Aortic Surgery - J. Ballard (2000) WW

367 Pages·2000·10.77 MB·English

LANDES
B I O S C I E N C E V
m

Jeffrey L. Ballard

a d e m e c u
V
LANDES
B I O S C I E N C E
a d e m e c u m

Table of contents

1. Pathogenesis of Aortic
Aneurysmal Disease

2. Epidemiology of Aortic
Aneurysmal Disease

3. Screening for Aortic
Aneurysmal Disease

4. The Pathophysiology of Aortic
Dissection

5. Carotid Screening before Aortic
Surgery

6. Cardiac Screening before Aortic
Surgery

7. Diagnostic Imaging Techniques
before Aortic Surgery

This is one of a new series of medical handbooks.

It includes subjects generally not covered in other handbook series, especially
many technology-driven topics that reflect the increasing influence of technology
in clinical medicine.

The name chosen for this comprehensive medical handbook series is Vademecum,
a Latin word that roughly means “to carry along”. In the Middle Ages, traveling
clerics carried pocket-sized books, excerpts of the carefully transcribed canons,
known as Vademecum. In the 19th century a medical publisher in Germany, Samuel
Karger, called a series of portable medical books Vademecum.

The Vademecum books are intended to be used both in the training of physicians
and the care of patients, by medical students, medical house staff and practicing
physicians. We hope you will find them a valuable resource.

Aortic Surgery

a d e m e c u m
V

Ballard

Aortic
Surgery

I SBN 1- 57059- 628- X

8. Surgical Exposure for Aortic
Surgery

9. Management of Small Aortic
Aneurysms

10. Aortic Surgery in the Very
Elderly

11. Aortic Reconstruction
for Occlusive Disease

12. Extra-Anatomic Bypass
for Aortoiliac Occlusive Disease

13. Stent Deployment for Aortoiliac
Occlusive Disease

14. Infrarenal Aortic Aneurysm
Repair

(excerpt)

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www.landesbioscience.com

LANDES
B I O S C I E N C E

David N. Krag, M.D.
University of Vermont Medical School
Burlington, Vermont, U.S.A.

Surgical Oncology

GEORGETOWN, TEXAS
U.S.A.

v a d e m e c u m

L A N D E S

B I O S C I E N C E

VADEMECUM
Surgical Oncology
LANDES BIOSCIENCE
Georgetown, Texas U.S.A.

Copyright ©2000 Landes Bioscience
All rights reserved.
No part of this book may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopy, recording, or any
information storage and retrieval system, without permission in writing from the
publisher.
Printed in the U.S.A.

Please address all inquiries to the Publisher:
Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626
Phone: [phone]; FAX: [phone]

ISBN: 1-57059-633-6

Library of Congress Cataloging-in-Publication Data

Surgical oncology / [edited by] David N. Krag.
p. ; cm. -- (Vademecum)
Includes bibliographical references and index.
ISBN 1-57059-633-6 (spiral)
1. Cancer--Surgery. I. Krag, David N. II. Series.
[DNLM: 1. Neoplasms--surgery. 2. Medical Oncology. QZ 268 S96105 2000]
RD651.S8832 2000
616.99′4059--dc21
00-057733

While the authors, editors, sponsor and publisher believe that drug selection and dosage and
the specifications and usage of equipment and devices, as set forth in this book, are in accord
with current recommendations and practice at the time of publication, they make no
warranty, expressed or implied, with respect to material described in this book. In view of the
ongoing research, equipment development, changes in governmental regulations and the
rapid accumulation of information relating to the biomedical sciences, the reader is urged to
carefully review and evaluate the information provided herein.

Dedication

This book is dedicated to Paul Gross, Ph.D. at the Unviersity of the Pacific.
It is a small gesture to recognize his influence as an outstanding educator
whose powerful messages have stood the test of time.

Contents

1. Breast Cancer .................................................................... 1
Lorraine Tafra
Scope of the Problem: Incidence ................................................................. 1
Risk Factors ................................................................................................ 1
Prevention .................................................................................................. 3
Screening .................................................................................................... 3
Methods of Diagnosis ................................................................................. 4
Types of Breast Cancer ................................................................................ 5
Preoperative Evaluation............................................................................... 6
Treatment Options ..................................................................................... 6
Treatment Outcomes ................................................................................ 12
Posttreatment Surveillance ........................................................................ 15
Special Considerations .............................................................................. 16

2. Melanoma ....................................................................... 18
Lee W. Thompson, Laurence H. Brinckerhoff, and Craig L. Slingluff, Jr.
Scope of the Problem ................................................................................ 18
Risk Factors for the Development of Melanoma ....................................... 18
Screening for Melanoma ........................................................................... 19
Methods of Diagnosis ............................................................................... 20
Preoperative Evaluation............................................................................. 20
Staging...................................................................................................... 22
Treatment ................................................................................................. 24
Distant Metastasis ..................................................................................... 25
Adjuvant Therapy ..................................................................................... 26
Experimental Therapy............................................................................... 27
Posttreatment Surveillance ........................................................................ 27
Special Considerations .............................................................................. 28

3. Nonmelanoma Skin Cancers ........................................... 31
Paul L. Baron
Introduction ............................................................................................. 31
Scope of the Problem ................................................................................ 31
Risk Factors .............................................................................................. 31
Screening .................................................................................................. 33
Diagnosis .................................................................................................. 34
Preoperative Evaluation............................................................................. 37
Staging...................................................................................................... 37
Treatment ................................................................................................. 37
Posttreatment Surveillance ........................................................................ 39
Unusual Tumors ....................................................................................... 40
Special Considerations .............................................................................. 42

4. Soft Tissue Sarcomas ....................................................... 43
Mary Sue Brady
Scope of the Problem ................................................................................ 43
Risk Factors for Development of the Disease ............................................ 44
Screening for STS ..................................................................................... 47
Methods of Diagnosis and Clinical Presentation ....................................... 47
Preoperative Evaluation............................................................................. 53
STS Staging .............................................................................................. 54
Prognostic Variables .................................................................................. 54
Treatment Options ................................................................................... 56
Outcome of Treatment.............................................................................. 62
Posttreatment Surveillance ........................................................................ 63

5. Head and Neck Cancer ................................................... 66
James C. Alex, Jason Klenoff
Introduction ............................................................................................. 66
Anatomy ................................................................................................... 66
Scope of the Problem: Epidemiology ........................................................ 68
Diagnosis .................................................................................................. 70
Staging...................................................................................................... 72
Treatment ................................................................................................. 72
Nasal Cavity and Paranasal Sinuses ........................................................... 75
Nasopharyngeal ........................................................................................ 76
Oral Cavity ............................................................................................... 76
Oropharynx .............................................................................................. 77
Hypopharynx............................................................................................ 77
Larynx ...................................................................................................... 78
Parotid Tumors ......................................................................................... 79

6. Esophageal Cancer .......................................................... 81
Philip D. Schneider
Scope of the Problem ................................................................................ 81
Risk Factors for Development of the Esophageal Cancer........................... 81
Barrett’s Esophagus ................................................................................... 82
Methods of Diagnosis ............................................................................... 83
Staging...................................................................................................... 84
Further Preoperative Evaluation ................................................................ 84
Treatment Options ................................................................................... 85
Neoadjuvant Chemotherapy ..................................................................... 92
Treatment Options for Unresectable Disease ............................................. 92
Outcome of Therapy ................................................................................ 92
Posttreatment Surveillance ........................................................................ 95
Special Considerations .............................................................................. 95

7. Gastric Cancer................................................................. 97
Stephen A. Shiver, Brian W. Loggie
Scope and Epidemiology ........................................................................... 97
Risk Factors .............................................................................................. 97
Screening .................................................................................................. 98
Diagnosis .................................................................................................. 99
Preoperative Evaluation........................................................................... 100
Staging.................................................................................................... 101
Treatment Options ................................................................................. 102
Outcome of Treatment............................................................................ 105
Follow Up and Posttreatment Surveillance .............................................. 105

8. Colon and Rectal Cancer .............................................. 107
Neil Hyman
Scope of the Problem .............................................................................. 107
Risk Factors for Development of Disease ................................................ 107
Screening for the Problem ....................................................................... 109
Methods of Diagnosis ............................................................................. 110
Preoperative Evaluation........................................................................... 111
Staging.................................................................................................... 111
Treatment Options ................................................................................. 112

9. Carcinoma of the Anal Region ...................................... 120
Peter Cataldo
Scope of the Problem .............................................................................. 120
Risk Factors ............................................................................................ 120
Screening for Anal Carcinoma ................................................................ 121
Clinical Presentation and Diagnosis ........................................................ 122
Staging.................................................................................................... 124
Premalignant Conditions ........................................................................ 124
Paget’s Disease......................................................................................... 126
Verrucous Carcinoma ............................................................................. 126
Malignant Neoplasms of the Anal Canal ................................................. 127
Tumors of the Anal Margin or Perianal Region ....................................... 128
Anal Melanoma ...................................................................................... 128
Adenocarcinoma ..................................................................................... 129
Conclusions ............................................................................................ 129

10. Liver Cancer .................................................................. 131
Joseph A. Kuhn, Todd M. McCarty, and Robert M. Goldstein
Scope of the Problem .............................................................................. 131
Risk Factors ............................................................................................ 131
Screening ................................................................................................ 131
Diagnosis ................................................................................................ 132
Preoperative Evaluation........................................................................... 134
Staging.................................................................................................... 134
Treatment ............................................................................................... 135

Outcome ................................................................................................ 140
Posttreatment Surveillance ...................................................................... 140
Special Considerations: Other Types of Primary Hepatic Malignancy ..... 140
Liver Metastases ...................................................................................... 143
Scope of the Problem .............................................................................. 143
Screening ................................................................................................ 143
Diagnosis ................................................................................................ 143
Preoperative Evaluation........................................................................... 144
Treatment ............................................................................................... 145
Outcome ................................................................................................ 147
Posttreatment Surveillance ...................................................................... 147

11. Cancers of the Pancreas and Biliary Tract ..................... 149
James C. Hebert
Cancer of the Pancreas ............................................................................ 149
Cancer of the Gallbladder and Extrahepatic Biliary Tract ........................ 158

12. Lung Cancer 2000 ........................................................ 166
Frederic W. Grannis Jr.
Scope of Problem: Incidence and Mortality ............................................ 166
History and Epidemiology ...................................................................... 166
Molecular Biology................................................................................... 167
Cell Types and Tumor Biology ................................................................ 167
Clinical Presentation ............................................................................... 168
Diagnostic Workup ................................................................................. 171
Principles of Surgical Treatment .............................................................. 174
Postoperative Care .................................................................................. 176
Radiation Oncology................................................................................ 177
Treatment Results ................................................................................... 177
Stage I..................................................................................................... 179
Stage II ................................................................................................... 182
Stage IIIA ............................................................................................... 183
Stage IIIB................................................................................................ 185
Stage IV .................................................................................................. 186
Posttreatment Follow-up ......................................................................... 186
Prospects for Improvement ..................................................................... 187
Political Reform ...................................................................................... 188
Legal Activism ........................................................................................ 188
Chemoprevention ................................................................................... 188
Screening ................................................................................................ 188
Surgical Research .................................................................................... 189
Basic Science Research ............................................................................ 190
Conclusion ............................................................................................. 191

13. Mediastinal Tumors ...................................................... 193
Bruce Jason Leavitt
Scope of Problem .................................................................................... 193
Risk Factors ............................................................................................ 193
Screening ................................................................................................ 193
Methods of Diagnosis ............................................................................. 194
Preoperative Evaluation........................................................................... 197
Staging.................................................................................................... 198
Treatment Options—Thymoma ............................................................. 204
Outcomes—Thymoma ........................................................................... 205
Posttreatment Surveillance ...................................................................... 206

14. Endocrine Tumors......................................................... 208
Thomas J. Kearney, David A. August
Introduction ........................................................................................... 208
Thyroid .................................................................................................. 208
Parathyroid ............................................................................................. 212
Adrenal ................................................................................................... 216
Endocrine Tumors of the Pancreas .......................................................... 221
Carcinoid Tumors ................................................................................... 225
Multiple Endocrine Neoplasia (MEN) .................................................... 227

15. Principles of Chemotherapy.......................................... 233
Dennis Sanders
Malignant Transformation and Molecular Targets for Chemotherapy ..... 234
Classes of Chemotherapeutic Agents ....................................................... 236
Cytidine Analogues ................................................................................. 237
Flourinated Pyrimidines.......................................................................... 238
Other Antimetabolites ............................................................................ 239
Alkylating Agents .................................................................................... 241
Antitumor Metabolites ........................................................................... 242
Topoisomerase Inhibitors ........................................................................ 243
Anthracyclines ........................................................................................ 244
Future Drugs .......................................................................................... 245
Signal Transduction Inhibitors ................................................................ 245
Antiangiogenesis Drugs........................................................................... 246

16. Major Principles of Radiation Oncology ...................... 248
Thomas A. Roland
Historical Perspective .............................................................................. 248
Clinical Perspective ................................................................................. 248
Radiation Therapy—Physical Basis ......................................................... 249
Radiation Therapy—Biological Basis ...................................................... 253
Interdisciplinary Management ................................................................ 255

17. Ultrasound Imaging in Surgical Oncology ................... 263
Jay K. Harness
Introduction ........................................................................................... 263
Basic Principles ....................................................................................... 263
Breast Ultrasound ................................................................................... 267
Thyroid Carcinoma and Neck Metastases ............................................... 274
Ultrasound Imaging in Cancer Staging ................................................... 278
Conclusion ............................................................................................. 287

18. Sentinel Lymph Node Biopsy........................................ 291
Frederick L. Moffat
Gamma Detection Probes ....................................................................... 291
Lymphatic Migration of Radiocolloids .................................................... 292
Preoperative Lymphoscintigraphy ........................................................... 294
SLNB in Cutaneous Malignant Melanoma ............................................. 294
SLNB in Breast Cancer ........................................................................... 295
SLNB in Other Tumors .......................................................................... 303
Pathological Examination of SLNs .......................................................... 304
Radiation Safety Issues ............................................................................ 304
Prospective Multi-Center Randomized Trials of SLNB ........................... 305
Discussion .............................................................................................. 306
Conclusion ............................................................................................. 308

Index ............................................................................. 312