Cancer centers--origins and purpose. The James Ewing lecture

Cancer centers in the United States date back to the beginning of this century, although there were few until the late 1950s and 1960s. The National Cancer Act of 1971 introduced a new era in serving as a major stimulus to the development of comprehensive cancer centers. Research scientists and physicians in centers have contributed significantly to the new knowledge of normal and abnormal regulation of cell growth and differentiation and to the advances in the diagnosis and treatment of cancer. The future for cancer centers is very bright. They will continue to play a major role in the advancement of knowledge about cancer. However, centers must be reevaluated at intervals to correct any deficiencies and to stimulate new and innovative approaches. Surgical oncologists should become more involved in cancer center research. Comprehensive cancer centers should develop more effective regional cancer control and prevention programs. Reevaluation of centers by the National Cancer Institute, Bethesda, Md, and its advisory body, the National Cancer Advisory Board, along with cancer center leaders, should result in a consensus concerning changes to enhance their contribution to a solution to the cancer problem.     

Biologic control of cancer. The James Ewing lecture

There is abundant clinical and laboratory evidence that host defenses are a significant factor in the progression and the control of cancer. The host immune system plays the major role, primarily through cell-mediated responses to the neoplastic threat. Great progress has been made in evaluating immune competence, although the specific defects have not been identified in all patients. The history of immunotherapy includes numerous trials, with few successes and many failures. Advances in knowledge and technology, however, indicate that efforts to manipulate and strengthen host defenses have great potential in the fight against cancer.     

Professionalism: the James Pryor memorial lecture

James Pryor was born in country Victoria in 1928 and died there in 2002. He received his medical degree from Melbourne University in 1950 with honours in surgery. He went on to become a Fellow of the Royal College of Surgeons and of the Royal Australasian College of Surgeons.     

The genetic bases of cancer. Lucy Wortham James lecture

The past three decades have witnessed enormous progress made in our understanding of the pathogenesis of cancer. Research results of the previous decades had indicated that a variety of agents, the carcinogens, could induce cancer in experimental animals. By extension, similarly acting agents were presumed to intervene in human cancer. Beyond this, the precise of the pathogenetic mechanisms underlying human malignancies remained obscure. In these last decades, the origins of cancer have been uncovered: specific genes and biochemical mechanisms are now known to drive the process of neoplasia.     

Strategies toward the primary prevention of cancer. Lucy Wortham James clinical research award lecture

This presentation reflects four decades of research on the origins and prevention of major human cancers linked to tobacco use and nutritional factors. Observations in the 1950s went on to prove the causal relationship between cigarette smoking and lung cancer. Attempts to lower the cancer risk by product modification have shown some promise, but an absolute risk reduction can be attained only by abstinence from tobacco use. The role of dietary fat as a risk factor for breast cancer is highlighted as an example of the link between nutrition and cancer. Preventive strategies of dietary modification need to delineate the roles of specific types of dietary fats in mammary carcinogenesis. Low-fat diets in conjunction with chemotherapy and ovarian ablation may even be effective in preventing metastasis or recurrence of breast cancer after surgery in premenopausal patients. Health education in schools and health promotion efforts involving all segments of the community need to be pursued as primary preventive strategies for cancer control, along with efforts to ward product modification and research on chemoprevention of cancer.     

Primary benign solid tumors of the liver.

The benign solid primary tumors of the liver separate into three major groups: (1) the most common lesions--small, nodular tumors, often found incidentally with histologic features suggesting a reactive etiology, that never rupture or metastasize, that seem to grow most rapidly in children and pregnant women, and that are probably unrelated to birth control medication; (2) the less common adenomas that are purely epithelial, that most often occur in menstruating females, that often show necrosis and rupture, and that are closely associated with oral contraceptive agents; and (3) very rare tumors, usually mesenchymal, occurring solely in children. The therapeutic and prognostic implications of these tumors are defined based upon a study of 111 patients, all but one of whom have undergone resection.     

James J Mason Brown memorial lecture Surgical training then and now

Paediatric surgical training has changed significantly since the birth of the specialty. It has evolved from the apprenticeship system to a complex, demanding, but ultimately time-limited experience for today's trainees. Historical development is reviewed, and the challenges of training within the current UK health care system is discussed.     

Benign solid tumors

The two most common solid benign tumors in the hand are lipoma and xanthoma, both painless; however, these tumors enlarge slowly until they are recognized (because of their unsightly appearance or interference with joint function) and treated.     

Minimal invasive surgery in pediatric solid tumors.

BACKGROUND: There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors. METHODS: A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005. RESULTS: Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results. CONCLUSIONS: With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.     

Minimal change nephrotic syndrome revealing solid tumors.

In 2 patients with the nephrotic syndrome, unsuspected solid tumors were found. One was a small cell lung carcinoma, accompanied with the syndrome of inappropriate ADH secretion. The other was a cancer of the breast with lymph node and bone metastases. In both, renal biopsy showed minimal change disease without immune complex deposits. There are only 14 other reported cases of paraneoplastic lipoid nephrosis complicating solid tumors. Such cases lead to the discussion on the respective roles of tumor cell gene product(s) inducing proteinuria and of lymphokine secretion by lymphocytes directed against the tumor itself. Cancer should be considered as a possible etiology of the minimal change nephrotic syndrome in the adult.     

MicroRNAs in solid tumors

MicroRNAs (miRNAs or miRs) are small, noncoding RNAs (approximately 20-22 nucleotides) that have critical functions in cell proliferation, apoptosis, and differentiation. These evolutionarily conserved RNA sequences are the result of a complex sequence of processing steps, which can regulate the expression of tens, and even hundreds, of genes. Their regulatory effect is based upon the degree of complementarity between the mature miRNA and the 3' untranslated region region of the target mRNA resulting in either complete degradation or translational inhibition of the target mRNA. In vertebrates they are often tissue specific in their expression patterns and dysregulated in malignancies. Thus, miRNA profiling has been used to create signatures for many solid malignancies. These profiles have been used to not only classify tumors, but also to help predict survival and outcome. Herein, we review the role of miRNAs in the development and progression of solid tumors.