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Small intestinal epithelial cells are remarkably resistant to the development of benign or malignant neoplasms. Why small-bowel adenocarcinomas are so rare compared to colorectal adenocarcinomas is unknown. Thus, the work of Neugut et al is important, as they provide an excellent overview of the current knowledge of this unique tumor, and the problems and limitations encountered in such research.

Thanks to advances in cancer diagnosis and treatment, there are now more than 10 million cancer survivors in the United States. Successful treatment of cancer has resulted in increased demands on survivors and has had diverse effects on the quality of life (QOL) of patients and their families. A model of QOL encompassing dimensions of physical, psychological, social, and spiritual well-being has been applied to illustrate the multidimensional needs of cancer survivors and the necessity of comprehensive care extending over the long term. Data from a recent survey of members of the National Coalition of Cancer Survivorship (NCCS) is presented, along with a summary of issues compiled by the NCCS that merit future attention. [ONCOLOGY 11(4):565-571, 1997]

For the sake of the 7.4 million Americans alive today who have a history of cancer, Ferrell and Hassey Dow's paper is important. Understanding more about the problems and issues faced by these individuals and their families, as well as identifying effective ways to ensure that they experience a high quality of survival, are significant issues for cancer care and research.

Of all the digestive tract tumors, small-bowel cancers are the least common. Why should we study these rare tumors, and what, if anything, can we learn from them? Sometimes the absence of an important event can provide the answer to a difficult problem. For example, consider the famous Sherlock Holmes mystery story, "Silver Blaze," in which the master sleuth solved a challenging case, simply because the watchdog didn't bark when he should have, implying that the murderer was well known to the dog.[1]

Even though the small intestine contains 90% of the gastrointestinal tract mucosa and is located between the stomach and large intestine, two organs with a high cancer incidence, adenocarcinoma of the small intestine is 1/50th as common as adenocarcinoma of the large bowel. In several other respects, small-intestinal adenocarcinoma resembles large bowel adenocarcinoma; eg, it arises from adenomatous polyps, co-occurs in the same individuals, and has a similar pattern of incidence rates by country. Small-intestinal adenocarcinoma is diagnosed prior to surgery in only about 50% of cases and often occurs in conjunction with small bowel obstruction. The mainstay of treatment is surgery; prognosis depends on stage at presentation. Little is known about the use of radiotherapy and chemotherapy in this malignancy, but most physicians utilize therapeutic strategies modeled on the management of large-intestinal adenocarcinoma. Clarification of the reason for the low incidence of small-intestinal adenocarcinoma could lead to new interventions for the prevention of colorectal cancer. [ONCOLOGY 11(4):529-536, 1997]

This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute and professor of medicine and chairman of the Department of Preventive Medicine and Public

Our phase II study results demonstrating high efficacy and low toxicity for a weekly schedule of high-dose, 24-hour infusional 5-fluorouracil(5-FU)/folinic acid (HD5-FU/FA) in intensively pretreated patients with metastatic

FORT LAUDERDALE, Fla--The new NCCN practice guidelines on antiemesis in patients receiving chemotherapy are divided into four categories based on the emetogenic potential of the chemotherapy regimen, ie, high, moderate, low, and unlikely, and further divided into primary treatment, breakthrough treatment, and use in subsequent chemotherapy cycles. The guidelines also cover antiemesis for radiation-induced nausea and vomiting.

WASHINGTON--Cancer ranked high among a package of seven Senate bills introduced by Sen. Olympia Snowe (R-Maine), all of them intended to address women's health issues.

Researchers at Duke University Medical Center and the Durham V. A. Medical Center say the psychological impact of taking even a single puff of a cigarette on a preset "quit day" means a smoker will probably go back to smoking within 6 months.

An expert panel of 10 international cancer researchers and practicing oncologists met in Boston to discuss the past, present, and future uses of antiestrogens in the treatment of breast cancer. The first four articles in this series, based on the symposium presentations, appeared in Oncology News International in Oct 1996 , Nov 1996, Dec 1996 , and Jan 1997 . The symposium was sponsored by Zeneca Pharmaceuticals.

In late January, the Agency for Health Care Policy and Research (AHCPR) released the first evidence report under its new evidence-based practice initiative. The report indicates that screening has been shown to be effective in detecting early-stage

CHICAGO--Although digital whole breast mammography has a number of possible advantages over conventional mammography, including enhanced image contrast and better exposure of dense tissues, it is not yet known whether the technology will be equal to or better than conventional film screen mammography in detecting breast cancer, Stephen A. Feig, MD, said at the Radiological Society of North America (RSNA) annual meeting.

PITTSBURGH--Nearly three years after it began its investigation, the federal Office of Research Integrity (ORI) has cleared Dr. Bernard Fisher of any scientific misconduct, stating that he did not include false data in his NSABP reports.

BETHESDA, Md--After considering the politically charged and complex issue of mammography screening for women between ages 40 and 49, the National Cancer Advisory Board (NCAB) created a special working group to craft a recommendation for the National Cancer Institute on what it might advise doctors to tell these women.

NEW YORK--Fatigue is a significant problem experienced by the vast majority of cancer patients--and also the most under-recognized and under-treated symptom, Barbara F. Piper, DNsc, RN, OCN, told Oncology News International in a telephone interview.

The autosomal, dominantly inherited multiple endocrine neoplasia (MEN) syndromes provide some of the best examples of the practical application of advancing technology, not only in the detection and treatment of neoplastic disease but also in the understanding of the mechanisms involved in the initiation and progression of malignancies.

WASHINGTON--President Clinton has asked Congress to approve $2.217 billion in funding for the National Cancer Institute (NCI) in fiscal year 1998, which begins next Oct. 1.

Ann Kelsall is a medical writer who reported on the NIH Consensus Development Panel meeting for Oncology News International. Here she considers, from the woman's perspective, the panel's arguments against mammography screening for women ages 40 to 49.

FORT LAUDERDALE, Fla--"The best way to reduce health care cost is to improve health care quality," said Lee N. Newcomer, MD, MS, in his keynote address at the Second Annual Conference of the National Cancer Center Network (NCCN). And managed care organizations are attempting to do this via measuring and improving the performance of physicians in its networks, he added.

DOWNERS GROVE, Ill--Vysis, Inc. has received FDA clearance to market its CEP X SpectrumOrange/CEP Y SpectrumGreen DNA Probe Kit, an in vitro diagnostic used as an adjunct to standard cytogenetic analysis to identify and enumerate the presence of X and Y chromosomes in bone marrow specimens from patients who have received sex-mismatched bone marrow transplants.

FORT LAUDERDALE, Fla--Preliminary data on the treatment of breast and colorectal cancer patients at National Comprehensive Cancer Network (NCCN) member institutions show that the members are in compliance with the network's guidelines, Jane Weeks, MD, MSc, of the Dana-Farber Cancer Institute, said at the second annual NCCN conference.

BETHESDA, Md--A new NCI study will evaluate three techniques to manage atypical squamous cells of undetermined significance that show up on Pap smears, including their cost effectiveness and acceptability to women.

Survey Show Americans Favor Higher Tax WASHINGTON, DC--Americans strongly favor raising the federal excise tax on tobacco, and the majority want Congress to do something to provide health care coverage for the uninsured, according to two polls conducted for the American Cancer Society (ACS).

WASHINGTON--Friends of Cancer Research, a coalition of major cancer organizations, was organized last year to mark the 25th anniversary of the National Cancer Act, signed into law on December 23, 1971.

NEW YORK--A nationwide survey of US cancer patients, oncologists, and caregivers documents that fatigue has profound effects on patients, including their ability to work, meet family needs, and cope with the disease.

Public policy initiatives and increased physician awareness are needed to maintain a healthy balance between the promise of genetic engineering and the potential for genetic discrimination, a Stanford/Veterans Affairs (VA) physician maintains. His

Tumor growth is the result of two opposing processes--cell division and cell loss. As long as division outpaces loss, tumors will continue to grow. The form of "active" cell death called apoptosis is now known to be controlled by specific genes, and it is hoped that manipulating the expression of these genes could shift the balance in favor of cell loss.

In a lively session featured at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Richie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

The incidence of ductal carcinoma in situ (DCIS) has increased dramatically since the advent of screening mammography in the 1980s. The age-adjusted DCIS incidence rates increased 17.5% annually from 1983 to 1992.[1] The percentage of patients with DCIS treated with mastectomy has decreased from 71% in 1983 to 44% in 1992. The percentage of patients with DCIS undergoing lumpectomy and radiation in 1992 was 23.3% and lumpectomy only was 30.2%.