Many patients with advanced cancer undergo a wasting syndrome associated with cancer anorexia/cachexia and asthenia. In defining these terms a bit further, anorexia is associated with a marked loss of appetite and/or an aversion to food. More »
Carcinoma of an unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. Patients in this group are heterogeneous, having a wide variety of clinical presentations and pathologic findings. More »
This management guide covers the symptoms, screening, diagnosis, and treatment of small-cell lung cancer (SCLC), mesothelioma, and thymoma from a surgical, medical, and radiation oncology approach. More »
This management guide of endocrine malignancies covers the risk factors, diagnosis, screening, and treatment of both thyroid and parathyroid cancers. More »
First recognized as "carcinoids" in the gastroenteropancreatic (GEP) tract, neuroendocrine tumors (NET) are a variety of neoplastic lesions distributed in most organs and apparata. The current World Health Organization (WHO 2010) define low and high grade neuroendocrine cancer types with the broad definition of neuroendocrine neoplasms and introduces grading (G1-G3) and Tumour Node Metastasis (TNM) staging for class definition. The proposed WHO 2010 grading system defines three classes (G1-G3) accordi
Pasireotide (SOM230) is a novel multireceptor-targeted somatostatin (sst) analog with high binding affinity for sst receptor subtype 1, 2, 3 (sst1,2,3) and sst5. Because of this binding profile, pasireotide may offer symptom control in patients with neuroendocrine tumors (NETs) and carcinoid syndrome no longer responsive to octreotide LAR. This was a phase II, open-label, multicenter study of pasireotide in patients with advanced NET whose symptoms of carcinoid syndrome (diarrhea
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Well-differentiated neuroendocrine tumors (NETs) of the jejunum, ileum, and appendix are also collectively known as midgut carcinoids. Similar to NETs in general, the diagnosed incidence of the midgut NETs is on the rise. Their presenting symptoms vary depending on stage and primary site. Local-regional NETs often present with vague and nonspecific symptoms. Classic carcinoid syndrome is more likely to appear in patients with advanced disease. Local-regional NETs of the small bowel should be resected whenever possible. With the exception of small well-differentiated NETs of the appendix, NETs of the midgut have substantial risk of relapse after resection and need to be followed for at least 7 years.Metastatic/advanced NETs of the midgut are incurable. Optimal management requires a multidisciplinary approach. Somatostatin analogs are effective in the management of carcinoid syndrome. Octreotide long-acting release has also recently been shown to delay disease progression.
Extrapulmonary poorly differentiated neuroendocrine carcinomas can originate in the gastrointestinal tract, bladder, cervix, and prostate. These high-grade malignancies are characterized by aggressive histological features (high mitotic rate, extensive necrosis, and nuclear atypia) and a poor clinical prognosis. They are infrequently associated with secretory hormonal syndromes (such as the carcinoid syndrome) and rarely express somatostatin receptors.Most poorly differentiated neuroendocrine carcinomas are locally advanced or metastatic at presentation. First-line systemic chemotherapy with a platinum agent (cisplatin or carboplatin) and etoposide is recommended for most patients with metastatic-stage disease; however, response durations are often short. Sequential or concurrent chemoradiation is recommended for patients with loco-regional disease. In patients with localized tumors undergoing surgical resection, adjuvant treatment (chemotherapy with or without radiation) is warranted
Among new biological markers that could become useful prognostic factors for lung carcinoma, Ki-67 is a nuclear protein involved in cell proliferation regulation. Some studies have suggested an association between Ki-67 and poor survival in lung cancer patients. In order to clarify this point, we have performed a systematic review of the literature, using the methodology already described by our Group, the European Lung Cancer Working Party. In total, 37 studies, including 3983 patients, were found to be eligible. In total, 49% of the patients were considered as having a tumour positive for the expression of Ki-67 according to the authors cutoff. In all, 29 of the studies dealt with non-small-cell lung carcinoma (NSCLC), one with small-cell carcinoma (SCLC), two with carcinoid tumours and five with any histology. In terms of survival results, Ki-67 was a bad prognosis factor for survival in 15 studies while it was not in 22. As there was no statistical difference in quality scores
Gastric carcinoids are a rare gut endocrinoma, and only a few series dealing with limited aspects have been published. This study evaluates the present status and characteristics of gastric carcinoids in a statistically reliable series of 1,094 cases that were carefully evaluated, computerized, and analyzed by the "Gut-Pancreatic Endocrinoma Analyzing System." Routine statistical analysis was carried out on 1,011 patients, excluding 83 with atypical carcinoids, focusing on clinical manifestations, location, depth, and size of the lesions in relation to metastases, immunohistochemistry, carcinoid syndrome, serotonin activity, electron microscopy, multicarcinoid complex with type A gastritis, and postoperative outcome. A tumor size of 20 mm or less comprised 60.8% of the series, with a metastasis rate of 15.1%, and depth of invasion to the submucosa occupied 53.8%, with a metastasis rate of 13.2%. Carcinoid syndrome was encountered in 4.0% of the patients. Elevated serotonin activity
The clinical findings of a population-based colorectal tumor registry have been analyzed to determine elements of supporting or not supporting the existence of different types of large bowel cancer. Age-specific incidence rate of the 409 registered patients rose sharply with increasing age in all segments of the large bowel; however, regarding left colon and rectum, the male: female ratio showed a marked male preponderance, more evident in the more advanced age groups. Histopathology, studied in 87% of patients, revealed adenocarcinoma as the most frequent feature; however, adenocarcinoma with concomitant adenoma (i.e., presumably arising in adenoma) was observed in 14.3% of cancers of the left colon, in 17.7% of rectal tumors, but in only 5.7% of neoplasms of the proximal colon (P less than 0.05 and P less than 0.01, respectively, vs. left colon and rectum). Some histological features (carcinoid and mucinous carcinoma) were observed in right-side tumors only. Analysis of the familial
Key Differences between FQHCs and RHCs Chastity Werner, RHIT, June 13, 2013 FQHCs and RHCs take up a unique niche among physician practices. And that affects compensation and billing.
Improving Care Coordination in Your Practice Susanne Madden, June 12, 2013 Practices are feverishly working to control the rising costs of healthcare - effective care coordination can help.
Refunding Overpayments: Two Options for Medical Practices Ericka L. Adler, June 12, 2013 Medicare and Medicaid providers must return overpayments once identified. Here are two different refund approaches for practices to consider when necessary.
iPad Alternatives for Mobile Physicians Marisa Torrieri, June 11, 2013 As more physicians are seeing the merits of media tablets, the market is expanding, too.