ONCOLOGY Vol 9 No 1

This paper by Abi-Rached and Neugut provides an overview of the diagnosis and treatment of gallbladder carcinoma, a rare, yet frustratingly difficult disease to manage [1]. Overall, we agree with the risk factors described in this review. We would add that, in addition to chronic cholecystitis, porcelain gallbladder, and retained gallbladder (secondary to cholecystostomy), cholecysto-enteric fistulas have also been associated with a higher incidence of gallbladder carcinoma [2,3] Patients with ulcerative colitis are known to be at higher risk for cholangiocarcinoma, and there is also some evidence that these patients have an increased risk of gallbladder cancer.

Many patients with non-small-cell lung cancer (NSCLC) respond to treatment with docetaxel (Taxotere), according to results presented at the 1994 European Society for Medical Oncology (ESMO) meeting in Lisbon, Portugal.

Developed as a way to sample mammographic abnormalities in a potentially less invasive way, stereotactic technology has generated significant controversy. Speaking at the 11th International Breast Cancer Meeting in San Antonio earlier this year,

Preliminary clinical results with gemcitabine, an investigational difluoronucleoside, were presented during scientific sessions organized by the 7th World Conference on Lung Cancer, which was held in Colorado Springs last year. The agent produced

In the 1970s, a radical mastectomy represented the sole option for women with breast cancer. Years later, when the issue of quality of life was raised, the era of reconstructive surgery, via silicone gel breast implants--internal prostheses, was born. For

A study published in the June 1, 1994 issue of the journal Blood demonstrates that amifostine (Ethyol), a selective cytoprotective agent, significantly shortens the time to bone marrow recovery in breast cancer patients undergoing high-dose

Physicians need to find more effective ways to determine their patients' preferences about cancer treatment, according to an editorial in the November 7, 1994 issue of the Journal of the National Cancer Institute.

Investigators at the University of California, San Diego (UCSD) School of Medicine have discovered a second pathway that the Ras proto-oncogene uses to cause cancer. The work sets the stage to develop new approaches for cancer treatment by

Neutrophil counts drop less and recover faster in chemotherapy patients who take colony-stimulating factors (CSFs), said George Demetri, MD, at the 6th International Symposium on Supportive Care in Cancer. Agents such as G-CSF [granulocyte

Carcinoma of the gallbladder is a rare malignancy, with an incidence rate in the United States of 2.2 to 4.4 per 100,000 persons. Its clinical presentation is nonspecific, and the majority of patients have advanced disease at

Although generally benign tumors, meningiomas can cause serious neurological injury and, at times, vexatious management difficulties. Currently, the accepted management of these tumors is attempted total surgical excision when technically possible and associated with an acceptable risk. However, even with innovations in instrumentation and refinements in surgical technique, the goal of total resection may not be achievable. For these patients, and for those with recurrent tumors, options for treatment include reoperation, radiation therapy, and chemotherapy. Recent developments in surgical technique and instrumentation, radiosurgery, and brachytherapy have increased the treatment options, while clinical trials with tamoxifen and mifepristone (RU486) are adding information on the effectiveness of these drugs as chemotherapeutic agents. While the search continues for a uniformly successful management plan, physicians must be aware of the available options and try to help the patient decide which treatment is appropriate, based on current medical knowledge. [ONCOLOGY 9(1):83-100]

Primary CNS lymphoma is rising in incidence in both the AIDS and non-AIDS populations. It is a non-Hodgkin's lymphoma that usually presents as a brain tumor, but the leptomeninges, eyes, and spinal cord also are

Endoscopically guided percutaneous gastrostomy tube placement was developed in 1980 by Jeffrey Ponsky [1].In the ensuing years, this procedure has evolved rapidly. The procedure began with a homemade kit consisting of urinary and intravenous catheters. Now the endoscopist has a choice of three different techniques and a host of commercially available kits from which to choose [2]. By 1989, percutaneous endoscopic gastrostomy became the preferred method of gastrostomy (over surgery), and presently is the second most common indication for EGD (esophago-gastro-duodenoscopy) in hospitalized patients in the United States (the most common indication is upper gastrointestinal bleeding). The long-term complication rate is extremely low [3,4], and both patients and nurses alike prefer percutaneous endoscopic gastrostomy to nasogastric tubes [3].

The use of safe and cost-effective endoscopic techniques for the placement of tubes in the gastrointestinal tract has led to increased utilization of long-term enteral feeding in patients with impaired GI function, including many

Dr. DeAngelis has written a succinct and accurate assessment of management of primary central nervous system lymphoma. Non-AIDS-related primary central nervous system lymphoma is a rare, highly malignant primary brain tumor. However, its incidence is increasing, as are AIDS-related tumors of this type. Patients with primary central nervous system lymphoma usually have widespread infiltration throughout the brain, rendering aggressive resection of no benefit. There is a significant incidence of leptomeningeal and ocular involvement (the latter a "sanctuary site," thus posing a particular therapeutic dilemma).

Surgical resection has been the preferred treatment for meningiomas since the era of the pioneering neurosurgeon, Harvey Cushing. The great majority of these tumors are histologically benign, circumscribed lesions that grow slowly and tend to compress and displace, rather than invade, the surrounding intracranial structures. In contrast to the intrinsic brain tumors of glial origin, most meningiomas have well-defined borders, enabling the surgeon to dissect the tumor capsule from the arachnoid lining of the adjacent brain, blood vessels, and cranial nerves. Consequently, complete removal can be accomplished without needing to sacrifice functional tissue. In these cases, surgery is often curative, and associated with the preservation of, if not improvements in, the neurological condition.

Drs. Abi-Rached and Neugut have presented a comprehensive review of the natural history and epidemiologic characteristics of patients who develop carcinoma of the gallbladder. They correctly point out that this tumor is a rare neoplasm, with the annual incidence in the United States being quite low; the number of patients dying from gallbladder cancer in 1978 was estimated to be 2,469, representing only .3% to 1.0% of total cancer deaths in the United States [1]. Since incidence rates vary significantly by geographical area, the risk factors associated with this tumor are of interest. For example, in Chile, cancer of the gallbladder and bile ducts accounts for 5.25% of cancer deaths [2]. Among Jews in Israel, the incidence appears to be higher in patients of European birth compared with those born in Asia [3]. Incidence also appears to be higher in Native Americans and Mexican-Americans born in the United States than in other population groups in the United States [4]. For instance, gallbladder cancer is the most common gastrointestinal malignancy among Southwestern Native Americans [5].

Dr. DeAngelis provides a succinct analysis of primary central nervous system lymphoma and its management. This malignancy remains a puzzle because of its unusual behavior, being widely disseminated within the CNS, and yet rarely involving the systemic compartment. Patients who develop primary central nervous system lymphoma need to be divided into two groups: Those who are immunocompetent and those who are immunocompromised, including patients with HIV infection and transplantation recipients.

Dr. DeMonte has used an interesting case report to provide an excellent summary of the state of the art in the management of meningiomas of the brain.