The modern management of endometrial cancer

Endometrial cancer is a relatively common gynecological cancer which is increasing in incidence. Survival rates are generally good for those with early disease but a significant minority of women have high risk or advanced disease. Better treatments are required to improve outcomes for these women. There is increasing interest in the use of chemotherapy and improved understanding of the molecular biology of endometrial tumours may pave the way for the use of therapeutic biologic agents that target specific molecular pathways. Recent years have seen greater emphasis on an evidence-based approach to the management of women with endometrial cancer. Extended surgery and adjuvant therapy are now used selectively after individual risk assessment for each woman and there is increased interest in the use of chemotherapeutic agents in the adjuvant setting. This review addresses the modern management of endometrial cancer in the light of available evidence and highlights areas of controversy.     

State of the art of minimally invasive breast biopsy: Principles and practice

In the last two decades, the increasing use of screening mammography with the early detection of breast cancer and the newly gained understanding of the biology and changing therapy of breast cancer, emphasizing systemic therapy and minimizing extensive local surgery, has contributed to the increasing development of minimally invasive techniques for the diagnosis of breast lesions. Minimally invasive techniques provide increased patient comfort, excellent cosmetic result and minimal morbidity They are also responsible for decreased costs and better medical care by allowing an informed discussion of breast cancer therapy and planning of surgery with an emphasis on negative margins and the dissection of the sentinel node. Techniques in use include Fine-Needle Aspiration Cytology, Core-Needle biopsy, Vacuum-Assisted Core biopsy (Mammotome) and Large Core biopsy (ABBI, Site-select). We present a balanced, evidence-based approach to the diagnosis of patients with palpable or mammographic abnormalities.     

肺癌筛查和早期诊断研究进展

在我国肺癌已居肿瘤相关死亡的首位,虽然进展期肺癌患者预后很差,但大部分早期肺癌是可以治愈的.早期诊断、外科治疗仍是提高肺癌治愈率的主要手段.本文复习有关胸片(CXR)、痰细胞学、荧光纤支镜、低剂量CT(LDCT)以及分子生物学技术等在肺癌筛查和早期诊断中应用的相关文献,并对它们的效果加以评估.LDCT是目前对高危人群筛查最有效的方法,荧光纤支镜、痰液基细胞学、分子生物学技术的进展则对早期诊断有重要作用.     

EGFR-mutated lung cancer: a paradigm of molecular oncology

The development of EGFR tyrosine kinase inhibitors for clinical use in non-small cell lung cancer and the subsequent discovery of activating EGFR mutations have led to an explosion of knowledge in the fields of EGFR biology, targeted therapeutics and lung cancer research. EGFR-mutated adenocarcinoma of the lung has clearly emerged as a unique clinical entity necessitating the routine introduction of molecular diagnostics into our current diagnostic algorithms and leading to the evidence-based preferential usage of EGFR-targeted agents for patients with EGFR-mutant lung cancers. This review will summarize our current understanding of the functional role of activating mutations, key downstream signaling pathways and regulatory mechanisms, pivotal primary and acquired resistance mechanisms, structure-function relationships and ultimately the incorporation of molecular diagnostics and small molecule EGFR tyrosine kinase inhibitors into our current treatment paradigms.     

复发性卵巢癌二线化疗临床价值的循证评价

目的评价复发性卵巢上皮癌化疗的临床价值。方法采用循证评价的方法，对1999年1月至2003年12月国内外公开发表的有关复发性卵巢上皮癌患者化疗对其生存期影响的所有文献进行复习，对符合循证系统评价的文献结果进行分析，从而评价化疗对复发性卵巢上皮癌患者生存期的影响。结果符合纳入标准的共14篇文献，循证评价结果显示：①铂类敏感的复发性卵巢癌中，接受了铂类或以铂类药物为基础的二线化疗者的总反应率为58．0％，中位反应率为57．0％。而接受了非铂类药物二线化疗者的总反应率为24．5％，中位反应率为24．2％。两者相比较，均有显著性差异，P〈0．05。②铂类耐药的复发性卵巢癌中，接受铂类或以铂类药物为基础的二线化疗的总反应率为52．6％，中位反应率为56．3％。而接受非铂类药物二线化疗的总反应率为19．2％，中位反应率为48．67％。两者相比较，均有显著性差异，P〈0．05。③铂类耐药型复发性卵巢癌患者选用铂类药物二线化疗的中位生存期为20个月，而用非铂类药二线化疗的中位生存期为14.5个月，两者相比较，有显著性差异，P〈0．05。结论二线化疗方案的选择及预后与对铂类化疗敏感性有关。复发性卵巢上皮性癌二线化疗应遵循个性化原则。为了改善复发性卵巢上皮性癌的预后和提高生存率，最佳的治疗方法仍需要进一步研究。     

Disparities between blacks and whites in tobacco and lung cancer treatment

Racial disparities exist in lung cancer incidence, morbidity, and mortality. Smoking is responsible for the majority of lung cancers, and racial disparities also exist in smoking outcomes. Black smokers are less likely than white smokers to engage in evidence-based tobacco treatment, and black smokers are less likely than white smokers to stop smoking. Continued smoking following a lung cancer diagnosis is a potential indicator of poor lung cancer treatment outcomes, yet lung cancer patients who smoke are unlikely to receive evidence-based tobacco treatment. The risks from continued smoking after diagnosis deserve attention as a modifiable factor toward lessening racial disparities in lung cancer outcomes.     

SEOM Clinical Guideline in ovarian cancer (2016)

Despite remarkable advances in the knowledge of molecular biology and treatment, ovarian cancer (OC) is the first cause of death due to gynecological cancer and the fifth cause of death for cancer in women in Spain. The aim of this guideline is to summarize the current evidence and to give evidence-based recommendations for clinical practice.     

Prognostic factors uterine corpus cancer

The accumulated clinico-pathological dates and recent molecular biological studies have identified several prognostic factors for endometrial cancers. FIGO staging has taken into consideration of the tumor expansion and is the most important predictor in evaluating patient outcome. Characteristics of tumor biology, such as morphology of tumor and depth of invasion are also important prognostic considerations. Molecular markers indicating genetic/molecular events in cancer biology appear to be the 3rd predictors in estimating the prognosis. Finally, treatment of uterine corpus cancer can be directly related to prognosis. Postoperative chemotherapy is gradually taking precedence over irradiation in considering evidence-based medicine.     

Surveillance imaging following definitive radiotherapy for non–small cell lung cancer: What is the clinical impact?

Lung cancer is the leading cause of cancer death worldwide. Recurrence rates at all stages are high, but evidence-based post-treatment surveillance imaging strategies to detect recurrence are poorly defined, and salvage options are frequently limited. A number of national and international oncology guidelines address post-treatment imaging, but are largely based on low-level, retrospective evidence because of a paucity of high-quality data, particularly in regard to cost-effectiveness and quality-of-life endpoints. Given the lack of randomized data addressing appropriate surveillance imaging modality and interval following definitive treatment of lung cancer, there remains an unmet clinical need. Meaningful surveillance endpoints should include the financial impact, patient quality-of-life outcomes, and access-to-care issues associated with intensive follow-up to ensure that guidelines reflect quality and sustainability. A need for prospective randomized data on the subject of imaging surveillance after definitive local therapy remains an unmet need, and an opportunity for collaboration and further research.     

Management of unusual histological types of breast cancer

There is increased understanding of the heterogeneity of breast tumors, with greater emphasis now being placed on histological and molecular profiles and, in particular, their implications for prognosis and therapy. This review addresses breast cancers of unusual histological subtype with an approximate incidence ≤1%. Given the rarity of these tumors, the literature contains primarily case reports, small series, and population-based studies. Data are heterogeneous and almost entirely retrospective, frequently gathered over long time periods, in the context of changing pathological techniques and reporting. In addition, our understanding of the disease biology and therapeutic context has also evolved significantly over this time. There is often limited information about the specific therapies used and the rationale for choosing such an approach. Meaningful comparisons of treatment modalities are not feasible and it is not possible to define management guidelines. Instead, this review correlates the available information to give an impression of how each subgroup behaves-of the favored surgical technique, responses to therapy, and prognosis-as well as the emerging molecular data, highlighting new research areas for potential target in clinical trials. Each tumor subtype described represents a small but real cohort of patients with breast cancer, and although inferences may be made from this review, we are mindful of the paucity of data. The management of each patient must be considered in the context of their unique clinical presentation and correlated with the evidence-based principles that apply to more common breast cancer histologies.     

Ethnic Differences in Survival for Female Cancers of the Breast,Cervix and Colorectum in British Columbia,Canada

Background: Chinese and South Asians are among the fastest growing minority populations in Canada;however little is known about the burden of cancer in these populations. Objective:The objective is to examinesurvival rates for breast, cervical and colorectal cancers in women within these two ethnic populations, ascompared to the BC general population. Methods: Survival rates were calculated for three time periods in theChinese, South Asian and BC general populations, using the BC cancer registry. Ethnicity within the registrywas determined using surnames. Results: Survival rates for female breast, cervical and colorectal cancers haveimproved over time in all three population groups, however general differences were found among the groups.Chinese women had higher survival rates than both South Asians and all BC women for breast and cervicalcancer, and intermediate survival rates between South Asians and all BC women for colorectal cancer. SouthAsian women had the highest survival rates for colorectal cancer, similar survival rates to all BC women forbreast cancer, and lower survival rates for cervical cancer. Interpretation: Differences in the observed survivalrates may be explained by variations in screening and early detection, treatment practices, and cancer biology.This is discussed more fully for each cancer site.     

Personalizing therapy with targeted agents in non-small cell lung cancer

In the last 6 years, since the first reports of an association between somatic mutations in epidermal growth factor receptor (EGFR) exons 19 and 21 and response to EGFR tyrosine kinase inhibitors (TKIs), treatment of non-small cell lung cancer (NSCLC) has changed dramatically. Based on laboratory and clinical observations, investigators have anticipated that these mutations could be predictive of response to EGFR TKIs and numerous studies have confirmed that the presence of mutation was associated with longer survival in patients receiving targeted therapy. Prospective trials comparing standard platinum-based chemotherapy with EGFR TKIs in patients with and without activating EGFR mutations validated the predictive value of molecular selection of patients for first-line treatment of advanced NSCLC. Recently, preclinical and first-in-human studies have demonstrated impressive activity of ALK TKI in tumors harboring ALK rearrangement. In this article, we review current data on molecular biology of lung cancer and evidence-based patient selection for targeted therapy.     

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.     

Knowledge of Evidence-Based Cancer Risk Factors Remains Low Among New Zealand Adults: Findings from Two Cross-Sectional Studies, 2001 and 2015

Objective: Cancer risk reduction messages are a part of cancer control efforts around the world. The complex reality is that risk factors differ for different types of cancer, making clear communication of desired behavioural changes more difficult. This study aims to describe awareness of risk factors for breast, bowel, cervical, prostate and lung cancer and cutaneous melanoma among New Zealanders in 2014/15 and identify changes in awareness since 2001. Methods: Two national telephone surveys, the first (CAANZ01) conducted in 2001, included 438 adults (231 females and 207 males, 64% response rate). The second, conducted in 2014/15 (CAANZ15), included 1064 adults (588 females and 476 males, 64% response rate). Results: In 2014/5, most participants could identify evidence-based risk factors for lung cancer and melanoma. In contrast, many participants were unable to name any risk factors (evidence-based or otherwise) for bowel (34.8%), breast (48.8%), cervical (53.9%) and prostate cancer (60.9%). Between 2001 and 2014/5 there were increases in the proportion of individuals identifying sunbeds as increasing melanoma risk, and alcohol consumption and family history as increasing risk for bowel and breast cancer. Conclusions: Effective communication of risk information for specific cancers remains a challenge for cancer control. Although some positive changes in awareness over the 14 year period were observed, there remains substantial room for progressing awareness of evidence-based risk factors.     

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.     

Colorectal Cancer Association of Canada consensus meeting: raising the standards of care for early-stage rectal cancer

The purpose of the meeting reported here was to develop a set of national evidence-based standards for assessing and managing patients with potentially resectable rectal cancer. This report represents the consensus of the multidisciplinary group of Canadian rectal cancer experts attending that meeting.     

Contemporary progress in ovarian cancer screening

Our limited understanding of the natural biology of ovarian cancer, along with its low prevalence in the general population make early detection especially challenging. To be successful at the population level, an ovarian cancer screening test must prove its beneficial effect on ovarian cancer-specific mortality while achieving near-perfect specificity in order to minimize the harms resulting from false-positive results. No current screening tests for ovarian cancer fulfill these expectations. We review the current status and the challenges of ovarian cancer screening in the context of evidence-based principles that define a valuable cancer screening program.     

Upper gastrointestinal tumors: current status and future perspectives

Recent therapeutic developments that have provided new promising and successful approaches to the treatment of solid tumors are in large part due to the increasing understanding of their molecular biology. Despite this progress, these new therapies have provided minimal benefit in the treatment of upper gastrointestinal (GI) malignancies. Hence, the overall survival of patients with upper GI tumors remains dismal. These disappointing results are largely due to the lack of early detection strategies, inadequate medical treatments and the poor understanding of upper GI tumor biology. Clinically, the treatment paradigm has been evolving for these malignancies. Esophageal cancer is now commonly treated with preoperative chemoradiation in the USA, in both academic and community cancer centers, due to its theoretical advantages. Adjuvant chemotherapy and chemoradiation are also frequently used in patients with pancreatic cancer. Exciting prospects remain in the medical and surgical treatment of these malignancies with the inclusion of biologic agents in many protocols, newer chemotherapeutic agents (such as S-1 in the treatment of gastric cancer), and the use of minimally invasive procedures for the treatment of premalignant and, possibly, early malignant lesions of the esophagus and stomach. This review focuses on the current practice in the management of upper GI tumors and summarizes the recent advances in the field.     

The Carolina Breast Cancer Study: integrating population-based epidemiology and molecular biology

Summary The integration of epidemiology and molecular biology provides a new strategy to identify additional risk factors for breast cancer and to better understand the role played by traditionally recognized risk factors. The Carolina Breast Cancer Study (CBCS) is a population-based, case-control study designed to identify causes of breast cancer among Caucasian and African-American women who are residents of a 24-county area of central and eastern North Carolina. Information on established and potential breast cancer risk factors is obtained by personal interviews. Blood samples are collected from all consenting participants. Medical record documentation and paraffin-embedded tumor specimens are obtained for all breast cancer patients. DNA from tumor tissue is tested for a variety of molecular alterations characteristic of breast cancer. Germline DNA from blood lymphocytes is evaluated for presence of alleles increasing susceptibility to breast cancer. Statistical analyses evaluate gene-environment interaction by exploring the associations between environmental/behavioral factors and breast cancer in relation to specific molecular alterations (germline and tumor). Results will help identify high-risk women, clarify causal pathways, and hopefully contribute to the prevention of breast cancer.     

Normal cell phenotypes of breast epithelial cells provide the foundation of a breast cancer taxonomy

The current classification system for breast cancer is based on expression of empirical prognostic and predictive biomarkers. As an alternative, we propose a hypothesis-based ontological breast cancer classification modeled after the taxonomy of species in evolutionary biology. This approach uses normal breast epithelial cell types and differentiation lineages as the gold standard to classify tumors. We show that there are at least eleven previously undefined normal cell types in human breast epithelium and that each breast carcinoma is related to one of these normal cell types. We find that triple negative breast cancers do not have a ‘basal-like’ phenotype. Normal breast epithelial cells conform to four novel hormonal differentiation states and almost all human breast tumors duplicate one of these hormonal differentiation states which have significant survival differences. This ontological classification scheme provides actionable treatment strategies and provides an alternative approach for understanding tumor biology with wide-ranging implications for tumor taxonomy.