bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunotherapy of gynecologic malignancies
Authors: Foon Kenneth A. , Fanning James
Published: February 2007

Systemic Corynebacterium parvum and BCG have limited activity in gynecologic malignancies. Although intraperitoneal C. parvum is active, its toxicity is prohibitive. Intraperitoneal alpha‐interferon is an active second line agent for minimal residual disease following combination chemotherapy. Intraperitoneal interferon trials are ongoing. Alpha‐interferon is also active against lower genital tract condyloma acuminata. Sufficient numbers of patients have not been evaluated to determine the activity of interleukin‐2(IL‐2) in gynecologic malignancies. Radioisotope labeled monoclonal antibodies can image gynecologic malignancies and may have a future therapeutic role. The last decade has witnessed a substantial growth in immunotherapy and has demonstrated a role for biologic agents in cancer therapy. Continued improvement in biologic therapies should lead to major advances in gynecologic cancer diagnosis and therapy.
Cervical metastases from an occult primary site
Authors: Harwick Robert D.
Published: February 2007

Less than 5% of patients with metastatic cervical carcinoma will not have a detectable primary site despite a proper work‐up. Recent aids for these diagnostic problems include fine needle aspiration and immunohistochemical panels to differentiate undifferentiated carcinoma from melanoma and/or lymphoma. CT scanning can suggest areas in the upper aerodigestive tract for biopsy and can be helpful in suggesting the pathology of the enlarged lymph nodes. EBV titers are often elevated when a nasopharyngeal carcinoma is small. Aggressive treatment of the occult primary patient with metastatic melanoma, thyroid cancer, and metastatic cancer presumed to arise from the skin of the head and neck or the mucous membranes of the upper aerodigestive tract is indicated as long‐term survival is often achieved.
Elective treatment of the neck in cancer of the oral tongue
Authors: Silver Carl E. , Moisa Idel I.
Published: February 2007

Management of the clinically negative neck in patients with carcinoma of the oral tongue remains a complex and controversial subject. While statistical proof of the value of elective neck dissection in tongue cancer remains elusive, the high incidence of occult cervical metastases, even with small primary tumors, and the poor salvage rates and increased incidence of extracapsular spread in cases that have developed palpable adenopathy, provide a logical basis for treatment of the neck in a preclinical stage.
Diagnosis and pitfalls in the treatment of parotid tumors
Authors: Spiro Ronald H.
Published: February 2007

Any swelling near the ear is best considered a parotid neoplasm until proved otherwise. The diagnosis is primarily based on the clinical examination. Imaging studies are best reserved for patients who present with palate or tonsil swellings, which must be distinguished from parapharyngeal or minor salivary gland tumors. Almost all benign, and most malignant parotid tumors can be resected with preservation of the facial nerve. Aspiration biopsy can add useful information, but is not essential for treatment planning as the extent of the surgical procedure is primarily determined by the extent of the tumor. Survival rates in patients with malignant tumors are most significantly influenced by tumor stage. Results seem to have improved in recent years, possibly because we are treating a larger proportion with favorable lesions. Another factor may relate to the enhancement of locoregional control now achieved with postoperative radiotherapy, particularly in patients with Stage III or IV tumors.
Mandibulotomy and mandibulectomy in difficult tumors of the base of the tongue and oropharynx
Authors: Shaha Ashok R.
Published: February 2007

Wide exposure of the tumors of the base of the tongue and oropharynx can be easily obtained via mandibulotomy, which provides equally good exposure for tumors of the posterior oral cavity and oropharynx. Segmental mandibulectomy can be avoided in patients where the tumor does not invade the mandible or is not in close proximity of the mandible. Preoperative work‐up may include evaluation by means of the fiberoptic telescope to determine the extent of the tumor, examination under anesthesia, panoramic X‐ray of the mandible, CT scan and MRI, as well as dental evaluation. Tracheostomy provides airway during the operation and tracheobronchial access for clearance of pulmonary secretions postoperatively. The technique for median labiomandibuloglossotomy is described, as well as the mandibular swing approach and mandibulectomy. Cosmetic deformity after segmental mandibulectomy is minimal but mandible reconstruction should nonetheless be considered based on the extent of the tumor, tumor control, and the need for postoperative radiation therapy.
Evaluation of thyroid nodules
Authors: Dorsch Thomas R.
Published: February 2007

The first consideration in evaluating the thyroid nodule is whether it is functioning and causing hyperthyroidism. Autonomous nodules should be treated with either surgery or 1–31, with surgery favored due to the possibility, although small, of malignancy. Thyroid scans are no longer recommended during the initial evaluation of the thyroid nodule. Ultrasound is useful in determining the size of the nodule and whether it is multinodular thyroid disease, but it cannot detect thyroid cancer. Fine needle aspiration biopsy is currently the procedure of choice for evaluating all thyroid nodules. For accuracy of the cytological analysis, it is important that adequate tissue samples be obtained. False negative findings are of most concern to the clinician and occur in 2–10% of reported fine needle aspiration biopsy series. Nodules thought to be benign will need continued follow‐up.
Modern methodologies of differentiating thyroid masses
Authors: Mafee Mahmood F. , Capek Vlastimil , Blend Michael , Renigers Sigrida A. , Friedman Michael , Belmont Heraldo
Published: February 2007

The rational treatment of thyroid diseases requires an understanding of the thyroid function and an accurate evaluation of its functional (endocrine), as well as it morphological alteration. There are several different imaging techniques which are available and are in use in the evaluation of thyroid diseases. In this article we present a protocol for the use of diagnostic imaging to evaluate a focal thyroid mass, a diffusely enlarged gland, regional, and distant metastatic disease. The current diagnostic applications of radionuclide scanning, ultrasound, computed tomography, and magnetic resonance imaging (MRI) will be discussed.
Papillary carcinoma of the thyroid
Authors: Cady Blake
Published: February 2007

The clinical behavior and mortality rate of papillary carcinoma of the thyroid varies widely, and clinically insignificant microscopic foci of the disease are frequently found. Dietary iodine and radiation to the head and neck in childhood play a role in etiology. Needle aspiration cytology provides a highly accurate diagnosis. Ultrasound, radioactive iodine, and technetium scans are not specific and should only be used to complete diagnostic studies when aspiration cytology is negative for papillary carcinoma. The most important aspect of prognosis of an individual patient with papillary carcinoma of the thyroid is the age at which the disease is diagnosed, with an excellent prognosis, even in advanced primary disease or extensive lymph node involvement, in children and young adults. A multifactorial clinical risk group definition (AMES) is easy to use and reliably separates patients into low risk and high risk. Since 90% of patients with this disease rarely have metastases or late complications from the cancer, total or subtotal thyroidectomy is necessary in only 10% of cases for later use of postoperative radioactive iodine. More conservative surgical procedures are advised in low‐risk patients. Papillary carcinoma incidentally found during operation for other conditions such as Graves disease or thyroiditis and reported first on the permanent pathology reports are always clinically insignificant and completely cured by removal; total thyroidectomy should be completely avoided. Postoperatively, thyroid hormone supplementation may be unnecessary after relatively conservative surgery in selected low‐risk patients. Thyroid hormone must be maintained permanently after total or subtotal thyroidectomy.
Incidence of thyroid cancer in Japan
Authors: Koike Akihiko , Naruse Takayoshi
Published: February 2007

The incidence of thyroid cancer was analyzed based on data provided by cancer registration in Japan and also based on data for 11, 104 cases of thyroid cancer registered at the Japanese Committee for Registration of Malignant Neoplasm of Thyroid (JCR‐MNT) from 1977 through 1986

Incidence rates for men and women gradually increased over the study period from 1959 through 1985. The age‐adjusted rates for 1985 showed 1.1 per 100,000 for men and 3.1 per 100,000 for women. The higher rates were observed in Hiroshima and Nagasaki cities. Male to female ratio was 1:6 in papillary and follicular carcinomas and 1:2 in medullary and anaplastic carcinomas. Papillary, follicular, and medullary carcinomas are more common in the fifth and sixth decades of life while anaplastic carcinoma is more common in the elderly. The age‐specific rates by histological classification showed no change over the study period of 1977 through 1986. The increased incidence could be attributed to improvements in diagnostic procedures.
Evaluation of a patient prior to second‐look surgery
Authors: Wanebo H. J. , Vezeridis M. P. , Llaneras M. R.
Published: February 2007

The evaluation of a patient with a suspected colorectal malignancy is well defined; however, the preoperative work‐up of a patient who is a candidate for second‐look surgery is controversial and based less on scientific evidence than on empiric or anecdotal grounds. The preoperative assessment of these patients can be divided into two phases. Phase I consists of a thorough history, physical examination, and routine laboratory tests as the most logical and traditional starting point. Phase II consists of specific tests aimed at evaluating the extent of the recurrence and the resectability of the tumor. Of the various modalities available, the enhanced computerized tomogram is currently the method most likely to provide significant information prior to carcinoembryonic antigen (CEA) directed second‐look surgery. The results of the preoperative evaluation together with a thorough understanding of the natural history of the disease will offer a clear perspective as to the most likely outcome.
CEA in tumors of other than colorectal origin
Authors: Chevinsky Aaron H.
Published: February 2007

Carcinoembryonic antigen has been demonstrated to be a valuable clinical aid in the management of patients with colorectal carcinoma. Its elevation in the serum prior to evidence of clinical recurrence in up to 80% of patients highlights its utility. CEA has also been found to be elevated in the serum of patients with other epithelial malignancies, but these have not been as well studied as has colorectal carcinoma

In patients with breast cancer CEA elevations may be found in 40–73% of patients presenting with disease in stages I‐IV. In addition, 80% of patients will have a CEA elevation 3–10 months prior to clinical symptoms of recurrence

Seventy‐seven percent of patients with bronchogenic lung cancer will have an elevated preoperative value. However, cigarette smoking also causes an increase in the CEA assay level and, thus, differentiation between benign and malignant conditions is more difficult. In small cell carcinoma of the lung, CEA assay levels above 10 ng/ml correlate highly with metastatic disease, while values less than 2.5 ng/ml correlate with localized disease

Pancreatic and gastric malignancies demonstrate CEA level elevations in just over 50% of cases. But these, however, have not been clinically useful

Epithelial neoplasms of the female reproductive tract (cervix, uterus, and ovary) also produce CEA in 47–75% of cases and may correlate with stage of disease at diagnosis and level of cellular differentiation

CEA assay levels are elevated in a variety of tumors and correlate with tumor stage, degree of differentiation, and effectiveness of therapy; they may also be the earliest marker of recurrence.
Radiotherapy and brachytherapy for recurrent colorectal cancer
Authors: Nag Subir
Published: February 2007

Radical surgical excision of locoregional recurrence of colorectal carcinoma usually produces the best survival and should be attempted whenever possible. However, recurrences are often unresectable; hence palliative local therapy may be indicated. There are several options for the radiation therapy of local, unresectable, recurrent, or metastatic colorectal cancer. Whole pelvis irradiation of 4,000–5,000 cGy followed by a coned‐down boost of 1,000–1,500 cGy generally provides good symptomatic palliation in 80–90% of patients, but long‐term control or cure is rarely achieved. External beam irradiation of 2,000–3,000 cGy to the whole liver with or without concurrent chemotherapy may be used for palliation of metastatic disease to the liver. A combination of intraoperative radiation therapy applied directly to the tumor bed and external beam irradiation may improve local control and survival rates. Multiple options are available for the intraoperative use of brachytherapy which can deliver high radiation doses to the residual tumor, or tumor bed, sparing normal tissue.
Immunotherapy of cancer with lymphokines and lymphokine‐activated killer cells
Authors: Yarbro John W.
Published: February 2007

Our expanding knowledge of the immune system has provided a basis of rationality for immunotherapy. Some non‐specific immunotherapy has achieved the status of standard treatment: interferon in hairy cell leukemia and chronic myelogenous leukemia, BCG in bladder cancer, and levamisole in colon cancer adjuvant therapy. Tumor infiltrating lymphocytes, moreover, offer a level of specificity heretofore unknown. Combined with the newly available synthetic cytokines that regulate the normal immune system there is the potential for a major breakthrough in biotherapeutics. Problems remain. We have yet to identify tumor antigens with the precision necessary for effective immunotherapy. Indeed, we have no assurance that tumors will regularly synthesize new antigens. In the broad spectrum of immune deficiency syndromes, we have yet to see an increase in the common epithelial tumors that account for the great bulk of human cancer. This suggests that we still have a great deal more to learn.
Immunotherapy for malignant melanoma: A review and update
Authors: C. Mcgee J. Michael
Published: February 2007

Several different approaches to the application of specific active immunotherapy for the adjuvant therapy of melanoma have developed independently. Specific active immunotherapy refers to autologous or allogenic inoculation or transplantation of tumor cells or cell products into patients with cancer. Several different types of tumor vaccines have been studied and have been combined with different immunotherapeutic modalities. This report will include a review of several of those different techniques and will also review the observed 5‐year survival rates for a melanoma tumor homogenate (concentrated) vaccine, developed by L.J. Humphrey and colleagues.
Immunotherapy of renal cell cancer
Authors: Crusinberry Richard , Williams Richard D.
Published: February 2007

Immunotherapy of metastatic renal adenocarcinoma (RCC) is currently an alternative to cytotoxic chemotherapy. Bacillus Calmette‐Guérin has been associated with a 22% response rate in small series, but no large‐scale clinical trials have been completed. Transfer factor, in combination with other immunotherapeutic and chemotherapeutic compounds, has a reported 13% incidence of response. Tumor vaccines have caused clinical response in only 5% of patients while monoclonal antibodies have produced partial remission in one of nine patients. Immune RNA has been associated with a 14% overall incidence of response. Tumor necrosis factor has not as yet been studied in any large‐scale clinical investigations but preliminary studies are not promising. Leukocyte‐derived and recombinant interferons alone have produced responses in 10–20% of patients with tolerable toxicity. Combinations of interferons or with cytotoxic chemotherapy have produced slightly improved responses with short duration and substantial toxicity. Adoptive immunotherapy using Interleukin‐2 alone, or with IL‐2 plus lymphocyte‐activated killer cells, or tumor infiltrating lymphocytes or interferons have produced clinical responses in 10–30% of patients treated. Combinations of specific forms of immune therapy may hold promise for better rates of clinical response in the future.
Immune responsiveness of patients with malignant melanoma and carcinoma of the breast
Authors: Humphrey Loren , Ms Om Singla
Published: February 2007

Lymphocyte blastogenesis (LB) with PHA, CON‐A, PWM, VII (homologous tumor extract) plus T/B ratio for pre‐IT, post‐IT (2 months), and 3, 6, 9, 12, 18, and 24 months prior to each VII booster are reported. Pre‐IT and post‐IT LB‐PHA were similar for Stage I (ST I) or Stage II (ST II) breast cancer (BC) patients who expired or survived. The pre‐booster results were similar except that prior to death, stimulation with PHA decreased. Melanoma (MM) patients LB‐PHA pre‐IT showed less stimulation for ST I patients than for ST II patients (survivors and expired). LB‐CON‐A and LB‐PWM showed similar results with slight variations. When compared to survivors, LB‐VII for BC patients who expired showed no stimulation. MM patients showed different results in LB‐VII. T/B ratios for BC patients during the first 3 months showed 72% normal (N), 14% below N, and 14% above N for survivors and 40% normal (N), 60% below N, and 0 above N for expired. MM T/B ratio were not remarkable. LB anamnestic response to immune stimulation evaluated in 16 of the 62 BC and 10 of 81 MM patients showed increased peak levels over trough for survivors and a decrease for expired. The significance of data as in vitro correlates of clinical response is discussed.
Mammographic detection of breast cancer and preoperative needle localization
Authors: Dershaw D. David
Published: February 2007

Since its early clinical use during the 1960s, mammography has become a widely accepted screening method for breast cancer. Its utilization may be capable of diminishing mortality by 40%. Screening programs have been instituted, and their cost effectiveness depends on the locale and age of the population screened. Mass screening has resulted in large numbers of nonpalpable lesions being biopsied. Needle localization techniques allow for these to be performed with a minimal chance of missing the lesion, while removing only a small volume of breast tissue. Although most lesions biopsied will be benign, 20–30% of those excised at any institution should be malignant. Consultation with experienced mammographers may be desirable when recommending mammography‐based biopsy. The rate of detection of malignancy is higher in women who have a prior history of ipsilateral or contralateral breast cancer.
Treatment of ductal carcinoma in situ of the breast
Authors: Moore Michael M.
Published: February 2007

Ductal carcinoma in situ (DCIS) is increasing in frequency, primarily because of the increasing use of routine screening mammography. The management of DCIS has become one of the more controversial aspects in the treatment of breast cancer. Although total mastectomy provides local control and long‐term survival approaching 100%, the move to breast conservation with early invasive breast cancer has forced a re‐evaluation of the treatment of in situ breast cancer. Recent advances in the evaluation and subclassification of DCIS according to histologic subgroupings and sizings have provided valuable insight into the biology of the disease. These biologic parameters may help to identify those lesions amenable to breast conservation. In properly selected patients, breast conservation affords a 1%/year local failure rate, with approximately one‐half of the recurrences being invasive.
Radiation therapy in breast conservation patients and postmastectomy
Authors: McCormick Beryl
Published: February 2007

Radiation has played a continuous but changing role in the management of breast cancer. At Memorial Hospital, the past 10 years have seen a marked increase in breast conserving therapy, and changing indications for postmastectomy adjuvant radiation.
Pregnancy‐associated breast cancer
Authors: Petrek Jeanne A.
Published: February 2007

The incidence of pregnancy‐associated (PA) breast cancer is rising, as childbirth is being delayed to the women's 30s and early 40s, when breast cancer is more frequent. Most reports consider “PA breast cancer” as that being diagnosed during pregnancy, or within one year after. The delay of diagnosis often seen in PA breast cancer may be due to physician oversight or reluctance to perform a biopsy during pregnancy. Two‐stage procedures are favored in this setting, with biopsy under local anesthesia, then extent‐of‐disease work‐up and definitive treatment, usually mastectomy. The use of scans for staging, and irradiation for treatment, is avoided, where possible, due to fetal risk. Likewise, chemotherapy is carefully gauged to avoid fetal damage. With these precautions, the prognosis for women with PA breast cancer, stage for stage, is similar to that of women of the same age treated at the same time period at MSKCC.
Management of occult breast cancer presenting as an axillary metastasis
Authors: Knapper William H.
Published: February 2007

The presentation of cancer in an axillary lymph node without an obvious primary site is a diagnostic challenge. This is particularly true in female patients. A diagnosis of metastatic adenocarcinoma consistent with occult breast primary requires further prompt therapy.
Gastric cancer mass survey in Chile
Authors: Llorens Pedro
Published: February 2007

A Chilean publication in 1969 reported the 5‐year survival rate of gastric cancer to be 12% of operated patients and only 3% of all patients diagnosed with gastric cancer. Encouraged by the excellent results obtained in Japan through a massive study of the population, Chile initiated in 1978 a program for massive detection of gastric cancer. From May 1978 to December 1986, 42,492 persons were screened under this system. Gastric cancer was detected in 0.43% in the massive group, and in 1.27% in the symptomatic group. The rate of early cancer detected per all gastric cancer was 14.69% in the former and 11.02% in the latter group. Gastric ulcer was found to be located more in the upper third of the stomach and less in the lower third, which may call attention in comparison with the foreign literature.
Endoscopic treatment of early gastric cancer
Authors: Okazaki Yukinori , Tada Masahiro
Published: February 2007

Laser therapy and endoscopic strip biopsy for early gastric cancer are useful measures from our experience. It is considered that the larger lesion of early cancer should be treated by laser therapy and the smaller lesion by strip biopsy. However, endoscopic therapy as a curative treatment still presents problems. Clinical trials with laser therapy has to accumulate to ascertain the effectiveness of laser on the gastric wall. Also, endoscopic treatment methods are limited to patients who cannot be admitted to surgery. Furthermore, it is difficult to judge the metastasis to lymph nodes surrounding the stomach with present diagnostic capabilities. Wider application of these endoscopic treatment methods will follow when these difficulties are overcome.
Surgical treatment of gastric cancer: Retrospective survey of 1,704 operated cases with special reference to total gastrectomy as the operation of choice
Authors: Meyer H.‐J. , Jahne J. , Wilke H. , Pichlmayr R.
Published: February 2007

Total gastrectomy is discussed as the operation of choice among different surgical approaches for gastric carcinoma. We prefer the performance of an elective total gastrectomy with systematic lymph‐adenectomy (compartments I and II) and obligatory splenectomy. A retrospective study of 1,704 consecutive cases of gastric carcinomas showed a better outcome following total gastrectomy in relationship to distal subtotal gastrectomy, but these results cannot be used as evidence because of the lack of a prospective study. Nevertheless, a precise analysis of our cases in regard to tumor site and tumor type could show a frequency of only 6% to maximally 30%, in which elective total gastrectomy may represent a procedure too extensive to justify for an oncological course.
Coeliac axis‐oriented approach in surgery for advanced gastric cancer
Authors: Orita Kunzo , Sakagami Kenichi , Kamikawa Yasuaki , Gouchi Akira
Published: February 2007

To achieve the systemic curative lymph node dissection in gastrectomy for advanced gastric cancer, coeliac axis‐oriented approach was proposed. Mobilization of the spleen as well as the tail and body of the pancreas from the left retroperitoneum and Kocher's maneuver lifting up the hepatoduodenal ligament and head of pancreas from the right retroperitoneum permits the observation of the coeliac axis under direct vision and enables the para‐aortic node dissection with ease. This approach was applied to 131 cases with advanced gastric cancer with neither mortality nor notable complication.
Type‐oriented therapy for gastric cancer effective for lymph node metastasis: Management of lymph node metastasis using activated carbon particles adsorbing an anticancer agent
Authors: Takahashi Toshio , Sawai Kiyoshi , Hagiwara Akeo , Takahashi Shigeru , Seiki Kosuke , Tokuda Hajime
Published: February 2007

Activated carbon particles are taken selectively up by lymphatics when injected into the tissues and visualize regional lymph nodes colored black. Furthermore, carbon particles adsorb a large amount of the anticancer agent mitomycin C (MMC) on their surface and release the drug reversibly. Using these properties of activated carbon particles, we have applied it for lymph node dissection and chemotherapy of lymph node metastasis. After injection of carbon particles, regional lymph nodes of the stomach were found to be black; blackened lymph nodes extending widely from perigastric to para‐aortic nodes were identified from other structures

Four hundred and twenty‐four patients with gastric cancer were treated with this method for lymph node metastasis during 1984–1988. Involved nodes were generally colored in high incidence, about 70% of involved ones except for highly positive nodes, which was the same as noninvolved nodes. In highly positive nodes, the colored incidence was decreased to about 48%. The cumulative 5‐year survival rate of the patients treated with this series was 74.6%, which was significantly higher than the figures without this method.
Staging patterns and early cancer detection
Authors: Smart Charles R. , Chu Kenneth C.
Published: February 2007

There is a great deal of indirect, nonexperimental evidence that a pattern of earlier‐stage disease at diagnosis has a better outcome. Increased early detection activities can change, these stage patterns while various biases and the question of generalizability need to be kept in mind in their interpretation. The indirect evidences of possible benefit from early detection activities includes an increase in the number of cases detected, a pattern of more early‐ and less advanced‐stage cases, an increase in the overall site‐specific survival rate, and a decrease in the case fatality rate. Unless these intermediate markers are favorable, it is unlikely that early detection will reduce mortality. In addition, one should also differentiate a reduced incidence or a change in treatment as a cause for reduced mortality. © 1992 Wiley‐Liss, Inc.
Staging of head and neck cancer
Authors: Baker W.
Published: February 2007

Revised staging systems for cancers of the upper aerodigestive tract, the major salivary glands, and the thyroid are presented. The staging has been accepted by both the American Joint Committee on Cancer and the International Union Against Cancer and is gaining worldwide acceptance. © 1992 Wiley‐Liss, Inc.
Role and extent of lymphadenectomy for early breast cancer
Authors: Robinson David S. , Senofsky Gregory M. , Ketcham Alfred S.
Published: February 2007

A better understanding of the locoregional and systemic approaches to breast cancer over the past decade and one‐half has altered the perspective on surgical management of the axilla. An increased awareness of the importance of early diagnosis and appropriate staging has focused further attention on the extent of resection of axillary lymph nodes. Examined here are the anatomy and physiology of the axillary lymph nodes, their clinical evaluation, the significance of histologic evaluation, a discussion of the procudure's role in staging and therapy, and a presentation of the complications of axillary lymph node dissection. It is in this light that we discuss the extent of axillary lymphadenectomy in early diagnosis of breast cancer. © 1992 Wiley‐Liss, Inc.
How staging directs treatment for esophageal and lung cancer
Authors: McKenna Robert Joseph
Published: February 2007

While staging systems may seem complicated and cumbersome at times, they are designed to stratify patients into groups by prognosis and treatment. This article reviews the staging of lung cancer and esophageal cancer, and it shows how this classification translates into different treatment plans based upon this staging. © 1992 Wiley‐Liss, Inc.
Tumor registrar's role in TNM staging
Authors: Creech Cynthia M.
Published: February 2007

The role of the tumor registrar in TNM staging has not been clearly defined. This paper shows how this can be clarified in individual hospital cancer programs and how the tumor registrar serves as a key member of the cancer team in implementing physician TNM staging. © 1992 Wiley‐Liss, Inc.
Cancer staging: Future directions for the TNM classification
Authors: Sobin Leslie H.
Published: February 2007

The major accomplishment of the 1987 edition of the TNM classification was the unification of criteria for all site classifications, namely, the elimination of all variations that had developed over the years. The main directions that TNM is taking for the future are 1) verification of published classifications, 2) classification of new sites and tumor types, 3) addressing the integration of nonanatomic factors with TNM to achieve prognostic grading, and 4) application of TNM beyond pure clinical‐pathological aspects to assess methods of early detection, quality of care, and population trends. © 1992 Wiley‐Liss, Inc.
Intraepithelial neoplasia of the lower female genital tract: Etiology, investigation, and management
Authors: Wright V. Cecil , Chapman William
Published: February 2007

Lower genital tract neoplasia appears associated with certain types of the human papilloma virus. Surgical approaches using lasers and electricity are available to treat the clinical diseases and in turn provide good cosmetic and functional anatomy. The surgical method employed depends upon the anatomical and histological distribution of disease regardless of its site. Of the three areas (cervix, vagina and vulva), cervical intraepithelial neoplasia is the least difficult to cure. Vulvar intraepithelial neoplasia is the most difficult since recurrences can occur at any time and in some patients for many years.
Application of lasers in bladder cancer
Authors: Hofstetter Alfons G.
Published: February 2007

The Nd:YAG laser enables endoscopic destruction of bladder tumors under excellent viewing conditions in a specific and calculable way for induction of homogeneous necroses with simultaneous occlusion of blood and lymphatic vessels. The low local relapse rate, in contrast to that with TUR, is remarkable. By Nd:YAG laser application in combination with or without pelvine lymphadenectomy we were able to reduce the cystectomy rate significantly in recent years.
Current status of lasers in neurosurgical oncology
Authors: Powers Stephen K.
Published: February 2007

During the past decade and a half, the photothermal and photochemical effects of several medical lasers have been studied for the clinical treatment of benign and malignant, primary and secondary central nervous system tumors. Increased precision and hemostasis during tumor excision while limiting manipulation and retraction of nervous tissues are possible with the microsurgical carbon dioxide, argon, and frequency doubled neodymium:YAG lasers. Computerized tomography and magnetic resonance imaging‐directed volumetric tumor removal by laser is feasible with computer‐generated visual displays referenced to the patient's anatomy using stereotactic instrumentation. Photodynamic therapy with hematoporphyrin derivative as the photosensitizer and neodymium:YAG laser hyperthermia are currently under evaluation for the treatment of residual and recurrent malignant tumors. Encouraging results have been reported for each of these nonablative forms of laser use.
Interstitial photoablative laser therapy guided by magnetic resonance imaging for the treatment of deep tumors
Authors: Castro Dan J. , Saxton Romaine E. , Lufkin Robert B.
Published: February 2007

The failure rate of cancer treatment remains unacceptably high, still being a leading cause of mortality in adults and children despite major advances over the past 50 years in the fields of surgery, radiation therapy, and, more recently, chemo and immunotherapy. In the United States, the 5‐year survival rate for all cancers in the population has increaed by only approximately 10% since 1960.

Surgical access to some deep tumors of the head and neck and other areas often require extensive dissections with residual functional and cosmetic deformities. Repeated treatment is not possible after maximum dose radiotherapy and chemotherapy is still limited by its systemic toxicity. An attractive solution to these problems would be the development of a new adjunctive method combining the best features of interstitial laser phototherapy for selective tumor destruction via minimally invasive techniques for access and 3D‐magnetic resonance imaging (MRI) as a monitoring system for laser‐tissue interactions. Our experience with this new technique is reviewed.
Interstitial laser hyperthermia
Authors: Masters Andrew , Bown Stephen G.
Published: February 2007

Experimental studies have shown that once the appropriate laser parameters are defined, interstitial laser hyperthermia (ILH) can produce well‐defined, predictable tissue necrosis in solid viscera which heal safely with little functional or structural sequelae. Preliminary clinical studies have illustrated that ILH is simple to perform, is well tolerated producing radiological and histological evidence of necrosis in liver, pancreatic, and breast cancer. Its future role in most cases will be palliative, controlling local tumour growth. Where the extent of necrosis can be matched accurately to tumour volume, the prospect for cure exists. Further research is necessary before ILH can be regarded as an established treatment and, in particular, its influence on patient survival is worthy of further evaluation.
Preactivation: A new concept for generation of photoproducts for potential therapeutic applications
Authors: Culliya Kirpal S. , Chanh Tran , Harriman Anthony , Aronoff Billie L. , Mathews James L.
Published: February 2007

Controlled exposure of photoactive compounds to light prior to their use in biological targets results in the formation of heretofore unknown photoproducts. This process of photoproduct generation, termed preactivation, renders the photoactive compound capable of systemic use without further dependence on light. We have demonstrated that preactivated Merocyanine and preactivated Photofrin‐II possess significant antitumor and antiviral activity against certain tumor cells and viruses, while under identical conditions normal cells and tissues are minimally affected. Thus, the preactivation procedure may represent a promising therapeutic modality for controlling systemic malignancies and viral infections.
Genetics of transitional cell carcinoma
Authors: Klein Eric A. , Chaganti R. S. K.
Published: February 2007

Several models of genetic events which define the origin and progression of human tumors have been elucidated over the last several years. These models suggest that the study of tumors at the level of both the chromosome and the gene can be useful in elucidating molecular events in tumor progression and in determining the biologic behavior of individual tumors. The genetics of transitional cell carcinomas are reviewed with emphasis on potential mechanisms of tumorigenicity and the clinical utility of genetic markers.
Experimental models of histogenesis and tumor cell heterogeneity in bladder cancer
Authors: Raghavan Derek , Russell Pamela J. , Brown Joanne L.
Published: February 2007

The histogenetic relationships between the subtypes of bladder cancer are not known. Each common pattern (transitional cell carcinoma, adenocarcinoma, and squamous carcinoma) can exist independently, although they may coexist in primary or metastatic bladder cancers, and tumors that are predominantly composed of transitional cell carcinoma may have regions of squamous or glandular differentiation. Morphologically identical tumors exhibit marked variation in their natural history and response to treatment. To study these aspects of the biology of human bladder cancer, a series of cell lines have been established and characterized as xenografts and in tissue culture. These studies have shown a likely common origin for transitional cell carcinoma, adenocarcinoma, and squamous carcinoma of the bladder. Morphologically similar xenografts and cell lines in vitro have shown a broad range of functional heterogeneity, including ultrastructure, tumor marker production, ploidy, cell surface characteristics, and response to chemotherapy. These are useful models of heterogeneity of response to treatment with established and new cytotoxic agents.
Growth factors and bladder cancer: Clinical implications of the interactions between growth factors and their urothelial receptors
Authors: Messing Edward M.
Published: February 2007

Growth factors (GFs) are a class of proteins that bind to specific cell surface receptors (GF‐Rs), inducing a variety of responses including mitosis, in susceptible target cells. Abnormal production, expression, and/or function of GFs or GF‐Rs can result in unregulated growth, the hallmark of malignant transformation. This chapter reviews those GFs/GF‐Rs that have been linked to human bladder cancer. It focuses particularly on one [epidermal growth factor (EGF), which is excreted in urine in high concentrations] and its possible role in the development and growth of urothelial malignancy. Potential clinical applications in diagnosis, staging, prevention, and treatment are discussed.
Cell surface differentiation antigens of normal urothelium and bladder tumors
Authors: Dalbagni Guido , Reuter Victor E. , Sheinfeld Joel , Fradet Yves , Fair William R. , Cordon‐Cardo Carlos
Published: February 2007

Bladder cancer ranks as the third most common malignancy among men and tenth among women. Superficial transitional cell carcinomas (stage Ta, Tis, and T1) account for approximately 70–40% of these tumors, while the remaining 20–30% are invasive (T2, T3, and T4). Approximately 70% of superficial tumors will have one or more recurrences, with 25% of these expressing a higher histologic grade and 10–15% subsequently developing invasive and/or metastatic disease. The detection and prediction of tumor recurrence and/or tumor progression is crucially important if timely and appropriate therapy is to be instituted. Conventional histopathologic evaluation usually provides definitive diagnosis upon which therapeutic planning is based. However, at present there are no more reliable morphologic indicator to identify which individuals will have recurrent disease or who will progress to invasive and/or metastatic cancer. Recent advances in tumor biology have identified markers that are good candidates for clinical applications in early tumor detection, as well as for the stratification of patients with like‐appearing morphological lesions with different biological and clinical behavior. The ultimate goal is to develop predictive assays that would segregate patients with high probability of failures versus patients who would be cured by localized modes of therapy.
Flow cytometry for detection and evaluation of urinary bladder carcinoma
Authors: Melamed Myron R.
Published: February 2007

Flow Cytometry (FCM) DNA assays of bladder irrigation specimens are now recognized as a clinically useful and reliable means of detecting and monitoring carcinoma of the bladder. This technique, which identifies carcinoma by the presence of an aneuploid population of cells, can be carried out on specimens obtained in an outpatient or hospital setting and is easily performed in any medium‐sized laboratory. It is most sensitive to superficial and high grade tumors. Overall, nearly 80% of superficial carcinomas of bladder will have positive flow cytometry, comparing very favorably with conventional cytology. Until now, the widest clinical application of FCM has been in monitoring the conservative treatment of stage 0–1 flat and papillary carcinomas, but newly developed dual parameter measurements are capable of quantifying proliferative activity, oncogene expression, growth factor receptors, and other cellular features that may better characterize the biologic potential of these tumors and can be expected to aid in the selection and timing of treatment.
Expression of blood group antigens in bladder cancer: Current concepts
Authors: Sheinfeld Joel , Reuter Victor E. , Fair William R. , Cordon‐Cardo Carlos
Published: February 2007

Blood group antigens are a group of carbohydrate structures bound to membrane lipids or proteins of erythrocytes and certain epithelial tissues including urothelium. The Lewis antigens are structures that are genetically and biochemically related to the ABO blood group. The ABO and Lewis blood group systems are differentially expressed in the normal urothelium of “secretors” versus “nonsecretor” individuals. The normal urothelium of “secretors” is rich in ABH, Leb, and Ley antigens while the urothelium of “nonsecretors” does not express these antigens. Therefore, deletion of ABH antigens, commonly noted in TCC, can only be reliably ascertained in “secretor” individuals. Neo‐expression of the Lewis X antigen (which is absent in normal urothelium) is noted in over 85% of TCC regardless of tumor stage and grade. Immunocytological detection of the Lewis X antigen on exfoliated bladder epithelial cells enhances the detection of urothelial tumor cells, particularly from low grade and low stage neoplasms.
Chemotherapy for urothelial tract malignancies: Breaking the deadlock
Authors: Scher Howard I. , Norton Larry
Published: February 2007

Chemotherapy treatments for urothelial tract tumors have improved to the point that some patients are enjoying long‐term disease‐free survival. Moreover, with currently available agents and combinations, and with our increased application of clinical and biologic prognostic factors, we are refining our ability to select appropriate therapies for individual patients. We have learned that once the decision is made to use combination chemotherapy, adequate doses should be used. This can be facilitated by the coadministration of hematopoeitic growth factors. Recently completed phase II trials have confirmed that higher doses and dose rates may increase response proportions of and in particular, the proportion of complete responses. The finding that granulocyte colony stimulating factor enhances the sensitivity of tumor cells to methotrexate in vitro and to other agents studied against urothelial tumors implanted in nude mice implies an expanded role for these compounds. However, because non‐hematologic toxicities are still important, it is unlikely that simple escalation of all components a four drug regimen such as of M‐VAC (cisplatin, methotrexate, vinblastine, and doxorubicin) will have a significant impact on survival.

In addition, as more is learned about the pharmacokinetic and pharmacodynamic relationships of the active agents, it appears that better schedules can be designed to improve the therapeutic index of the compounds. Ultimately we will be able to determine drug sensitivities, both at the start of therapy and as it evolves during treatment, that will allow a better selection of a particular chemotherapeutic regimen. For example, mdr1 induction appears to play a significant role in the therapy for treatment‐resistant tumors. The availability of a number of active salvage regimens that are not constrained by this mechanism hints that changes in drug sequencing and drug scheduling may provide a significant improvement in outcome.

While established combination chemotherapy regimens should be considered standard therapy in appropriately selected patients, promising strategies and new agents need to be investigated if we are to “break the deadlock” that has appeared in the treatment of urothelial tumors. These investigations can be performed safely in a well‐controlled fashion to enable the identification of new regimens and to compare promising strategies with appropriate control populations in randomized trials.
Cellular and molecular biology of melanoma
Authors: Porta Giuseppe Della
Published: February 2007

Melanoma cells have surface markers that are expressed differently than in normal melanocytes and nevus cells. Monoclonal antibodies may define a phenotypic map of the various melanocytic lesions and can be used in immunohistopathology and immunoscintigraphy. Monoclonal antibodies directed against melanoma‐associated glycoproteins and glycolipids are being tested for therapy. Rearrangements or deletions on chromosome 1, 6, and 7 are the most frequently observed cytogenetic abnormalities. Molecular studies have not given a clear picture. A subset of HRAS alleles has been reported to be associated with melanoma. NRAS activation by point mutation has been found in one fourth of the cases. Allele losses at different loci have been reported. Genetic linkage studies have given conflicting results on the presence of a gene for the melanoma‐dysplastic nevus syndrome on the short arm of chromosome 1.
Precursor lesions of melanoma: Do they exist?
Authors: Mihm Martin C. , Barnhill Raymond L. , Sober Arthur J. , Hernandez Manuel Howe
Published: February 2007

The question of whether definite precursors to melanoma exist is answered in the affirmative. Three cutaneous lesions likely to be such precursors are described and discussed as to their clinical and histologic appearance and incidence. Additionally, a type of conjunctival melanosis that has been associated with malignant melanoma of the conjunctiva is discussed and an attempt is made to define it; a proposed classification of this entity is reviewed. Basic approaches to management and analysis of precursor lesions are elaborated.
Treatment of regional nodes
Authors: Cascinelli Natale , Belli Filiberto
Published: February 2007

The appearance of nodal metastases from cutaneous melanoma represents a poor prognosis. Surgery is the only possible treatment for these patients since chemotherapy or immunotherapy have no confirmed specific efficacy in adjuvant or therapeutic schedules. If, for clinically metastatic regional nodes, there is complete agreement on the opportunity of dissection, in the case of clinically uninvolved nodes some controversy exists. For melanomas of the extremities, two different randomized studies have demonstrated no difference in the long‐term outcome of patients with stage I melanoma, whether immediate or delayed node dissection is performed. For axial melanomas, although definitive data are not available, there are preliminary statistical results as well as anatomical and technical reasons, suggesting an identical surgical approach to that performed for primaries of other sites. Therefore, apart from specific cases, there is good evidence that node dissection should be planned only for patients with clinically involved regional nodes.