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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) All titles available at 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: 512/ 863 7762; FAX: 512/ 863 0081 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

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