Thank you for purchasing this e-book. To receive special offers and news about our latest products, sign up below. Or visit LWW.com The Washington Manual of Oncology Third Edition Editors Ramaswamy Govindan, MD Professor Division of Oncology Alvin J. Siteman Cancer Center at Washington University School of Medicine St. Louis, Missouri Daniel Morgensztern, MD Associate Professor Division of Oncology Alvin J. Siteman Cancer Center at Washington University School of Medicine St. Louis, Missouri Acquisitions Editor: Julie Goolsby Senior Product Development Editor: Emilie Moyer Production Project Manager: David Orzechowski Manufacturing Manager: Beth Welsh Marketing Manager: Stephanie Kindlick Design Coordinator: Terry Mallon Production Services: S4Carlisle Publishing Services Copyright © 2015 by Department of Medicine, Washington University School of Medicine, Published by Wolters Kluwer. Copyright © 2008, 2002 by Department of Medicine, Washington University School of Medicine, Published by Lippincott Williams & Wilkins All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data The Washington manual of oncology / [edited by] Ramaswamy Govindan and Daniel Morgensztern. — Third edition. p. ; cm. Manual of oncology Includes bibliographical references and index. ISBN 978-1-4511-9347-3 (alk. paper) eISBN 978-1-4963-1843-5 I. Govindan, Ramaswamy, editor. II. Morgensztern, Daniel, editor. III. Washington University (Saint Louis, Mo.). School of Medicine, issuing body. IV. Title: Manual of oncology. [DNLM: 1. Neoplasms—physiopathology—Handbooks. 2. Neoplasms—therapy—Handbooks. 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LWW.com Dedicated to our colleagues in the Division of Oncology at the Washington University School of Medicine Preface It has been nearly 13 years since we launched the first edition of The Washington Manual of Oncology. Over the past decade we have witnessed enormous progress in our understanding of molecular alterations in cancer and the use of targeted therapies and immunotherapies. Cancer care has become naturally complex and daunting. The current edition has been extensively revised to include these recent developments. Almost all the chapters have been extensively revised or rewritten. As before, this manual is written keeping the trainees in mind while also providing a quick update for the practitioners of oncology. It is our hope that you, the reader, find this manual practical, useful, and stimulating. As always, we will be very grateful to you for pointing out any inadvertent errors that have slipped all our editorial review process. Please feel free to email us with your suggestions, feedback and comments. Ramaswamy Govindan, MD Daniel Morgensztern, MD Preface to the First Edition These are exciting times in oncology. The novel imaging techniques, improved supportive care, and the availability of several new agents that have novel mechanisms of action hold considerable promise in improving the outcomes of cancer patients. In this era of information overload, it is critically important to have a practical manual that is helpful to physicians taking care of patients with cancer. The chapters are arranged in a logical order beginning with evaluation of symptoms and proceeding in an orderly fashion through the work-up, staging, and stage-directed therapy, and finally ending with discussion on epidemiology and current focus of research. We have embarked on this first edition of The Washington Manual of Oncology to provide a very practical manual that is helpful to medical residents, fellows in training, nurse practitioners, and other practitioners of clinical oncology. Our plan is to publish this book in a timely fashion every two years to keep the information current and up-to-date. Ramaswamy Govindan, MD Acknowledgments First and foremost, I am delighted to welcome my dear colleague, Daniel Morgensztern, as the co-editor for this edition. Dan is a terrific clinician, clinical investigator and a walking encyclopedia of Medical Oncology. His hard work, diligence, commitment and passion have truly left an indelible mark on this edition. It is no exaggeration to say that this edition would not be in your hands without Dan’s help. I am truly grateful to him. Sadly, Jonathan Pine, Senior Executive Editor at Wolters Kluwer, passed away a year ago. Jonathan had worked with me for the past 12 years. He was instrumental in guiding the production of the first two editions and initiated the process for this edition. I will miss him very much. I want to thank the individual contributors, who are all my dear and well- respected colleagues, for their efforts. As I have found over the years, a number of individuals also work behind the scenes to produce a book. At Wolters Kluwer, Julie Goolsby, Acquisitions Editor, and Emilie Moyer, Senior Product Development Editor, were instrumental in keeping the project moving and persistent with follow-up. Julie and Emilie were kind enough to accommodate our busy schedules and remarkably patient with our delays. I am very grateful for their insight, wisdom and patience. My administrative assistant Johanna Duke is a remarkable individual. Her thoughtful, intelligent, analytical and organized approach made the editing process an enjoyable one. She is a significant contributor to the success of this edition. I am grateful to my nursing and secretarial staff for their help while I was busy working on this project. My work was made not only easy but also pleasurable by the great environment at Washington University School of Medicine in St. Louis. I owe a particular debt of gratitude to the leadership provided by the Chief of the Division of Oncology, John F. DiPersio, MD, PhD. Even though my two children Ashwin and Akshay are now in their teen years, they continue to be adorable (most of the time). I am forever grateful to my lovely wife, Prabha, and my two children who make everything worthwhile. Ramaswamy Govindan, MD