&gt;&lt;p&gt;There is also growing evidence that diet, physical activity, and related factors can help some cancer survivors live longer, lower their risk of the cancer returning (or of a new cancer developing), and limit some side effects of treatment. It can also lower their risk of developing some other serious diseases and improve their overall health and wellness.&lt;/p&gt;&lt;p&gt;There is no guarantee that following the advice in this guideline will achieve all of these benefits for every cancer survivor. If you have questions about how lifestyle factors might affect you as an individual, speak with your cancer doctor or other members of your cancer care team.&lt;/p&gt;&lt;p&gt;Eating nutritious foods can help cancer survivors manage their energy levels, feel better, and stay stronger. The nutritional needs of cancer patients during treatment depend on the type of cancer they have, which treatments they get, and what side effects they have.&lt;/p&gt;&lt;p&gt;Patients getting cancer treatment may face eating challenges, such as poor appetite; having problems chewing, swallowing, or digesting; and feeling very tired from the treatment or cancer, all of which can affect their nutritional status.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;The ACS recommends that nutrition screening, assessment, and counseling begin as soon as possible after cancer is diagnosed:&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;The goal is to prevent or resolve nutrient deficiencies, preserve muscle mass, and manage side effects of treatment that may cause problems with eating.&lt;/p&gt;&lt;p&gt;If your health care team determines that you're at risk for malnutrition or have other diet-related issues that could affect your nutritional status, they should refer you to a Registered Dietitian Nutritionist (RDN) or Registered Dietitian (RD) for personalized nutritional counseling.&lt;/p&gt;&lt;p&gt;Being physically active after a cancer diagnosis can help improve survival for breast, colorectal, and prostate cancer survivors, and evidence is growing that it can be helpful for some other cancer types as well. Physica","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 3","pages":"263-265"},"PeriodicalIF":254.7,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21721","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5720091","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":"Noninvasive biopsies may be faster and more effective for diagnosing HPV-associated head and neck cancer","authors":"Mike Fillon","doi":"10.3322/caac.21725","DOIUrl":"https://doi.org/10.3322/caac.21725","url":null,"abstract":"<p>A new prospective, observational study finds that cell-free HPV DNA tests may diagnose HPV-HNSCC more accurately, at lower cost, and more quickly than tissue-based approaches. The study appears in <i>Clinical Cancer Research</i> (doi:10.1158/1078-0432.ccr-21-3151).</p><p>According to the researchers, “HPV-associated cancers make up 5% of all cancers worldwide … HPV-HNSCC is the most common HPV-associated malignancy in the United States and continues to increase in incidence.” The goals of the study, says study author Daniel Faden, MD, an assistant professor in the Department of Otolaryngology at Harvard Medical School Massachusetts Eye and Ear, Massachusetts General Hospital, and the Eli and Edythe L. Broad Institute of MIT and Harvard in Boston, Massachusetts, were to compare the diagnostic accuracy of a ctHPVDNA-based diagnosis, combined with routine cross-sectional imaging and a physical examination, with the standard tissue-based clinical workup for the diagnosis of HPV-HNSCC. Additionally, the researchers investigated whether or not ctHPVDNA produced quicker results and lower costs than tissue biopsies using modeling. “This study is the first to evaluate a liquid biopsy-based noninvasive diagnostic approach for HPV-associated head and neck cancer and shows strong proof of principle to support such an approach, disrupting the existing dogma,” says Dr. Faden.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 3","pages":"200-201"},"PeriodicalIF":254.7,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5688935","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":"Breast cancer recurrence risk can remain for 10 to 32 years","authors":"Mike Fillon","doi":"10.3322/caac.21724","DOIUrl":"https://doi.org/10.3322/caac.21724","url":null,"abstract":"<p>During the past several decades, the combination of improved treatment, increased detection of early disease, population growth, and population aging has led to a growing number of long-term breast cancer survivors. Although late recurrence in survivors of nonmetastatic female breast cancer has been documented in some small studies and case series, more current and detailed information on this phenomenon is needed for optimal follow-up care of these women. A new study from Denmark, published in the <i>Journal of the National Cancer Institute</i> (doi:10.1093/jnci/djab202), confirms an increasing body of literature showing BCR occurring more than 10 years after diagnosis. More importantly, the new study is the first to document an elevated risk of BCR persisting more than 25 years after primary surgery, and it also reports on demographic and clinical factors associated with the risk of BCR.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 3","pages":"197-199"},"PeriodicalIF":254.7,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5850631","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":"Genetic testing in prostate cancer management: Considerations informing primary care","authors":"Veda N. Giri MD,&nbsp;Todd M. Morgan MD,&nbsp;David S. Morris MD, FACS,&nbsp;Jacob E. Berchuck MD,&nbsp;Colette Hyatt MS, CGC,&nbsp;Mary-Ellen Taplin MD","doi":"10.3322/caac.21720","DOIUrl":"https://doi.org/10.3322/caac.21720","url":null,"abstract":"<p>Inherited genetic mutations can significantly increase the risk for prostate cancer (PC), may be associated with aggressive disease and poorer outcomes, and can have hereditary cancer implications for men and their families. Germline genetic testing (hereditary cancer genetic testing) is now strongly recommended for patients with advanced/metastatic PC, particularly given the impact on targeted therapy selection or clinical trial options, with expanded National Comprehensive Cancer Network guidelines and endorsement from multiple professional societies. Furthermore, National Comprehensive Cancer Network guidelines recommend genetic testing for men with PC across the stage and risk spectrum and for unaffected men at high risk for PC based on family history to identify hereditary cancer risk. Primary care is a critical field in which providers evaluate men at an elevated risk for PC, men living with PC, and PC survivors for whom germline testing may be indicated. Therefore, there is a critical need to engage and educate primary care providers regarding the role of genetic testing and the impact of results on PC screening, treatment, and cascade testing for family members of affected men. This review highlights key aspects of genetic testing in PC, the role of clinicians, with a focus on primary care, the importance of obtaining a comprehensive family history, current germline testing guidelines, and the impact on precision PC care. With emerging evidence and guidelines, clinical pathways are needed to facilitate integrated genetic education, testing, and counseling services in appropriately selected patients. There is also a need for providers to understand the field of genetic counseling and how best to collaborate to enhance multidisciplinary patient care.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 4","pages":"360-371"},"PeriodicalIF":254.7,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5833806","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":"Cancer statistics for African American/Black People 2022","authors":"Angela N. Giaquinto MSPH,&nbsp;Kimberly D. Miller MPH,&nbsp;Katherine Y. Tossas PhD, MS,&nbsp;Robert A. Winn MD,&nbsp;Ahmedin Jemal DVM, MPH,&nbsp;Rebecca L. Siegel MPH","doi":"10.3322/caac.21718","DOIUrl":"https://doi.org/10.3322/caac.21718","url":null,"abstract":"<p>African American/Black individuals have a disproportionate cancer burden, including the highest mortality and the lowest survival of any racial/ethnic group for most cancers. Every 3 years, the American Cancer Society estimates the number of new cancer cases and deaths for Black people in the United States and compiles the most recent data on cancer incidence (herein through 2018), mortality (through 2019), survival, screening, and risk factors using population-based data from the National Cancer Institute and the Centers for Disease Control and Prevention. In 2022, there will be approximately 224,080 new cancer cases and 73,680 cancer deaths among Black people in the United States. During the most recent 5-year period, Black men had a 6% higher incidence rate but 19% higher mortality than White men overall, including an approximately 2-fold higher risk of death from myeloma, stomach cancer, and prostate cancer. The overall cancer mortality disparity is narrowing between Black and White men because of a steeper drop in Black men for lung and prostate cancers. However, the decline in prostate cancer mortality in Black men slowed from 5% annually during 2010 through 2014 to 1.3% during 2015 through 2019, likely reflecting the 5% annual increase in advanced-stage diagnoses since 2012. Black women have an 8% lower incidence rate than White women but a 12% higher mortality; further, mortality rates are 2-fold higher for endometrial cancer and 41% higher for breast cancer despite similar or lower incidence rates. The wide breast cancer disparity reflects both later stage diagnosis (57% localized stage vs 67% in White women) and lower 5-year survival overall (82% vs 92%, respectively) and for every stage of disease (eg, 20% vs 30%, respectively, for distant stage). Breast cancer surpassed lung cancer as the leading cause of cancer death among Black women in 2019. Targeted interventions are needed to reduce stark cancer inequalities in the Black community.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 3","pages":"202-229"},"PeriodicalIF":254.7,"publicationDate":"2022-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5791668","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":"Tumor board presentation of a woman with metastatic, hormone receptor-positive, mismatch repair-deficient endometrial cancer","authors":"Jennifer A. Bennett MD,&nbsp;Gini F. Fleming MD,&nbsp;Katherine C. Kurnit MD,&nbsp;Kathryn A. Mills MD,&nbsp;Willem Jan vanWeelden MD","doi":"10.3322/caac.21715","DOIUrl":"https://doi.org/10.3322/caac.21715","url":null,"abstract":"&lt;p&gt;A 65-year-old woman presented to an outside hospital with vaginal bleeding in 2009. Dilatation and curettage showed endometrial endometrioid carcinoma, International Federation of Gynecology and Obstetrics (FIGO) grade 2. She underwent exploratory laparotomy with pelvic washings, total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, and an omental biopsy. Pathology was read as uterine carcinosarcoma, homologous type, invading 3.5 cm into a 4-cm-thick myometrium, with involvement of the endocervical epithelium (no stromal involvement) and lymphovascular invasion. All 14 of the sampled lymph nodes (6 left pelvic, 1 left common iliac, 1 left aortic, 3 right pelvic, 2 right common iliac, and 1 right aortic) were negative for carcinoma. The tumor-node-metastasis (TNM) pathologic stage using current staging (2018 FIGO Cancer Report&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;) was pT1b N0 &lt;i&gt;American Joint Committee on Cancer [AJCC] Cancer Staging Manual&lt;/i&gt;, eighth edition), FIGO stage IB. Postoperative positron emission tomography/computed tomography (CT) imaging studies demonstrated no evidence of disease.&lt;/p&gt;&lt;p&gt;The patient was otherwise healthy. Her father had lung cancer, but there was no other history of cancer in the family. She received pelvic radiotherapy and 4 cycles of paclitaxel 135 mg/m&lt;sup&gt;2&lt;/sup&gt; plus ifosfamide 1600 mg/m&lt;sup&gt;2&lt;/sup&gt;, with mesna and granulocyte-colony–stimulating factor support.&lt;/p&gt;&lt;p&gt;Five years later (at age 71 years), she developed abdominal pain and vomiting and was managed conservatively for a partial small bowel obstruction. CT scans of the abdomen and pelvis showed a large, heterogeneously enhancing mass in the left suprarenal space, measuring 8.9 × 8.6 cm, likely originating from the left adrenal gland. A lobular mass in the posterior left lung base measuring 3.2 × 1.6 cm was also noted. A CT scan of the chest revealed multiple, bilateral pulmonary nodules, the largest measuring 2.4 × 2.2 cm, some with central cavitation, most consistent with metastatic disease. A fine-needle aspirate of the suprarenal mass showed poorly differentiated carcinoma with extensive necrosis.&lt;/p&gt;&lt;p&gt;At that time, the patient presented to a university hospital. Review of the original pathology reclassified the tumor as endometrial endometrioid carcinoma, FIGO grade 3 (Fig. 1A), with the suprarenal mass morphologically consistent with the patient's primary. Estrogen receptor (ER) and progesterone receptor (PR) were strongly and diffusely positive (Fig. 1B,C).&lt;/p&gt;&lt;p&gt;Subtyping of high-grade endometrial carcinomas is diagnostically challenging for pathologists, with even expert gynecologic pathologists reaching consensus in only 63% to 72% of tumors.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The most common disputes include endometrioid versus serous carcinoma, serous versus clear cell carcinoma, and endometrioid/clear cell/undifferentiated carcinoma versus carcinosarcoma.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Morphological","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"72 2","pages":"102-111"},"PeriodicalIF":254.7,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6035432","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}