bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser therapy of cancer of the gastrointestinal and biliary tracts
Authors: Pietrafitta Joseph J.
Published: February 2007

Endoscopic laser therapy for the palliation of malignant tumors of the gastrointestinal (GI) tract has rapidly gained widespread acceptance by the medical community. This form of therapy can offer significant tumor palliation in a relatively noninvasive manner to patients who have few other therapeutic options. Since its initial use for the treatment of esophageal cancer it has been extended to the treatment of a number of other GI, tract malignancies and has in fact been utilized for the palliation of intra‐ as well as extrahepatic bile duct tumors. A number of advances have occurred, including improvements in lasers and laser delivery systems, refinement of treatment techniques, development of new wavelengths, and refinement of drugs that allow more specific therapy of cancer. With continued laboratory and clinical investigations, laser therapy should realize its full potential, ultimately becoming a curative treatment modality that will offer patients benefits that are equal to or greater than more invasive and disfiguring surgery without its attendant morbidity and mortality.
Contact yag laser system in abdominal surgery, in particular hepatic and pancreatic surgery
Authors: Joffe Stephen N.
Published: February 2007

The SLT contact Nd:YAG laser system offers a new method of obtaining a hemostatic incision through the anterior abdominal wall and a surgical tool for performing various intraabdominal resectional procedures.

Advantages include reduction in intraoperative bleeding, reduced tissue damage, and tactile sensation with a reduction in laser power requirements. Sterile disposable laser scalpels, fibers, synthetic sapphire probes, and a user friendly laser system offer a new dimension in intraabdominal surgery, especially relating to liver and pancreatic surgery. Potentially, all general surgical procedures could use the SLT contact laser, which may, in the future, replace conventional electrocautery and the surgical steel scalpel. Cost containment and improved quality of care will probably be the driving forces for its acceptance.
Laser technology in the diagnosis and treatment of head and neck cancer
Authors: Shapshay Stanley M.
Published: February 2007

The carbon dioxide (CO2) laser has been used with microsurgical precision as an excisional biopsy tool in the diagnosis, staging, and treatment of laryngeal, oral, and oropharyngeal cancer. Selected early cancers of the larynx and oral cavity have been treated for cure, and more advanced and recurrent tumors have been treated for palliation. Other laser wavelengths, such as the neodymium‐yttrium aluminum garnet laser (Nd‐YAG) and the argon dye laser employed in tumor photosensitization, have shown promise in the diagnosis and treatment of head and neck cancer. Laser technology is most useful when used in conjunction with the standard cancer therapies, such as radiotherapy, surgery, and chemotherapy.
Cytodiagnosis and other methods of biopsy in the modern management of breast cancer
Authors: Preece Paul E. , Hunter Susan M. , Duguid Helen L. D. , Wood Robert A. B.
Published: February 2007

Since 1970 fine‐needle aspiration cytology for breast tumours has grown in popularity and is now routinely used in the initial diagnosis of palpable breast masses in the United States and other parts of the world. Fast staining methods of the aspirate enables reporting within 10 minutes of the aspirate being performed. Training and experience is important in obtaining satisfactory smears for diagnosis, and pitfalls are false‐negative and false‐positive findings, which may have dire consequences for the patient if cytological diagnosis is the final arbiter. Conditions such as benign mammary dysplasia and sclerosing adenosis are the most common sources of highly cellular smears and often show marked atypia, which makes distinction from carcinoma difficult. Also, atypical papillary formations present a diagnostic problem, and biopsy is indicated to exclude a papillary carcinoma. Fine‐needle aspirations very seldom cause traumatic complications, and these are usually of a minor degree. Seeding along the needle track has occurred, but in most cases with a larger‐caliber (18 s.e.g.) needle. Aspiration itself has been shown to have no effect on the survival rates in breast carcinoma. Contemporary reports show that around 90% of cases of breast cancer can be detected with confidence by means of this procedure. The reduction in scar formation facilitates future evaluation of the patient as scar tissue often interferes with the interpretation of mammograms. Cost effectiveness is evident in terms of decreased use of anaesthetics and operating time and a reduction in the use of frozen section histology by about 80%. Evidence from the literature and firsthand experience for over 10 years commend the technique to both clinicians and pathologists for its simplicity and usefulness in their own practices, preferably in collaboration with each other and with awareness of the potential pitfalls described. Tissue‐obtaining techniques, such as open biopsy with frozen section, and tissue‐obtaining needle techniques are described. The disadvantages of drill biopsy outweigh its advantages, and the technique is not widely used. Trademarked cutting needle biopsy techniques have been developed, and their efficacy is discussed and compared.
Changing strategies in the treatment of hormone‐dependent breast cancer
Authors: Dao Thomas L.
Published: February 2007

Hormone Receptor concept provides better prediction of hormone dependency ofbreast cancer therefore proper selection of therapy. The fate of receptors following hormonal manipulation is not clearly understood. It is suggested that in a hormone‐dependent breast cancer, the cessation of response to one form of hormonal therapy is not an indication of emergence of hormone independence of the cancer. Contrary to the present belief, the author suggests that the hormone‐dependent tumors retain their biological and biochemical characteristics in the recurrent tumor and therefore will respond to other forms of endocrine therapy. The presence ofExtraglandular synthesis of estrogen is considered as a major reason for the relapse of a regressing breast cancer following endocrine manipulation. A hypothesis is advanced for test in a clinical trial.
Modern thoughts on lymph nodes in breast cancer
Authors: Sacre R.
Published: February 2007

Axillary lymph node status remains the single most useful prognostic parameter in breast cancer patients. As clinical examination, imaging techniques, and lymph node sampling methods cannot accurately assess the axillary node involvement, a complete axillary dissection should always be performed. Moreover, this technique provides an excellent treatment modality for regional disease, abolishing the need for radiotherapy to the axilla. The status of the internal mammary lymph nodes is of less importance in the management of the breast cancer patient.
Axillary metastasis in breast cancer: When, how, and why?
Authors: Hartveit Flora
Published: February 2007

Axillary metastasis in breast cancer is a time‐dependent phenomenon that varies greatly from tumour to tumour. It is discussed in relation to tumour diameter and the growth rate of the tumour cells. It parallels the former but is not directly related to either. A tumour age coefficient (Tac) is presented that demonstrates this lack of interrelationship. Tumour growth in the axillary nodes is progressive and in general mimics the potential tumour load elsewhere in the body. Qualitative rather than quantitative assessment is needed. This can be provided by simple means, using hilar nodal sections from standardised nodal samples. There is, however, as yet no definitive method of predicting the presence/absence of occult distant metastatic spread in either node‐negative or node‐positive cases. Treatment is thus based on statistical probability, which may or may not be relevant in the individual case.
Skin cancer—early detection
Authors: Thompson Lewis W.
Published: February 2007

Skin cancer, the most frequently occurring of all cancers, shows an encouragingly high rate of cure if detected early and treated properly. Etiologies of nonpigmented and pigmented premalignant lesions and malignant lesions are discussed, where known, with solar exposure frequently cited. Criteria for diagnosis are discussed; however, the clinical similarity of some malignant lesions to premalignant or nonmalignant conditions makes excision necessary in order to establish a definitive diagnosis—when in doubt, take it out. Treatment ranges from close observation of certain nevi to complete lesional destruction at the initial treatment. Prevention is also stressed, with “suntan parlors” coming under some indictment. Overall, the paper emphasizes early detection and points out that even some melanomas undergo a biologic period when metastasis is unlikely and the melanoma is curable if detected and adequately treated during this period.
Head and neck cancer: Early detection
Authors: Thompson Lewis W.
Published: February 2007

Head and neck cancers are discussed in four categories: oral cavity, pharynx, larynx, and salivary glands. The incidence of head and neck cancers varies with the site of the lesion and ranges from the most common area of involvement, the lip, to those of the nasopharynx, which are extremely rare. The exact etiology of most of these malignancies has not been determined, but an association has been made with many factors, such as immune impairment, environmental (tobacco, chemical, radiation), and genetic. With few exceptions, the cure rate is excellent when these lesions are diagnosed early and initially eradicated completely. Early signs and symptoms are discussed, and guidelines are given for performing examinations to detect early cancers.
Screening for colorectal carcinoma
Authors: Lytle Glenn H.
Published: February 2007

Colorectal carcinoma will occur in some 147,000 Americans this year. This disease accounts for 15% of all cancers and 12% of all cancer deaths. Screening for colorectal carcinoma may allow the disease process to be found earlier and, in some situations such as when polyps are found and removed, may even prevent the disease. The two main modalities of screening are fecal occult blood tests and sigmoidoscopy. By general screening of asymptomatic patients as well as by selective screening of those at high risk, there is hope that the incidence and mortality of this cancer will diminish. Absolute confirmation of this benefit is still lacking, making the evaluation of the cost‐effectiveness of this screening somewhat questionable. Current educational efforts are designed to increase compliance and to help solve some of these unanswered questions.
Cancer prevention and detection centers: An overview and critique
Authors: Humphrey L. J. , Lester P.
Published: February 2007

Cancer screening is ideally carried out in free standing centers that are located near shopping centers, are quite visible, and have a warm, friendly appearance. This chapter describes the basic elements of such a center, including the use of a mobile mammogram van based at the center. While the precise size, location, and design of a center will vary depending on the specific demographics of an area, these data should facilitate such planning.

Programs that can be carried out in this center are described utilizing information from preceding chapters. This chapter enlarges upon their application and then outlines criteria and services. Furthermore, a large section on general or whole‐body screening is included. As in other programs, those at risk and the benefits are discussed. While not a high volume, income producer, this program is a requisite component offering great service to the customer.
Epidemiology of head and neck cancers
Authors: Sanghvi L. D. , Rao D. N. , Joshi S.
Published: February 2007

Head and neck cancers are common in India and account for about 30% of cancers in males and about 13% in females. In males, oral cavity and pharynx are the commonly affected sites, followed by larynx. In females, oral cavity is the preponderant site. Reliable data on incidence rates from several cancer registries in India is compared with selected data from the United States and France. A wide variety of tobacco habits prevalent in the country are primarily responsible for the occurrence of these cancers. Among them, bidi smoking, tobacco chewing, and cigarette smoking, in that order, account for a large majority of these cancers. In addition, alcohol and some aspects of the Indian diet have been suspected to contribute to this number of head and neck cancers. The government of India has accorded a high priority to prevention of tobacco‐related cancers by the turn of the century in its National Cancer Control Programme.
Surgery for cancer of the buccal mucosa
Authors: Pradhan S. A.
Published: February 2007

Buccal Mucosa cancer is common in India, T4 tumours being the most common (66%). T1 tumours are rarely seen (4%). Disease‐free survival (DFS) at 18 mo with surgery alone for T2, T3, and T4 tumours is 57%, 43%, and 21%, respectively. Addition of postoperative radiation therapy (RT) for T3 and T4 lesions increases DFS to 60% and 35%, respectively.

Marginal mandibulectomy is advocated for lesions close to the lower gingiva when the bone is clinically and radiologically uninvolved. The local control rate with marginal mandibulectomy is 79%.

In T3/T4 tumours, results with supraomohyoid dissection are comparable to radical neck dissection when the upper jugular nodes are histologically negative.

In T4 tumours, histological grading forms an important parameter for identification of a favourable subset. In well‐differentiated tumours DFS was 48% with surgery and 72% with surgery and postoperative RT; in moderately differentiated tumours it was 12% and 21%, respectively; and in the poorly differentiated group there were no survivors.
Prophylactic neck dissection in squamous cell carcinoma of oral tongue: A prospective randomized study
Authors: Fakih A. R. , Patel A. R.
Published: February 2007

This paper presents the first report of an ongoing prospective randomised clinical trial in early T1T2N0 carcinoma of the oral tongue. The problems of regular follow‐up in an indigent population from the vast rural expanse of India has been successfully overcome in this trial by close personal follow‐up. The trial addresses itself specifically to prophylactic vs. therapeutic surgical management of the neck in T1T2N0 patients with cancer of the oral tongue. Overall disease, free survival (median follow‐up 22 months) is higher (64% vs. 47%) in the group receiving prophylactic neck dissection. Disease‐free survival for those with positive nodes at prophylactic neck dissection was twice that of those who underwent a subsequent therapeutic neck dissection (57% vs. 28%).

Contralateral neck node metastasis has been identified as a significant factor in neck failures in those patients undergoing simultaneous prophylactic neck dissection.
Post‐cricoid cancer: An overview
Authors: Pradhan S. A.
Published: February 2007

Two retrospective studies of post‐cricoid cancer are presented: study A, of 283 cases for demographic data, disease pattern, statistics and radiotherapy results; and study B, of 100 surgically treated cases for results of surgery and comparison of three methods of reconstruction.

Study A revealed a male:female ratio of 1:2. Thirty‐one percent of cases were too advanced at presentation for any form of treatment. Most patients were offered radiation therapy, but 21.7% did not complete it due to nutritional depletion. Disease‐free survival (DFS) in patients who completed radiation therapy (137) was 66%, 21%, 4%, and 2% in stages I, II, III, IV respectively.

Study group B showed that the DFS following surgery for stages III and IV was 28%. Reconstruction of the gullet by gastric transportation affected early swallowing but had the highest mortality; the pectoral myocutaneous flap method had the lowest mortality but a high leak rate and postoperative stenosis; the deltopectoral flap showed a high leak rate, delayed swallowing, and the longest hospitalisation of all 3 methods.

Early diagnosis, nutritional support during radiation therapy, surgery in stages III and IV, and one‐stage reconstruction are recommended.
Induction chemotherapy in head and neck cancer: Present status and future
Authors: Advani S. H. , Gopal R. , Saikia T. , Pai V. R.
Published: February 2007

Over the past two decades, induction chemotherapy in head and neck cancer has become popular due to the availability of effective agents and to the high objective response rates with combination chemotherapy in untreated and advanced cancer. Single‐agent induction chemotherapy with moderate‐dose methotrexate (200 mg/m2) did achieve 80% overall response. A combination of cisplatin, bleomycin, and methotrexate also showed 90% overall response in previously untreated patients with stage III and IV disease. Numerous studies support the general observation that initial dramatic response with excellent palliation is seen in patients who have not had any prior regional treatment. Also, chemotherapy responders do better on follow‐up than non‐responders. However, to achieve the goals of improved relapse‐free status and survival, we must recognise the deficiencies of current treatment approaches and explore, in a randomized fashion, new ways to integrate the therapeutic modalities.
Reconstructive surgery in head and neck cancer
Authors: Kavarana N. M. , Bhathena H. M.
Published: February 2007

In the past 15 years dynamic changes have taken place in primary reconstructive procedures for head and neck cancer. We have here described the latest techniques used at the Tata Memorial Hospital in reconstruction of major defects in head and neck cancer surgery.
Natural killer and lymphokine‐activated killer cell‐mediated cytotoxicity in patients with oral cancer
Authors: Gangal S. G. , Tatake R. J. , Krishnan N. , Mukhopadhyaya R. , Naik S. L. , Fakih A. R. , Rao R. S.
Published: February 2007

Peripheral blood lymphocytes (PBL) from untreated and treated oral cancer patients, lymph node lymphocytes (LNL) from metastatic (met) and nonmetastatic (non‐met) lymph nodes, and tumour infiltrating lymphocytes (TIL) were tested for natural killer (NK) and lymphokine activated killer (LAK) cell cytotoxicity using appropriate targets in a short‐term chromium release assay. The results showed that while both NK and LAK functions of PBL from oral cancer patients were comparable to those of normal healthy donors, the NK activity of metastatic and nonmetastatic LNL and TIL was highly compromised. On the other hand, potent LAK activity could be generated from all three lymphoid populations. Individual patients showing low NK activity displayed good LAK cytotoxicity, indicating that endogenous cells with low NK potential have adequate ability to respond to interleukin 2 (IL‐2). LAK activity tested on autologous tumour targets revealed that TIL were the best source of LAK cells, followed by PBL and LNL.
Palliative management of esophageal cancer
Authors: Swaroop V. Santhi , Desai P. B.
Published: February 2007

Symptomatic esophageal cancer is usually an advanced disease and only palliation is possible in the majority of the cases. Endoscopic methods of palliation are becoming very popular because of the simplicity and the low incidence of morbidity and mortality. Endoscopic laser therapy, dilatation, placement of endoprosthesis, bipolar electrocoagulation, and injection therapy are the various methods currently in use. The advantages and disadvantages of different methods are discussed and the need for controlled trials highlighted.
Overview of biological response modifiers
Authors: Staren Edgar D. , Essner Richard , Economou James S.
Published: February 2007

The immune system is regulated by a variety of lymphokines, monokines, and colony‐stimulating factors. Most have now been cloned and it is clear that these cytokines have a broad range of overlapping immunological, inflammatory, and physiological properties. Some of these cytokines might favorably influence the biological therapy of cancer and they have been collectively referred to by clinicians as “biological response modifiers.” This review summarizes current knowledge about the molecular biology and biological properties of most of the common cytokines and provides a brief survey of their therapeutic potential in patients with cancer.
Tumor necrosis factors
Authors: Wanebo Harold J.
Published: February 2007

Tumor necrosis factor (TNF) is a well‐described and characterized cytokine which can be elicited in the intact animal by endotoxin. This factor produces necrosis of subcutaneous tumors in the classic model: Meth A sarcoma in the Balb C mouse. It has been shown to be cytostatic or cytotoxic for a variety of human cancer cell lines, as well as to have effects against both mouse tumors and human cancers carried in the nude mouse. TNF is most likely produced by the macrophage. TNF has been cloned, and has been shown to have a molecular weight of 17,000 and to contain approximately 157 acids in its active form. The genes responsible for TNF are contained on chromosome 6 in man, which also contains genes of the major histocompatibility complex. Although there are similarities to lymphotoxin, which is produced by mitogen‐stimulated lymphocytes, and to interleukin‐1 (IL‐1), which is also produced by macrophages, TNF has distinctive differences, primarily in its antiproliferative effects. TNF is also allied with the effects of cachexia and has been shown to be similar to, if not exactly the same as, cachectin. Although it appears that effects of TNF require expression of receptors to facilitate binding to the cell, there is not a quantitative relationship between receptors and the sensitivity. TNF cytotoxic effects appeared to be amplified by pretreatment of cells with chemotherapeutic agents such as Actinomycin D, Adriamycin, and Cytoxan as well as to have synergistic effects with gamma interferon, alpha interferon, and IL‐2. Although initial phase I and phase II studies of TNF in man have shown the expected toxicity, there have been minimal antitumor effects. It is anticipated that with more sophisticated studies, perhaps combining TNF with either biological or chemotherapeutic agents, TNF's true role in cancer therapy may well unfold.
Active specific immunotherapy with antiidiotypic antibodies in patients with solid tumors
Authors: O'Connell M. J. , Chen Z. J. , Yang H. , Yamada M. , Massaro M. , Mittelman A. , Ferrone S.
Published: February 2007

Tumor‐associated antigens (TAA) provide appropriate targets for selective manipulation of the patient's immune response in the immunotherapy of cancer. Active specific immunotherapy utilizing antiidiotypic antibodies to anti‐TAA antibodies has been implemented in phase I clinical trials both in patients with colorectal carcinoma and in those with melanoma. The theoretical basis for immunotherapy with antiidiotypic antibodies, the results of these clinical trials, and an evaluation of appropriate parameters for future clinical trials of active specific immunotherapy with antiidiotypic antibodies in patients with solid tumors are reviewed.
Human monoclonal antibodies: Prospects for the therapy of cancer
Authors: Wong Jan H. , Irie Reiko F. , Morton Donald L.
Published: February 2007

Human monoclonal antibodies have been produced in a number of laboratories to a number of cell surface and cytoplasmic antigens. Although currently more difficult to produce than murine monoclonal antibodies, human monoclonal antibodies provide several potential advantages over conventional murine monoclonal antibodies in the therapy of human cancer. We review the human monoclonal antibodies produced to human tumors and describe our clinical experience with the use of human monoclonal antibodies in the treatment of recurrent cutaneous melanoma.
Development of diagnosis and surgical treatment for patients with carcinoma of the esophagus
Authors: Sugimachi Keizo , Tsutsui Shinichi
Published: February 2007

Early‐stage esophageal carcinomas are extremely difficult to detect because the patients have no complaints, and findings on the X‐rays are nil. Lugol‐combined endoscopy is the most effective method for detecting the presence of small carcinoma of the esophagus. This paper was, first, conducted on the diagnostic features of early‐stage esophageal carcinoma, detected through the use of Lugol‐combined endoscopy. As the prognosis of patients with esophageal carcinoma is related to many factors, we investigated the prognostic contribution of 15 discrete variables with multivariate analysis. The variables are resectability of the malignant lesion, DNA distribution pattern of the cancer cells, and postoperative complications. As the DNA pattern of cancer cells cannot be changed by surgeons, early detection and postoperative care play key roles in determining the survival of patients with esophageal carcinoma.
Chemosensitivity test for carcinoma of digestive organs
Authors: Maehara Yoshihiko , Kohnoe Shunji , Sugimachi Keizo
Published: February 2007

For the chemosensitivity for carcinoma of digestive organs, gastric, colorectal, and hepatic cancer tissues were examined using in vitro succinate dehydrogenase inhibition (SDI) test and in vivo subrenal capsule (SRC) assay. The chemosensitivity varied in the tissue. The origin of an organ tumor, histological differentiation, and difference of primary or metastatic lesions are critical for determining chemosensitivity. Biochemical analysis shows that antitumor drugs have an increased susceptibility in tissues with high activity of pyrimidine nucleotide synthesis.
Clinical applications of the pathological properties of small cell carcinoma, large cell carcinoma, and adenoid cystic carcinoma of the lung
Authors: Ishida Teruyoshi , Yano Tokujiro , Sugimachi Keizo
Published: February 2007

Lung cancer has considerable treatment problems, with a poor 5‐yr survival rate after surgery. Application of histopathological and immunohistopathological subtyping have proven to be powerful tools for the assessment of prognosis. Results in 33 patients with small cell carcinoma, 44 with large cell carcinoma, and five with adenoid cystic carcinoma of the lung are discussed. The 5‐yr survival rates in patients with small cell carcinoma of the oat cell type and intermediate type were 24 and 44%, respectively. Argyrophilic granules and neuron‐specific enolase, neuroendocrine markers, were detected more frequently in the oat cell type rather than in the intermediate type. In contrast, keratin, epithelial membrane antigen, and carcinoembryonic antigen, epithelial origin markers, were present more frequently in the intermediae type than in the oat cell type. The 5‐yr survival rates with large cell carcinoma of the compact growth type and the loose structure type were 46 and 28%, respectively, based on evidence of morphologically intercellular cohesion. The epithelial origin markers were detectable and more frequent in the compact growth type than in the loose structure type. The growth patterns of adenoid cystic carcinoma are classified as tubular, cribriform, and solid. The solid pattern was the most aggressive with extensive perineural invasion. We propose that the pathological properties of lung cancer should be examined as a prognostic implication of subtyping.
Gastrinoma
Authors: Townsend Courtney M. , Thompson James C.
Published: February 2007

The Zollinger‐Ellison syndrome with its main symptom of massive gastric hypersecretion presents problems with both the medical and surgical approaches to treatment. Successful medical treatment depends on a lifelong commitment to rigid medication schedules requiring careful ongoing supervision and is subject to pitfalls of compliance, drug side effects, drug resistance, and complications of persistent tumor growth. Surgical therapy carries risks of operative mortality and complications. If a low operative mortality can be maintained and the nutritional results after total gastrectomy are good, then it is the authors' opinion that the permanent relief from dangers of hypersecretion afforded by total gastrectomy makes surgery a worthwhile approach. Based on our operative experience in 34 patients and interpretation of the experience of others, we believe that resection of all tumor that can be resected, combined with total gastrectomy, is safe and dependable. The results compare well with those of long‐term medical management.
Origin of oncologic anesthetic techniques
Authors: Howland William S.
Published: February 2007

The patient with cancer poses a challenge to the anesthesiologist for a variety of reasons including the effects of cancer (altered hemostasis, depressed immune response, and compromised airways), the effects of chemotherapy (malfunction of the myocardium, lungs, kidneys, and bone marrow; depression of pseudocholinesterase; and production of the syndrome of inappropriate secretion of antidiuretic hormone), as well as effects of radical cancer surgery (massive blood loss and the need for prolonged anesthesia). Anesthetic techniques to address these problems had their beginnings in the Department of Anesthesiology at Memorial Sloan‐Kettering Cancer Center. This paper traces the development of modern oncologic anesthesia and discusses how these advances significantly reduced operative mortality.
Anesthetic considerations in the pediatric cancer patient
Authors: Hall Steven C. , Stevenson G. W.
Published: February 2007

Cancer is second only to trauma as the leading cause of death in children 1–15 years of age. Pediatric cancer patients have unique physiologic, pharmacologic, and psychologic considerations that present a unique challenge to the anesthesiologist. A thorough understanding of pediatric tumors, along with chemotherapeutics and their complications, is necessary to plan anesthetic management properly. Special attention is directed to the psychologic needs and preparation of both the patient and parents. Close cooperation and coordination among the pediatric oncologist, surgeon, and anesthesiologist are necessary for safe and expeditious operative care.
Tumour lysis syndrome and the anaesthesiologist: Intensive care aspects of paediatric oncology
Authors: Stokes D. N.
Published: February 2007

Children presenting with advanced leukaemia and non‐Hodgkin's lymphoma may develop life‐threatening complications in the early stages of management. Major metabolic disturbances with encephalopathy, septicaemic shock, pneumonitis, massive haemorrhage, or the physical effects of tumour masses may on occasion warrant intensive therapy. Close liaison between paediatric oncologists, oncological surgeons, and anesthesiologists is essential in establishing admission criteria for such cases and in defining therapeutic end points in the event of multisystem failure. This paper discusses the principles of intensive care management of patients with haematological malignancies by considering two cases who developed the tumour lysis syndrome with respiratory and renal failure. A case associated with metabolic encephalopathy is also described.
Anesthetic technique for safe laser use in surgery
Authors: Garry Brendan P. , Bivens Hollis E.
Published: February 2007

The use of lasers has simplified, shortened, and made less traumatic many surgical procedures. It has also increased the range of conditions amenable to treatment in all of the surgical specialties. There are, however, potentially serious hazards associated with the surgical use of lasers. The most serious hazards are explosions and fire, particularly during surgery on the airway, where flammable material, i.e., the endotracheal tube, high oxygen concentrations, and the laser, which is a high energy ignition source, are in close proximity. This report deals with techniques of anesthesia delivery that minimize the risks to the patient and operating room environment consequent on laser use in the airway. Laser use elsewhere in or on the body is associated with no greater danger than the use of electro‐cautery and requires no special anesthetic adaptation.
Anesthetic considerations for gynecologic cancer surgery
Authors: Powell Lionel , Garfield Joseph M.
Published: February 2007

Preoperative, intraoperative, and postoperative anesthetic considerations in gynecologic cancer surgery are discussed. Preoperatively, the anesthetist must document the patient's disease state, physical condition, responses to prior chemotherapeutic regimens and toxic side effects, particularly from Adriamycin and bleomycin. Laboratory studies should include electrolytes, hepatic, renal, and hematologic indices. The anesthetist should also recognize that patients may be under great emotional stress, which may require prescribing anti‐anxiety medications for several days prior to surgery. Planning the anesthetic includes consultation with the surgeon relative to procedure planned, positioning requirements, anticipated blood loss, monitoring, and postoperative care requirements. Intraoperative considerations again involve close communication with the surgeon. The use and benefits of a combined regional/general anesthetic technique are discussed. Postoperative considerations are directed toward hemodynamic stability and control of postoperative pain. Techniques of epidural narcotic and local anesthetic administration, as well as patient‐controlled analgesia (PCA) are discussed.
Instituto nacional de enfermedades Neoplásicas: Past and present
Authors: Luis Pinillos A.
Published: February 2007

The Instituto Nacional de Enfermedades Neoplásicas was established by the government of Peru as an institution for the treatment of cancer patients in 1939; it has existed under different names until the current title was adopted in 1952. Between 1980 and 1987, attendance increased by 70% and a new and larger facility came into use at the beginning of 1988. This institution has national responsibility for cancer prevention, detection, treatment, education, and research and is currently organizing satellite treatment centers in other parts of the country. More than 80% of the medical staff has been trained in the institute's residency program, the majority of whom received additional postgraduate training in the United States and Europe; 90% of the medical staff hold academic appointments in medical schools. In 1952 the Institute became the first hospital in Peru with a formal postgraduate training system for various medical disciplines, including surgical oncology and medical oncology. So far we have trained about 500 surgical oncologists who are working in all parts of Peru. The Maes‐Heller Institute for Cancer Research forms part of the National Cancer Institute complex. Research will be directed mainly toward new diagnostic and therapeutic approaches, multidisciplinary tumor therapy, and large‐scale cancer screening. The Institute focuses on early detection and prevention of cancer and is active in breast self‐examination education and antismoking campaigns. It enjoys community support evidenced in the women's organization, Adainen, involved in fundraising; 460 women volunteers give at least 4 hr service per week to the Institute. The Institute has grown from 9,000 patients seen per year in its early days to 215,000 attendances in 1986.
Percutaneous intrathoracic aspiration biopsy
Authors: Rubini Carlos , De La Flor Jorge , Misad Oscar , Arnao Adolfo Puente , Cisneros Felix , Chang Alfonso , Garcia Jorge
Published: February 2007

An analysis of 617 percutaneous intrathoracic aspiration biopsies (PIAB) performed on 587 patients with pulmonary and mediastinal lesions between 1954 and 1985 are presented. The effectiveness of the procedure between 1954 and 1980 and between 1981 and 1985 with a positivity of 71.6% and 84.9%, respectively, was compared. These results are statistically significant and reflect improvement in the technique employed. A greater positivity was found where the lesion measured 2 to 3 cm in diameter. Complications for this series were 7.8%.

In diffuse infiltrating lesions, the positivity is less than that obtained for the whole series, and the risk of developing a pneumothorax is greater. The false‐negative cases include those in which an inadequate sample was obtained for diagnosis (13.9% of the total series) and samples containing elements of the chest wall or blood (5.2%).
Invasive and noninvasive techniques of staging in potentially operable lung cancer
Authors: Ginsberg Robert J.
Published: February 2007

The author reviews the various noninvasive and invasive techniques for preoperatively staging patients with lung cancer who are potentially operable. The value of computed tomography and mediastinoscopy is emphasized and their role in treatment decisions is outlined. Prior to consideration of surgery in patients with lung cancer, preoperative staging, as accurate as possible, is required in order to determine the best treatment. Complete staging is only available after surgical resection and pathologic examination.
Neoadjuvant treatment in locally advanced non‐small cell lung cancer
Authors: Faber L. Penfield , Bonomi Philip D.
Published: February 2007

Any neoadjuvant or preoperative treatment program that would increase survival in clinically advanced non‐small cell lung cancer (NSCLC) patients would be of significant benefit. In addition to improving patient survival, the program should be associated with minimal toxicity and surgical mortality. The rationale for any preoperative program is that the ability to resect the advanced cancer will be enhanced and micrometastasis will be eradicated. We have analyzed 323 patients enrolled in various types of neoadjuvant and preoperative studies. Review of this data indicates that cisplatin containing regimens produce relatively high responder rates in locally advanced NSCLC patients, resectability rate can be increased by a neoadjuvant program and chemotherapeutic toxicity and operative mortality are not prohibitive. Survival data frequently includes T3NO‐1 patients, but there does appear to be increased survival at 3 and 4 years. These studies remain experimental and continued analysis is necessary before they can be accepted as standard therapy for clinically advanced NSCLC cancer.
Adjuvant treatment in resected lung cancer
Authors: Holmes E. Carmack
Published: February 2007

There have been many attempts to develop effective postoperative adjuvant therapy in patients with resected lung cancer. Metastatic disease is the commonest site of first recurrence. In squamous cell carcinoma local failure is another major problem and in adenocarcinoma brain metastases are frequent.

There is evidence to suggest that radiotherapy can prevent local recurrence but does not appear to impact on survival. Response rates to chemotherapy alone and chemo‐radiotherapy with prolongation of diseasefree survival have been encouraging in locally advanced (resected stage II, III) disease when treated postoperatively.

Results of clinical trials using immunotherapy or chemotherapy in early stage disease have been disappointing. Several prospective randomized studies by the Lung Cancer Study Group were undertaken to assess the merits of various adjuvant treatments and are presented.
Neoadjuvant chemotherapy and surgery of cancer of the esophagus
Authors: Kelsen David P. , Bains Manjit , Burt Michael
Published: February 2007

Neoadjuvant, or pre‐operative, chemotherapy for esophageal cancer has become an area of increasing interest because of the failure of conventional therapy (surgery or radiation) to improve disease‐free or overall survival. Several autopsy series have demonstrated that, in many symptomatic Western patients, esophageal cancer is a systemic disease. Neoadjuvant chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single‐arm, phase II multi‐modality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality has not been increased. Large‐scale randomized trials, needed to evaluate the impact of this technique on disease‐free and overall survival, have been designed and will shortly be activated.
Adenocarcinoma in Barrett's esophagus
Authors: Altorki Nasser K. , Skinner David B.
Published: February 2007

Adenocarcinoma arising in association with the columnar‐lined esophagus is now recognized with increasing frequency. The incidence of malignant degeneration in Barrett's esophagus, its etiology, and pathogenesis are all issues of ongoing debate. The role of gastroesophageal reflux in driving the malignant change remains unproven. Surgical resection is the treatment of choice; however, prognosis is generally poor. Surveillance of patients with non‐malignant Barrett's esophagus permits detection of early lesions where resection results in excellent long‐term survival.
Surgical resection of pulmonary metastases
Authors: McCormack Patricia
Published: February 2007

Since the first pulmonary resection for metastatic carcinoma to lung in 1939, this procedure can now be offered to any patient who fills the following criteria: has a controlled primary, resectable lung lesion, has no better treatment method available, and is a good surgical risk.

With the increased incidence of this procedure, more and more attention is being directed to the predictors of survival to determine which patients will obtain the best benefit. Disease‐free interval, tumor doubling time, and number of lesions are discussed with the effect each has on survival.

This paper covers our experience from 1965 to 1985 of 415 patients who underwent resection for primary carcinomas with metastases to lung. The overall mortality rate is 2%, morbidity rate under 10%, and survival rate best for testicular (51%), and head and neck primaries (47%). This procedure has a proven efficacy for increasing survival rates in properly selected patients.
Pathology of gynecologic malignancies
Authors: Young Robert H. , Bell Debra A. , Scully Robert E.
Published: February 2007

This review encompasses advances in the pathology of female genital tract tumors that have been deemed to have clinical significance. A number of newly described neoplasms are discussed as are the results of analyses of large series of cases of previously described tumors. Recent revision in terminology and the application of newer techniques for evaluating neoplasms, such as flow cytometry, are also briefly reviewed.
Ovarian cancer
Authors: Ozols Robert F.
Published: February 2007

Even though cisplatin‐based combination chemotherapy results in increased clinical and surgical complete remission rates and improved median survival compared with single‐agent alkylating agent chemotherapy, the 5 year survival rates for stages III and IV ovarian cancer have only improved to 25–30%. New methods being evaluated to improve response rates, median survival, and 5 year survival rates include the use of high‐dose carboplatin, dose intensity using platinum compounds, intraperitoneal chemotherapy, concomitant intravenous and intraperitoneal chemotherapy, and the recent discovery of new active agents against epithelial ovarian cancer—Taxol, and Ifosfamide plus mesna.
Recent advances in endometrial cancer
Authors: Creasman William T. , Eddy Gary L.
Published: February 2007

There are well‐defined prognostic factors that identify patients with clinical stage I (confined to the uterus) endometrial adenocarcinoma and patients at high risk vs. low risk for recurrent disease and allow for treatment tailored to those specific prognostic indicators. This had led the International Federation of Gynecologists and Obstetricians (FIGO) in 1988 to revise the FIGO staging from a clinical to a surgical/histopathological evaluation. The use of these prognostic factors should lead to improved initial surgery and adjuvant therapy for patients considered at high risk for recurrence.
Clear cell adenocarcinoma of the vagina and cervix secondary to intrauterine exposure to diethylstilbestrol
Authors: Herbst Arthur L. , Andersond Diane
Published: February 2007

Intrauterine diethylstilbestrol (DES) exposure is associated with an increased risk for the development of clear cell adenocarcinoma (CCA) of the vagina and cervix. The age of the DES‐exposed patients has varied from 7 to 34 years with the highest frequency from 14 to 22 years. The risk among the exposed is small and is on the order of 1 per 1,000. Factors that may increase the risk are maternal history of prior miscarriage, exposure to DES in early gestation, a fall season of birth, and prematurity. Pregnancy does not appear to influence adversely the tumor characteristics or prognosis of patients who have developed these malignancies. Criteria for appropriate local therapy of small clear cell adenocarcinomas of the vagina are presented. Recurrent CCA has been observed as long as 20 years after primary therapy emphasizing the importance of prolonged follow‐up.
Gestational trophoblastic tumors
Authors: Lurain John R.
Published: February 2007

Gestational trophoblastic tumor is a term applied to invasive mole, choriocarcinoma, and placental‐site trophoblastic tumor. The overall cure rate in the treatment of these gestational trophoblastic tumors now exceeds 90%. This high success rate is the result of (1) inherent sensitivity of trophoblastic tumors to chemotherapy, (2) ability to monitor therapy effectively with the use of human chorionic gonadotropin as a tumor marker, and (3) identification of prognostic factors which allows categorization of patients into high‐ and low‐risk groups for selection of treatment. Virtually all patients with nonmetastatic and low‐risk metastatic disease can be cured using single‐agent methotrexate or Actinomycin‐D chemotherapy. Intensive therapy with combination chemotherapy including etoposide, high‐dose methotrexate and Actinomycin D and, where indicated, adjuvant radiotherapy and surgery has resulted in cure rates of 80–90% in patients with high‐risk metastatic disease. The factors which are most important in determining response to treatment are: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, (4) previous failed chemotherapy, and (5) WHO score ⩾8.
Current management and treatment of squamous cell carcinoma of the vulva
Authors: Malfetano John H.
Published: February 2007

Treatment for squamous cell carcinoma of the vulva remains surgical, the standard procedure being radical vulvectomy and bilateral inguinal lymphadenectomy. There has been recent interest in refining histopathologic prognostic factors that would be highly predictive of regional lymph node metastases, recurrences, and survival. With such factors have come new innovative approaches to the management and treatment of minimally invasive carcinomas, regional nodal disease, and advanced lesions. These modifications from standard therapy could result in less morbidity, disfigurement, and hospitalization while not compromising survival.
Invasive cervical cancer in the 1990s
Authors: Piver M. Steven
Published: February 2007

The death rate from invasive cervical cancer has decreased by 70% since the classic work by Papanicolaou and Traut in 1941 on the use of cytologic evaluation to detect cancer of the uterine cervix in the preinvasive in situ stage—a nearly 100% curable disease. Unfortunately, the survival stage for stage of invasive cervical cancer has remained static over the nearly 5 decades since their report. However, discoveries in the decade of the 1970s of the natural spread of cervical cancer, not only to the known pelvic lymph nodes, but the increasing incidence of paraaortic lymph node metastasis with advanced stages, the higher dose of radiation required to sterilize pelvic lymph node metastasis discovered at the time of radical hysterectomy or for locally advanced cervical cancer treated solely by radiation therapy, and the use of radiation potentiators, such as hydroxyurea, should lead to the significant reduction in the annual 7,000 deaths from this disease in the decade of the 1990s.