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 »
Gastric cancer is more common than esophageal cancer in Western countries but is less fatal. More than 21,000 new cases of gastric cancer will be diagnosed in the United States in the year 2010, with 10,750 deaths expected. More »
This management guide of endocrine malignancies covers the risk factors, diagnosis, screening, and treatment of both thyroid and parathyroid cancers. More »
This management guide for non–small-cell lung cancer (NSCLC) covers the symptoms, screening, diagnosis, staging, and treatment of adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma of the lung. More »
BACKGROUND: Serum chromogranin A (CgA) or alkaline phosphatase (ALP) are often assessed in patients with advanced neuroendocrine tumor (NET) patients but their prognostic significance continues to be debated. We evaluated whether elevated CgA or ALP levels were associated with shorter survival in a large, prospectively collected cohort of NET patients. METHODS: We identified patients with metastatic NET enrolled in an institutional database between 2003-10. We used the single measurement of serum CgA o
Introduction: Gastrointestinal (GI) carcinoids are neuroendocrine (NE) tumors that secrete hormones causing carcinoid syndrome. Metastatic carcinoids are not amenable to curative surgery. Therefore, siRNA-mediated gene silencing, in combination with targeted chemotherapy, may be a potential therapeutic strategy for patients with carcinoid neoplasms. We have developed and assessed antitumor effects of a gold nanorod (Au NR)-based nanocarrier conjugated with an anticancer drug (doxorubicin (DOX)) and sma
Introduction: Lung neuroendocrine tumors (NET) comprise typical (TC) and atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and small cell lung carcinoma (SCLC). Phosphatase and tensin homolog (PTEN) protein is a known cytosolic tumor suppressor with recently described novel nuclear functions. We investigated this differential PTEN protein compartmentalization together with its genomic status in pulmonary NETs. Patients and Methods: A retrospective multicenter cohort of 192 patients w
There is a large effort in the public domain to systematically perform DNA and RNA sequencing on large numbers of tumor samples. These efforts will bring us to a greater understanding of tumor biology and lead to identification of new tumor drivers. However, these efforts may fall short in allowing us to understand the progression of tumor resistance, relapse and metastasis, factors which make tumors difficult to treat and increase mortality rates. We are currently performing targeted DNA sequencing on
Bronchial carcinoids are pulmonary neuroendocrine cell derived tumors comprising typical (TC) and atypical (AT) malignant phenotypes. The 5-year survival rate in metastatic disease, despite multiple current therapies, is 14-25%. Carcinoids are found in the gastrointestinal tract are more frequent (61%) and also more aggressive; however, 31% of carcinoids are located in bronchopumonary system, which can metastize beyond the longs. Therefore, new strategies are needed for effective treatment of carcinoid
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
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
