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Malignancies have been detected in approximately 40% of all patients with acquired immunodeficiency syndrome (AIDS) sometime during the course of their illness. These cancers have been both a primary cause of death in some patients and also a source of considerable morbidity. In the current era of highly active antiretroviral therapy (HAART), patients infected with the human immunodeficiency virus (HIV) are surviving longer than ever. HAART appears to have substantially reduced the incidence of Kaposi’s sarcoma (KS) and non-Hodgkin lymphoma (NHL) and may enhance the efficacy of treatment for those patients who do develop these tumors. Unfortunately, HAART has not shown a similar effect on the development of other types of neoplasms, and caring for patients who develop malignancies in the setting of HIV remains a challenge. Furthermore, HAART is not available universally, with many patients in resource-poor developing countries not having access to antiretroviral drugs.

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. A patient should be considered to have carcinoma of an unknown primary site when a tumor is detected at one or more metastatic sites, and routine evaluation (see below) fails to define a primary tumor site.

Intracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue. The overall annual incidence of primary brain tumors in the United States is 14 cases per 100,000 population.

News that President Obama received a clean bill of health from a virtual colonoscopy several days ago rubbed influential gastroenterologists the wrong way.

Worldwide, hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer mortality. Most patients with hepatocellular carcinoma suffer from cirrhosis primarily caused by alcoholism or chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV); decades may pass between infection with viral hepatitis and development of this cancer. The approximately equal annual incidence and mortality of 1 million reported around the world stands as evidence of its lethality.

Despite the existence of excellent screening and preventive strategies, colorectal carcinoma (CRC) remains a major public health problem in Western countries. The American Cancer Society (ACS) estimated that in 2009, 146,970 people will be diagnosed with CRC, and 49,920 will die of the disease. CRC is the third most common type of cancer in both sexes (after prostate and lung cancers in men and lung and breast cancers in women) and the second most common cause of cancer death in the United States.

Gastric cancer is more common than esophageal cancer in Western countries but is less fatal. More than 21,130 new cases of gastric cancer will be diagnosed in the United States in the year 2009, with 10,620 deaths expected. Worldwide, gastric cancer represents approximately 930,000 new cases and accounts for more than 700,000 deaths. The incidence and mortality of gastric cancer have been declining in most developed countries, including the United States; the age-adjusted risk (world estimate) fell 5% from 1985 to 1990.

Pancreatic cancer is the fifth leading cause of cancer death in the United States. In the year 2009, an estimated 42,470 new cases are expected to be diagnosed, and 35,240 deaths are expected to occur.

Bone sarcomas are extremely rare neoplasms, which precludes determination of their true incidence. In 2009, approximately 2,570 new cases of cancer of the bones and joints will be diagnosed in the United States, and some 1,470 patients will succumb to the disease. Population-based tumor registries seldom separate bone sarcomas into various histologic types.

Internationally renowned breast cancer scientist, V. Craig Jordan, OBE, PhD, DSc posed an important question: Where do we go from here in endocrine therapy. In an interview with ONCOLOGY, Dr. Jordan highlighted some of the fundamental clinical issues that he explored during his presentation, “Challenges to Improve Adjuvant Endocrine Therapy.”

Lung cancer has been the leading cause of cancer death among men in the United States for years, and since 1988, it has become the number-one cause of cancer death among women. An estimated 219,440 new cases of lung cancer are expected in 2009, and 159,390 deaths due to this disease are expected to occur, roughly 30% of all cancer deaths. This exceeds the combined number of deaths from the leading causes of cancer (breast, prostate, and colon cancers). It accounts for 6% of all deaths in the United States.

In the year 2009, an estimated 70,980 new cases of bladder cancer will be diagnosed in the United States, and approximately 14,330 patients will die of this disease.Urothelial cancers encompass carcinomas of the bladder, ureters, and renal pelvis; these cancers occur at a ratio of 50:3:1, respectively. Cancer of the urothelium is a multifocal process. Patients with cancer of the upper urinary tract have a 30% to 50% chance of developing cancer of the bladder at some time in their lives. On the other hand, patients with bladder cancer have a 2% to 3% chance of developing cancer of the upper urinary tract. The incidence of renal pelvis tumors is decreasing.

As discussed in chapter 3, there are two major subdivisions of lung cancer: small-cell lung cancer (SCLC), for which chemotherapy is the primary treatment, and non–small-cell lung cancer (NSCLC). SCLC is decreasing in frequency in the United States, with recent data showing it represents only 14% of lung cancers. This chapter provides information on the staging and prognosis, pathology and pathophysiology, treatment, and follow-up of long-term survivors of SCLC and concludes with brief discussions on mesothelioma and thymoma.

In 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

Endocrine malignancies, although relatively uncommon, are often difficult to diagnose and treat effectively. According to American Cancer Society (ACS) estimates, more than 39,000 new cases of endocrine neoplasms will be diagnosed in the United States in 2009, and approximately 2,470 deaths will result from these cancers. This chapter will focus on thyroid and parathyroid cancers. (A discussion of carcinoid tumors, insulinomas, gastrinomas, and other gastrointestinal neuroendocrine tumors, as well as adrenocortical cancer, can be found in chapter 11.)

In our exclusive on-site coverage of this event, ONCOLOGY has engaged nationally recognized breast cancer specialist Harold J. Burstein, MD, PhD, Associate Professor of Medicine, Harvard Medical School to provide insight on the meeting’s most clinically relevant sessions.

On Feb. 28 President Obama was screened for colorectal cancer using CT colonography. The results from this exam, also called virtual colonoscopy, along with those from the rest of the president’s annual physical, which was done at the National Naval Medical Center in Bethesda, described the president as “fit for duty.”

It’s a kind of man bites dog story: unusual, remarkable, yet oddly plausible. The Centers for Medicare and Medicaid Services has told its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March.

The journal ONCOLOGY presents exclusive on-site coverage of the 27th Annual Miami Breast Cancer Conference. Nationally recognized breast cancer specialist Harold J. Burstein, MD, PhD, Associate Professor of Medicine, Harvard Medical School provides expert insight into the optimal multidisciplinary management of patients with breast cancer and the application of innovative approaches to practice-coverage includes special emphasis on sessions dealing with the rapidly changing advances in the treatment of metastatic disease.

The RIBBON-2 trial met its primary endpoint of prolonged progression-free survival.

The FDA granted accelerated approval for the use of lapatinib (Tykerb) with letrozole (Femara) as a first-line, oral treatment for women with metastatic disease.

Higher doses of the estrogen-receptor antagonist fulvestrant (Faslodex) may increase treatment benefit without increasing toxicity, according to results from the international, randomized, double-blind phase III CONFIRM trial.

Also, French surgical oncologists discuss their experience with treament of heterogenous Merkel cell carcinoma.

Fulvestrant-anastrozole combination did not demonstrate advantage despite a better dose loading schedule and compelling preclinical data.

The U.S. Radiation Therapy Oncology Group has greenlighted the routine use of SBRT, but physicians overseas call for more scientific evidence to support its widespread use.