{"title":"Triple-Negative Breast Cancer","authors":"D. Radford, J. Abraham, S. Grobmyer","doi":"10.2310/cgso.16011","DOIUrl":"https://doi.org/10.2310/cgso.16011","url":null,"abstract":"Triple-negative breast cancers (TNBCs), negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, account for 15 to 20% of all female breast cancers. TNBC is heterogeneous based on gene expression microarray, and identification of TNBC subtypes and their behavior has the potential to enable more targeted, neoadjuvant, and adjuvant interventions. TNBCs usually are higher grade (Nottingham score 3) and are more common in younger, Hispanic, and African American women. They are more aggressive, have an increased likelihood of distant disease and mortality, are larger at presentation, and are more likely to be associated with lymph node metastases. Patients with TNBC are at a higher risk for visceral metastases early in the course of the disease. Genetic risk evaluation is recommended for patients with TNBC diagnosed at or before 60 years of age. Surgical management may be influenced by gene testing results. Standard adjuvant chemotherapy is anthracycline or taxane based.\u0000\u0000This review contains 5 figures, 8 tables, and 51 references.\u0000Key Words: adjuvant, BRCA, chemotherapy, hormone receptor negative, neoadjuvant, genetics, triple-negative breast cancer, breast neoplasm.","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123711470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Imaging and Staging for Stomach Malignancy","authors":"Moamen Gabr, T. Berzin","doi":"10.2310/cgso.16056","DOIUrl":"https://doi.org/10.2310/cgso.16056","url":null,"abstract":"Therapeutic decisions regarding surgical, endoscopic, and medical management of gastric tumors depends on tumor type, anatomic location of the tumor, and, in the setting of malignant tumors, the clinical staging of the lesion. Common types of stomach tumors include adenocarcinoma, which accounts of 90% of stomach malignancies, lymphomas, gastrointestinal stromal tumors (GISTs), and neuroendocrine tumors. A detailed physical examination during initial evaluation may help target the approach during malignancy staging. Endoscopy offers a large armamentarium of tools for diagnosis and staging of gastric tumors. EUS is currently the mainstay in local staging and obtaining tissue diagnosis of primary tumor and nodal metastasis. Advances in imaging modalities have provided precise tools for diagnosis and staging of stomach malignancies.\u0000This review contains 11 figures, 1 table, and 35 references.\u0000Key Words: endoscopy, endoscopic ultrasonography, gastric malignancy, GIST, MALT lymphoma, neuroendocrine tumors, staging","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116789235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrent and Persistent Hyperparathyroidism","authors":"Anna C. Beck","doi":"10.2310/cgso.16042","DOIUrl":"https://doi.org/10.2310/cgso.16042","url":null,"abstract":"Persistent and recurrent hyperparathyroidism is defined. Key components of preoperative planning including imaging modalities are discussed. Indications for surgery and emerging techniques to aid identification of abnormal parathyroid tissue in the reoperative neck are described.\u0000This review contains 2 figures, 2 tables and 22 references\u0000Key Words: indocyanine green fluorescence angiography, methylene blue injection, near-infrared autofluorescence imaging, parathyroid cryopreservation, parathyromatosis, persistent hyperparathyroidism, recurrent hyperparathyroidism, selective parathyroid hormone venous sampling","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131740861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Parathyroid Carcinoma","authors":"Anna C. Beck, S. Sugg","doi":"10.2310/cgso.16043","DOIUrl":"https://doi.org/10.2310/cgso.16043","url":null,"abstract":"The clinical presentation and genetic mutations associated with parathyroid cancer are reviewed. Surgery, other treatment modalities, and outcomes are discussed.\u0000This review contains 1 table and 19 references.\u0000Key Words: CDC73-related parathyroid carcinoma, denosumab, HRPT2 germline mutation, hyperparthyroidism-jaw tumor syndrome, parathyroid carcinoma","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117257677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Duodenal Malignancies","authors":"E. Newton, Benjamin H Schmidt, M. Meyers","doi":"10.2310/cgso.16072","DOIUrl":"https://doi.org/10.2310/cgso.16072","url":null,"abstract":"Although malignancies involving the small bowel are rare, one-third of these are located in the duodenum. The majority of duodenal tumors are adenocarcinoma but also may include gastrointestinal stromal tumors (GIST), carcinoid or neuroendocrine tumors, sarcomas, and lymphoma. These commonly present with nonspecific symptoms, but obstructive patterns predominate when symptoms are present. Preoperative diagnosis is made via endoscopy and/or cross-sectional imaging. This section focuses on treatment and surgical management for adenocarcinoma, carcinoid tumors, and GISTs of the duodenum. Surgical resection is the primary treatment of for all three of these, but all have significant nuances in surgical planning and decision-making as well as variability in the role of adjunctive treatment in their management. Functional carcinoid tumors can have hormone-driven symptoms and are associated with an increase in risk of carcinoid crisis, which may be prophylactically treated with intravenous octreotide. Resection of these tumors relies heavily on tumor relationship to the ampulla. Key anatomic distinctions and clinical tips to identify the ampulla to ensure an appropriate duodenal resection are discussed in this review.\u0000\u0000This review contains 12 figures, 5 tables, and 54 references.\u0000Key Words: carcinoid, duodenal carcinoma, duodenal adenocarcinoma, duodenal resection, duodenal tumors, neuroendocrine tumor, gastrointestinal stromal tumor, small bowel tumors","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128875892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of Neuroendocrine Tumors of the Pancreas","authors":"R. C. Martin II","doi":"10.2310/cgso.16074","DOIUrl":"https://doi.org/10.2310/cgso.16074","url":null,"abstract":"Neuroendocrine tumors (NETs) comprise a heterogeneous group of malignancies, with differences in prognosis and effective therapies. Traditionally, NETs have been characterized by tumor grade, site of primary tumor, functional status, and presence of underlying familial syndrome. However, increased feasibility and use of next-generation sequencing and other methodologies have revealed new genomic and epigenetic aberrations. In the past decade, treatment options available for metastatic well-differentiated gastroenteropancreatic NETs have expanded, with the approval of antiangiogenic and mTOR-directed targeted therapies, and our armamentarium of active therapies is likely to further increase. Optimal surgical therapy both for nonfunctional and functional PNETs has become more personalized and strategic to optimize long-term quality of life time. Management of localized metastatic PNET has become a true multidisciplinary management opportunity that all treating physicians should use. Peptide receptor radioligand therapy is an emerging treatment that uses functional imaging to personalize dosimetry to the tumor and avoid nephrotoxicity. Nevertheless, there is a critical need for further biomarkers, particularly multianalyte biomarkers, to aid in prognostication and predict efficacy of therapies.\u0000\u0000This review contains 1 figure, 1 table, and 72 references.\u0000Key Words: carcinoid tumor, islet cell carcinoma, neuroendocrine tumors, pancreatic, surgical management, medical management, metastatic, localized.","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129660567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anal Cancer","authors":"Miriam W Tsao, D. Shibata","doi":"10.2310/cgso.16033","DOIUrl":"https://doi.org/10.2310/cgso.16033","url":null,"abstract":"This chapter focuses on anal squamous cell carcinoma and its precursor lesions and summarizes the relevant epidemiology, evaluation, and management. Risk factors including human immunodeficiency virus status and sexual practices as well as the role of human papilloma virus in anal cancer pathogenesis are reviewed. Further understanding of the molecular biology of anal cancer will inform future strategies for targeted therapy, and biomarkers such as p16 and p53 may emerge as important prognostic indicators. Anal low-grade or high-grade squamous intraepithelial lesion histologies are particularly prevalent in at-risk populations, and surgical oncologists should understand the principles that underlie surveillance and management strategies. Finally, the role of chemoradiation and salvage abdominoperineal resection and the options for systemic therapy in the setting of metastatic disease are outlined. \u0000\u0000This review contains 10 figures, 5 tables, and 77 references.\u0000Key Words: Anal cancer, Anal HSIL, Anal LSIL, Anal margin cancer, Anal squamous cell, carcinoma, HPV, p16, Perianal cancer","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126957330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Use of Adjuvant or Neoadjuvant Chemotherapy in Extremity and Truncal Sarcoma","authors":"R. Canter","doi":"10.2310/cgso.16100","DOIUrl":"https://doi.org/10.2310/cgso.16100","url":null,"abstract":"Although neoadjuvant chemotherapy has been an established component of multimodality cancer care for patients with pediatric sarcomas for the past 25 years, the role of adjuvant or neoadjuvant chemotherapy in the management of adult patients with soft tissue sarcoma (STS) amenable to treatment with curative intent remains controversial. Overall, meta-analyses have revealed modest improvements in survival outcomes with the use of adjuvant or neoadjuvant chemotherapy, but individual trials have demonstrated inconsistent results leading some to question the robustness and external validity of the results. A recent randomized trial using anthracycline- and ifosfamide-based chemotherapy has provided further positive evidence in support of neoadjuvant chemotherapy for adult STS patients, but concerns persist regarding the risks of chemotherapy-related toxicities and the generalizability of the findings. Given the substantial risk of distant recurrence and disease-specific death for adult STS patients with tumors greater than 10 cm, especially those with synovial sarcoma and myxoid or round liposarcoma histologies, these patients should be strongly considered for neoadjuvant chemotherapy as part of a combined modality approach. The impact of recent level I data on the broader implementation of adjuvant or neoadjuvant chemotherapy in adult STS remains to be seen.\u0000 This review contains 5 figures and 34 references\u0000Key Words: chemotherapy, limb salvage, myxoid/round cell liposarcoma, multimodality therapy, soft tissue sarcoma, surgery, survival, synovial sarcoma, undifferentiated pleomorphic sarcoma\u0000 ","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123881905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Treatment for Hepatocellular Carcinoma in the Era of Multiple Staging and Algorithm","authors":"S. Yamashita, K. Joechle, J. Vauthey","doi":"10.2310/cgso.16061","DOIUrl":"https://doi.org/10.2310/cgso.16061","url":null,"abstract":"A plethora of staging systems for hepatocellular carcinoma (HCC) has existed, as the management for HCC is made complex by the interplay of tumor characteristics and the health and underlying functions of both the patient and the liver. The majority of patients with HCC have nonsurgical HCC. The Barcelona Clinic Liver Cancer (BCLC) classification has been regarded as the optimal staging system and treatment algorithm for HCC. However, even in patients with intermediate or advanced stage in BCLC classification, who had not been originally recommended to undergo surgery, some could benefit in terms of long-term survival by surgical treatments. An expert panel on HCC has stated that the American Joint Committee on Cancer staging system, whose predictive power on the outcome have been improved by continuous amendments, should be applied for patients undergoing surgery. Herein, we review the recent staging system focusing on patients with HCC undergoing surgery.\u0000 \u0000This review contains 5 figures, 3 tables and 34 references\u0000Key Words: American Joint Committee on Cancer, Barcelona Clinic Liver Cancer, hepatic resection, hepatocellular carcinoma, orthotopic liver transplantation","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131259543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Liposarcoma","authors":"J. Crompton, Arun S. Singh, S. Dry, F. Eilber","doi":"10.2310/cgso.16107","DOIUrl":"https://doi.org/10.2310/cgso.16107","url":null,"abstract":"Liposarcoma is a mesenchymal malignancy that predominantly arises in the retroperitoneum, trunk, and extremities. Histologic subtypes of liposarcoma include well-differentiated/dedifferentiated, myxoid/round cell, and pleomorphic liposarcoma. Although liposarcoma is rare and can occur in almost any anatomic location, it is the most common soft tissue sarcoma in the retroperitoneum, and surgery remains the only potentially curative therapy. This review discusses liposarcoma pathogenesis, classification, clinical-diagnostic evaluation, treatment, and surveillance. The cornerstone of treatment is surgery, with the main therapeutic goals of improving survival, limiting local recurrence, maximizing function, and minimizing morbidity. Perioperative radiation therapy may be indicated in patients with large high-grade liposarcomas. Systemic treatment—whether traditional chemotherapy or molecularly targeted therapy—may benefit patients depending on their histologic subtype, location, and extent of disease. For the majority of patients, however, systemic treatment is not curative. Controversial issues in the management of liposarcoma, such as surgical margins and extent of resection, are also discussed. \u0000\u0000This review contains 2 figures, 5 tables and 39 references\u0000Key words: atypical lipomatous liposarcoma, liposarcoma, myxoid liposarcoma, pleomorphic liposarcoma, retroperitoneal sarcoma, soft tissue sarcoma, well-differentiated/dedifferentiated liposarcoma","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134032177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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