Overview of breast cancer staging and surgical treatment options

Following diagnosis of breast cancer, patients undergo assessment for local and systemic treatment. Establishing a relationship and communication with the patient is critical to this assessment, as are history-taking, clinical breast examination, review of imaging studies, and interactive discussion with the patient of treatment options and possible breast reconstruction. Some type of surgical therapy is indicated in virtually all women with breast cancer, generally as the first part of a multicomponent treatment plan. The main goal of surgical therapy is to remove the cancer and accurately define the stage of disease. Surgical options broadly consist of breast conservation therapy, generally followed by radiation therapy, or mastectomy. The surgical procedure also includes assessment of regional lymph nodes for metastasis, either by axillary lymph node dissection or by the less-invasive sentinel lymph node biopsy, for the purpose of cancer staging and guiding adjuvant therapy.     

Imaging spectrum of cholangiocarcinoma: role in diagnosis,staging, and posttreatment evaluation

Cholangiocarcinoma, a tumor of biliary epithelium, is increasing in incidence. The imaging appearance, behavior, and treatment of cholangiocarcinoma differ according to its location and morphology. Cholangiocarcinoma is usually classified as intrahepatic, perihilar, or distal. The three morphologies are mass-forming, periductal sclerosing, and intraductal growing. As surgical resection is the only cure, prompt diagnosis and accurate staging is crucial. In staging, vascular involvement, longitudinal spread, and lymphadenopathy are important to assess. The role of liver transplantation for unresectable peripheral cholangiocarcinoma will be discussed. Locoregional therapy can extend survival for those with unresectable intrahepatic tumors. The main risk factors predisposing to cholangiocarcinoma are parasitic infections, primary sclerosing cholangitis, choledochal cysts, and viral hepatitis. Several inflammatory conditions can mimic cholangiocarcinoma, including IgG4 disease, sclerosing cholangitis, Mirizzi’s syndrome, and recurrent pyogenic cholangitis. The role of PET in diagnosis and staging will also be discussed. Radiologists play a crucial role in diagnosis, staging, and treatment of this disease.     

经阴道超声诊断子宫内膜癌的研究进展

子宫内膜癌是一种常见的妇科肿瘤,患者年龄越大,预后情况越差。子宫内膜癌的肌层浸润深度是临床治疗方案选择的重要依据,也是评估患者预后的主要因素,故明确诊断和精准分期尤为重要。子宫内膜癌的诊断主要依靠患者的临床表现、分段诊刮,以及经阴道超声、CT、MRI等影像学检查,超声以其高分辨率、价廉、可重复性高及无损伤性等优势被作为首选检查。本文就各超声检查方法诊断子宫内膜癌的研究进行综述,以期更精准地指导临床。     

Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) can be a very confusing diagnosis. The goal of this article is to familiarize the audience with the diagnosis, treatment, and outcome of TTTS. An overview of twinning mechanics, as well as the pathophysiology, staging, treatment options, and outcomes of TTTS, will be discussed. It is important for nurses to understand all of the treatment options available so that support can be given regardless of the path families have chosen.     

Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis

Malignant melanoma is an aggressive, therapy-resistant malignancy of melanocytes. The incidence of melanoma has been steadily increasing worldwide, resulting in an increasing public health problem. Exposure to solar UV radiation, fair skin, dysplastic nevi syndrome, and a family history of melanoma are major risk factors for melanoma development. The interactions between genetic and environmental risk factors that promote melanomagenesis are currently the subject of ongoing research. Avoidance of UV radiation and surveillance of high-risk patients have the potential to reduce the population burden of melanoma. Biopsies of the primary tumor and sampling of draining lymph nodes are required for optimal diagnosis and staging. Several clinically relevant pathologic subtypes have been identified and need to be recognized. Therapy for early disease is predominantly surgical, with a minor benefit noted with the use of adjuvant therapy. Management of systemic melanoma is a challenge because of a paucity of active treatment modalities. In the first part of this 2-part review, we discuss epidemiology, risk factors, screening, prevention, and diagnosis of malignant melanoma. Part 2 (which will appear in the April 2007 issue) will review melanoma staging, prognosis, and treatment.     

Malignant melanoma: treatments emerging,but early detection is still key

Although we are beginning to develop treatment options for malignant melanoma, earlier recognition of potential primary melanomas remains the most effective way to increase survival in this highly malignant disease. This article reviews prominent risk factors for melanoma, key physical findings in at-risk patients, new melanoma staging guidelines, and recent and emerging therapy options.     

Staging of gynecologic malignancies

Magnetic resonance imaging (MRI) is gaining momentum for staging gynecologic malignancies. MRI staging is an adjunct to clinical and surgical staging in women with cervical or endometrial cancer, respectively. For women with possible adnexal pathology, MRI is useful for lesion characterization. In patients with ovarian cancer, MRI determination of disease extent helps treatment planning, either as a surgical roadmap or to identify nonresectable patients.     

Endoscopic ultrasound-guided fine needle aspiration in hollow viscus cancer

Accurate cancer staging is essential in patients with hollow viscus malignancy to decide therapeutic modalities. Endoscopic ultrasound (EUS) is considered as the best modality for local staging of hollow viscus cancer. EUS-guided fine needle aspiration (FNA) is a minimally invasive and effective sampling method. EUS-FNA should be applied when positive diagnosis of malignancy can possibly change the choice of therapeutic options. EUS in conjunction with EUS-FNA can optimize stage-directed therapy which is helpful in selecting minimally invasive treatment option including endoscopic treatment and avoiding unnecessary surgery in advanced cases.     

Mesenteric ischemia

Mesenteric ischemia is a morbid, potentially life-threatening disease that is associated with a relatively high mortality, often due to its late diagnosis. Currently, the incidence of mesenteric ischemia in the United States is low; however, the incidence is predicted to increase because of the aging population. Therefore, whether the presentation is acute or chronic in nature, the challenge for the physician remains early diagnosis through a high index of suspicion based on vague and often atypical presentations. Surgical intervention remains the mainstay of therapy. Despite ongoing investigations of the different treatment options, including single vs multivessel bypass, antegrade vs retrograde graft placement, autogenous vs prosthetic conduits, and endovascular vs open surgical repair, many questions remain unanswered. This review summarizes the clinical presentation, diagnosis, and treatment options, including both open and endovascular approaches, for acute and chronic mesenteric ischemia.     

The role of imaging in staging renal adenocarcinoma

Numerous surgical options are available to physicians treating patients with renal adenocarcinoma. In the current clinical setting, imaging plays a key role in determining which options are selected. Newer imaging techniques such as helical CT with CT angiography, MRI, and ultrasound (US) have improved staging capabilities in this patient population. However, to approach staging accuracies recently reported, attention must be paid to proper imaging parameters. This article describes the strengths, limitations, and proper techniques used for staging renal adenocarcinoma with CT, MRI, and US.     

The progression of hepatitis B- and C-infections to chronic liver disease and hepatocellular carcinoma: presentation, diagnosis, screening, prevention, and treatment of hepatocellular carcinoma

Much information has been gained in the diagnosis and treatment of HCC during the last 15 years. Ever improving imaging technology has made nonhistologic diagnostic criteria possible, albeit controversial. Liver transplantation, resection, and RFA are considered curative options. Yet, HCC incidence is steadily rising because of limited progress on disease prevention. Accurate and cost-effective screening is necessary. Presently, only 10% to 15% of HCC patients present with a curative stage of disease. Because the field of HCC is rapidly changing, patients with HCC should be referred to liver centers with a full array of services, from surgical to oncologic. The prognosis for HCC patients will surely improve with a multi-disciplinary approach to care and further clinical research. Better screening and prevention of recurrence should eventually improve survival. It is hoped that antiviral treatment studies will lower the risk of HCC, and that these changes will occur soon enough to help the many patients at risk for or diagnosed with HCC over the next several years.     

Surgical management of non-small cell lung cancer

OBJECTIVES: To provide an overview of the surgical management of early stage non-small cell lung cancer (NSCLC) and its impact on survival and quality of life. DATA SOURCES: Published articles, book chapters, websites, and research studies. CONCLUSION: The primary treatment choice for early stage NSCLC is surgical resection. Advances have been made in all phases of care from diagnosis to rehabilitation, including better technology for staging, less invasive surgical techniques, and intra-operative and post-operative care that focuses on decreasing complications and improving survival and quality of life. New indications for the addition of adjuvant therapy to surgery can improve disease-free and long-term survival in a disease where the 5-year survival of stage I and II can be less than 50% and overall survival regardless of stage only 15%. IMPLICATIONS FOR NURSING PRACTICE: As health care educators and caregivers, nurses should be informed of the advancements in staging and surgical technique associated with early stage NSCLC and its impact on survival and quality of life.     

Chronic thromboembolic pulmonary hypertension: The disease, the diagnosis, and the treatment

Chronic thromboembolic pulmonary hypertension is a disease of unknown etiology, the diagnosis and treatment of which has changed dramatically in the past decade. Increased clinical awareness and recent developments in imaging techniques combine to promote earlier and less invasive diagnosis. Improved surgical thromboendarterectomy techniques and decreased perioperative mortality have enabled remarkable cures for most patients with this previously fatal condition. This article reviews current understanding of the disease process, imaging modalities used in diagnosis, and surgical treatment of patients with chronic thromboembolism.     

Clinically localized ovarian cancer. Progress in management

A decade ago the five-year survival rate in patients with stage I ovarian carcinoma was only 60% to 70%. Significant advances in staging and treatment, however, promise an improvement. Initially, improvement will be seen because some patients with clinically localized ovarian cancer will be discovered to have subclinical or occult metastasis at initial surgical staging and thus will be upstaged and treated appropriately for more advanced disease. More encouraging are results of recent studies on adjuvant therapy, which indicate that in some patients the need for postoperative adjuvant therapy may be obviated. A major advance in diagnosis would be development of a serum test specific for ovarian cancer--a discovery that may be forthcoming.     

Current approach to diagnosis and management of chronic lymphocytic leukemia

The care of patients with chronic lymphocytic leukemia (CLL) has changed dramatically during the past decade. This review summarizes the work-up of lymphocytosis and the current diagnostic criteria and management of CLL. Although clinical staging (Rai and Binet) remains the foundation for determining prognosis, 50% of patients with early-stage disease at diagnosis will experience an aggressive course of disease with early progression and premature death due to CLL. New laboratory techniques (CD38, fluorescence in situ hybridization [FISH]) can identify some patients with early-stage CLL at high risk of rapid disease progression. The array of treatment options has expanded in recent years and now includes monoclonal antibodies used alone or in combination with purine nucleoside analogues and alkylating agents, which have culminated in dramatically improved response rates. Supportive care guidelines now include vaccination strategies, surveillance for secondary malignancies, and aggressive management of infectious complications. An early hematology consultation is recommended for all patients at diagnosis to identify and counsel high-risk patients with early-stage disease who may benefit from more frequent follow-up or early treatment as part of a clinical trial.     

Lower-extremity arterial disease

Peripheral arterial disease is a common disorder in the aging United States population that is both underdiagnosed and undertreated. In this review, we outline the general approaches to the diagnosis and management of lower-extremity arterial diseases. A broad array of current treatment options, including medical, catheter-based, and open surgical interventions are available for patients with symptomatic peripheral arterial disease. A patient-oriented approach based on anatomic and physiologic principles for the treatment of peripheral arterial disease is presented. Embolic and aneurysmal diseases of the lower-extremity arteries are also briefly reviewed. All surgeons should be aware of these common conditions and their applicable management strategies.     

TNM/Okuda/Barcelona/UNOS/CLIP International Multidisciplinary Classification of Hepatocellular Carcinoma: concepts,perspectives, and radiologic implications

Hepatocellular carcinoma (HCC) is a major health problem worldwide. Moreover, the liver cancer field is evolving rapidly, with early diagnosis, new therapies, and a better understanding of HCC’s biology and development. Accurate staging is important for determining prognosis and selecting the most appropriate treatment for each patient. Surgical intervention remains the most effective treatment for HCC and is the only potentially curative modality. However, in HCC patients, overall survival is also independently affected by underlying liver disease and cirrhosis, which in turn affect the applicability and efficacy of treatment. Although several staging classification and prognostic scoring systems have been proposed for determining the stage and prognosis of HCC, no consensus exists on the best classification method. The most common staging classification systems include tumor-node-metastasis stage, Okuda staging, Cancer of the Liver Italian Program score, Barcelona Clinic Liver Cancer staging classification, the French, the Chinese University Prognostic Index, Japanese Integrated Scoring, and the Tokyo score. Radiologists should be aware of the different staging classification systems for HCC and familiar with the system relevant to their respective referring clinicians, as it will provide pertinent radiological evaluation for multidisciplinary management.     

胃肝样腺癌患者的临床特点与诊治(附1例临床病例)周达1,韩晶2,李锋1*

目的 探讨胃肝样腺癌(hepatoid adenocarcinoma of stomach, HAS)患者的临床特点、诊治方法。方法 分析1 例胃肝样腺癌患者的临床资料,结合国内外文献进行分析讨论。结果与结论 HAS易被误诊,拥有独特的临床病理特征,与普通型胃癌相比,预后更差。早期进行pTNM分期、手术治疗和辅助化疗可能对改善疾病预后更有利。对于淋巴结转移或/和术前远端转移的患者强烈推荐新辅助疗法。