cancer diagnosis and treatment

Q&A about Bladder Cancer

2008-10-24T10:12:00.000-07:00

1. How common is bladder cancer?
Approximately 54,300 new cases of bladder cancer were diagnosed in 2001 in the United States, and 12,400 patients died. The male-to-female ratio is almost 3:1.

2. What are the risk factors for bladder cancer?
Cigarette smoking, exposure to aniline dyes or aromatic amines, phenacetin abuse, and chemotherapy (cyclophosphamide).

3. How does bladder cancer present?
Painless hematuria (gross or microscopic). Frequency, urgency, and dysuria also may be presenting symptoms, especially for carcinoma in situ (CIS).

4. What is the most common histologic type of bladder cancer?
Transitional cell carcinoma (TCC) makes up > 90% of bladder cancers. Other histologic types include adenocarcinoma, squamous cell carcinoma, and urachal carcinoma.

5. How is TCC of the bladder treated?
With transurethral resection of the bladder tumor. Further treatment is determined by the pathologic stage of the disease.

6. Is CIS a less aggressive type of bladder cancer?
No. TCC in situ is a flat but poorly differentiated tumor. It can metastasize and should be treated as an aggressive form of bladder cancer.

7. How is CIS treated?
Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is currently the first-line treatment. Response rates to BCG approach 70%. Other intravesical agents, such as mitomycin C, are generally less effective than BCG.

8. What are the side effects of BCG?
Mild symptoms of urinary frequency, urgency, and dysuria are common. Myalgias and low-grade fever (flulike symptoms) also occur. High or persistent fever suggests a more serious problem requiring antituberculous therapy. Rarely, death from BCG has been reported.

9. How is muscle-invasive bladder cancer treated?
Radical cystectomy (or cystoprostatectomy in men) with some form of urinary diversion.

10. What types of urinary diversion are used with radical cystectomy?
Diversion techniques require either a conduit or a continent reservoir. The most common is an ileal conduit. An external collection device must be worn with a conduit. Continent reservoirs are made of combinations of large and small bowel and must be emptied via the urethra or a continent stoma

11. How is metastatic bladder cancer treated?
Metastatic bladder cancer requires chemotherapy. Most regimens include a platinum-based agent.

12. Can invasive bladder cancer be cured without removal of the entire bladder?
This issue is controversial. Some cancers may be suitable for partial cystectomy (i.e., tumors isolated in the dome of the bladder). Investigations are ongoing to evaluate transurethral resection of bladder tumor plus radiation and chemotherapy to try to preserve the bladder in invasive TCC.

Prostate Cancer - Questions and Answers

2008-07-13T10:12:00.000-07:00

Prostate cancer is the most common malignancy diagnosed in men in the United States.
The best screening method is a combination of digital rectal exam and serum prostate-specific antigen.
Clinically localized prostate cancer is treated with surgery, radiation, cryotherapy, or watchful waiting.

1. How common is prostate cancer?
It is the most common malignancy diagnosed in men in the United States; almost 200,000 new cases were diagnosed in 2001.

2. Do most men die with prostate cancer, rather than from it?
Yes, but approximately 31,500 men died of prostate cancer in 2001 in the United States. Thus, it should not be treated as benign.

3. What are the early symptoms of prostate cancer?
There are none. By the time significant symptoms develop, the disease is likely to be advanced. This is an argument for screening to detect prostate cancer.

4. What is the best screening method for prostate cancer?
Digital rectal examination (DRE) combined with serum prostate-specific antigen (PSA). Since PSA testing was introduced, there has been a stage migration with less metastatic disease and more local-regional disease being detected.

5. How is prostate cancer diagnosed?
It is diagnosed with prostate biopsy, which is a biopsy using transrectal ultrasound for guidance. Many cancers are discovered incidentally at transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).

6. When is prostate biopsy indicated?
When either the PSA or DRE result is abnormal.

7. Does an elevated PSA level mean a man has prostate cancer?
No. PSA can be elevated with BPH, prostatitis, or after prostate trauma. It is prostate specific, not prostate cancer specific.

8. What is a free PSA?
Free PSA is the percentage of PSA that is not bound to a serum protein carrier. The ratio of free to total PSA is helpful in determining when to do a prostate biopsy. "Free" is good because a higher ratio of free to total PSA is less likely to represent a prostate cancer.

9. Are there any known risk factors for prostate cancer?
Yes. African-American men and men with a family history of prostate cancer are at an increased risk. A high-fat diet may play a role in increasing risk of many cancers, including prostate cancer.

10. What is Gleason's sum?
It's a score that the pathologist gives prostate cancer to estimate its aggressiveness. The two predominant patterns of cancer are scored 1 to 5, and the sum is, therefore, between 2 and 10. Tumors can be well differentiated (2, 3, 4), moderately differentiated (5, 6, 7), or poorly differentiated (8, 9, 10).

11. How is clinically localized prostate cancer treated?
Surgery (radical prostatectomy), radiation therapy by external beam or interstitial seed implant, cryotherapy, or watchful waiting.

12. How is advanced metastatic prostate cancer treated?
Hormonal ablation therapy (orchiectomy or luteinizing hormone-releasing hormone agonist drugs) or chemotherapy, but these treatments are palliative and not curative.

13. What is the best treatment for prostate cancer?
This is highly controversial. Patients must weigh factors such as age, overall health, grade and stage of the disease, and risk of side effects versus complications from the various treatment options.

WHAT IS CANCER?

2006-07-30T06:29:00.000-07:00

1. What is a neoplasm?

A neoplasm is a new growth of tissue (tumor) in which cells grow progressively under conditions that do not prompt the growth of normal cells. A malignant neoplasm (cancer) is composed of cells that invade other tissues and spread.

2. What kinds of cancers are there?

Malignant tumors of epithelial (surface tissue) cells are carcinomas. Malignant tumors of mesenchymal (connective tissue) cells are sarcomas. Carcinomas and sarcomas are solid tumors. Hematologic malignancies, such as leukemia, are liquid tumors of mesenchymal origin.

3. What about skin cancers?

Most basal cell and squamous skin cancers are life-threatening only if neglected. They occur in tremendous numbers and are seldom fatal with proper treatment. Although the general principles of cancer management apply to skin cancers, they usually are not considered in the same class with other solid tumors.

4. Why is cancer bad for you?

There is no simple answer. The replacement of normal tissue by tumor eventually causes organ dysfunction. If a tumor outgrows its blood supply and becomes necrotic, local inflammation ensues. Often obstruction (with compromise of the lumen) of the gastrointestinal tract, bile ducts, or airway develops as the tumor grows. Occasionally the cancer bleeds (but life-threatening bleeding is rare). Nerve invasion or inflammation typically cause pain, which may be excruciating. Cancers also may elaborate humoral factors (e.g., gastrin) that cause symptoms.

5. Are all cancers life-threatening?

Cancer is a fatal disease. It is uncommon for a patient with an untreated cancer to die of something else. Currently more than 50% of patients with cancer in the United States are cured.

6. How do cancers start?

No one knows, but cells begin to grow under circumstances when they should not. They stop responding to antigrowth signals, promote their own blood supplies, are seemingly able to replicate endlessly, and do not undergo programmed cell death (apoptosis).

7. Is this process the same for all cancers?

No, the order in which these changes take place seems to vary among types of cancer and even between individual tumors with the same histologic type. Occasionally, a single mutation alone causes cancer, but many genetic alterations are usually involved.

8. Do all cancers spread?

About 25% of patients with solid tumors have detectable metastases at the time of diagnosis. Fewer than 50% of the remainder develop metastases during the course of treatment. At diagnosis, a cancer is usually at least 1 cm in diameter (and often much larger), containing millions of cells. It is surprising that metastases have not occurred in all patients at the time of diagnosis.

WHAT IS CANCER? Part II

2006-07-28T06:35:00.000-07:00

9. How does cancer spread?

Most cancer cells that enter the bloodstream or lymphatics do not cause metastases. Only rare malignant cells actually survive to cause distant tumor implants by recruiting new blood vessels. Many cells do not seem to come to rest in tissues conducive to their growth. Perhaps others are extirpated by the immune system.

10. Does this process have an effect on how surgeons treat patients with cancer?

Operations to treat benign conditions are designed to remove as little tissue as possible while creating a new and desirable physiologic or anatomic state. Cancer operations, on the other hand, are designed to remove as much tissue as possible while leaving the patient with acceptable function. Cancer operations typically remove the primary tumor as well as the lymph nodes draining the primary site. Surgical resection is the single most effective treatment for solid tumors.

11. Why are lymph nodes removed during cancer operations?

More than 100 years ago, William S. Halsted (if you don't know the answer to any historical question posed on rounds, you should always guess "Halsted") appreciated that tumor recurrence on the chest wall after mastectomy was related to tumor in remaining lymph nodes. Halsted believed that cancer of the breast spread in an orderly fashion (or perhaps even contiguously) from the primary tumor to regional lymph nodes and eventually to distant sites. He popularized en bloc dissection of the breast with axillary lymph nodes for treatment of breast cancer. Conceptually, this approach was adopted for surgical treatment of most solid tumors.

12. What is a sentinel lymph node?

Sentinel lymph nodes are the first stop for tumor cells metastasizing through lymphatics from the primary tumor. Often there is more than one sentinel node, even for a small tumor. If no tumor is present in a sentinel lymph node, it is unlikely that tumor is present in any of the other nodes. Sentinel lymph node mapping has been used for cancers of many organs (including the skin, breast, colon, thyroid, and head and neck neoplasms). Careful evaluation of sentinel lymph nodes has proven reliable in the staging of melanoma. It will probably prove equally successful in managing breast cancer and head and neck tumors, sparing many patients far more morbid lymphadenectomies (lymph node dissections).

13. Do solid tumors spread in an orderly way?

Not necessarily. Another view of breast cancer behavior became popular by the 1970s. Bernard Fisher postulated that cancer is widespread at its inception. He stated that "breast cancer is a systemic disease … and that variations in effective local regional treatment are unlikely to effect survival substantially."

14. How do these different models of cancer affect treatment?

Surgeons who believe that tumors spread in an orderly way tend to perform complete lymph node dissections in concert with resection of the primary tumor. They generally believe that lymphadenectomy will cure some patients who have lymph node involvement without distant metastases and that local recurrence is a preventable cause of death. Surgeons who believe that lymph node metastases are simply markers for systemic disease are usually far less aggressive in performing lymph node dissections because (in their view) removal of lymph nodes that contain tumor will not cure patients who probably already have metastatic disease.

WHAT IS CANCER? Part III

2006-07-26T10:20:00.000-07:00

17. What is adjuvant therapy?

Adjuvant means "assisting or aiding," but we use this term to mean assisting after surgical or radiotherapeutic control of the primary tumor. Adjuvant chemotherapy is of documented benefit in the treatment of breast cancer, colorectal cancer, stomach cancer, pancreatic cancer, and ovarian and testicular tumors. Adjuvant radiation therapy is effective in reducing the risk of tumor recurrence around the surgical site. It is often used in treating patients with rectal, breast, head and neck, and stomach cancers as well as sarcomas. Conceptually, both surgery and radiation are local/regional therapies. Although chemotherapy is obviously a systemic treatment, it may help sensitize tumors to radiation. The term "neoadjuvant" doesn't really mean anything, but it is often used to describe preoperative chemotherapy or radiotherapy (which might more accurately be described as "induction" treatment).

18. What cancer treatments are available in addition to surgery, radiation therapy, and cytotoxic chemotherapy?

Hormonal manipulation has been used for decades to slow the growth of some tumors. Stimulation of the patient's immune system to combat cancer is potentially promising. This approach may involve vaccines, training of T cells, or enhancement of the immune response. New types of anticancer agents include drugs that interfere with tumor angiogenesis, antibodies and other drugs that interfere with growth factor receptors, other sorts of drugs that alter intracellular signaling, and drugs that restore cell cycle control. The limitation of all of these approaches resides in our inability to specify a target unique to cancer cells. Hence, treatments damage the rest of the patient, with potentially fatal toxicity.

19. Does the body fight cancer on its own?

Certainly. Some scientists believe that early cancers are regularly extirpated by the immune system (as we "catch" cancer every day) and that clinical cancers reflect a breakdown in immune surveillance. Immunocompromised patients with transplants or AIDS develop cancers with frightening frequency. Thus, rejection and sepsis are no longer the most common causes of death among kidney transplant patients-it's cancer. "Spontaneous remissions" of melanoma and renal cell carcinoma do occur and must be immunologically mediated. Indeed, these are the tumors that initially seemed to respond well to "adoptive immunotherapy" and interleukin-2.

20. What is a tumor-infiltrating lymphocyte (TIL)?

TILs are lymphoid cells that infiltrate solid tumors and appear reactive to autologous tumor antigens. Compared with circulating lymphocytes, TILs more aggressively target cancer.

21. What are palliative treatments?

Palliative means "affording relief but not curing."

22. Give some examples of palliative procedures.

Resection of the primary tumor in the face of distant metastases may be performed to treat bleeding or obstruction. Procedures to bypass intestinal or biliary obstruction in patients with unresectable cancer are common. Tracheotomies are created for patients who are unable to breathe because of upper airway obstruction, and feeding tubes may permit enteral nutrition in patients who cannot eat. Removal of isolated brain metastases often improves the patient's quality of life. Many patients with functioning endocrine tumors benefit from reduction in tumor mass.

23. What is cytoreductive surgery?

Cytoreductive ("debulking") procedures are designed to decrease tumor burden. Simply reducing tumor bulk is seldom sufficient to prolong survival. For cytoreductive surgery to be beneficial, the nonsurgical (adjunctive) therapy must be highly effective-such as radiation for glioblastoma or chemotherapy for ovarian cancer.

What is melanoma?

2006-06-30T10:26:00.000-07:00

1. What is melanoma?

The term melanoma implies a malignant tumor; malignant melanoma is redundant. The most malignant of all skin cancers, melanoma usually forms from a preexisting nevus or mole but may develop de novo.

2. What is the incidence of melanoma?

It is the sixth most common cancer in the United States and the fastest rising cancer in men. The lifetime risk in the year 2000 was 1 in 75 versus 1 in 150 in 1985. Over 51,000 new cases of melanoma are reported each year.

3. What are the types of moles? Which are most prone to malignant change?

Intradermal: the most benign form
Junctional: the junctional component may be the site of melanoma formation
Compound: intradermal and junctional together; intermediate activity
Spitz: once called juvenile melanoma, it is actually a spindle cell epithelioid nevus that is quite benign
Dysplastic: the most likely to turn malignant (especially in dysplastic nevus syndrome)

4. What are the risk factors in melanoma formation?

Large number of moles (> 50 moles > 2 mm in diameter)
Changing nevi
Family history of melanoma
Light, poorly tanning skin; blonde or reddish-brown hair
History of episodic, acute, severe sunburns
Dysplastic nevus syndrome, or familial atypical multiple mole melanoma syndrome (FAMMM)
History of melanoma

5. Which skin lesions often mimic a primary melanoma?

Spitz nevus (spindle cell epithelioid nevus)
Atypical benign nevus
Halo nevus
Recurrent benign nevus after inadequate excision
Metastatic melanoma to skin
Mycosis fungoides
Extramammary Paget's disease
Bowen's disease
Dark sebaceous keratoses
Kaposi's sarcoma
Pigmented basal cell carcinoma

6. What is the familial melanoma syndrome?

The inherited FAMMM syndrome has been defined as the occurrence of melanoma in one or more first- or second-degree relatives and the presence of > 50 moles of variable size, some of which are atypical histologically. The risk of melanoma in this syndrome runs as high as 100% in the person's lifetime.

7. Is a specific gene involved in melanoma development in the FAMMM syndrome?

Genetic studies have revealed a specific gene (i.e., p16 mapped to chromosome 9) in many people with the FAMMM syndrome.

What is melanoma? part II

2006-06-28T06:23:00.000-07:00

8. Are any groups at low risk for melanoma formation?

Children younger than 10 years, African Americans, Asians, Native Americans, and dark-complected whites are at low risk.

9. What are common sites of melanoma development?

The most common sites are the posterior trunk in men and lower extremities in women. All sun-exposed areas are possible sites. Uncommon sites for melanoma formation are the soles of the feet, palms, and genitalia. Unusual noncutaneous sites for melanoma formation are the eye, anus, and gastrointestinal tract.

10. Where is melanoma most common?

Melanoma is most common in Australia, especially the northern part of the continent, where light-skinned descendants of the original settlers are exposed to tropical sun.

11. What are the warning signs of melanoma?

Skin lesions that display:

A = Asymmetry

B = Irregular border

C = -Color: variable; spotted; often very black with irregular tan areas; red or pink spots; ulcerated when advanced (bleeds easily)

D = Diameter (> 5-6 mm)

E = Enlargement or Elevation

12. What are the types of melanoma and their incidence?

Superficial spreading: 75% of all cases; most common

Nodular: 15% of cases; most malignant; well circumscribed; deeply invasive

Lentigo maligna melanoma: 5% of cases; relatively good prognosis

Acral lentiginous: 5% of cases; most common type in people of color; appears on the soles, palms, subungual sites

13. Which moles should be considered for removal?

Growing and darkening nevi should be excised, especially in sun-sensitive patients. Itching is a sign of early malignant change. Ulceration is a late sign. Because melanoma may be familial in origin, children of patients with melanoma should be carefully screened for very dark nevi.

14. How should suspicious nevi be biopsied?

Total excision of the lesion with a narrow (1-mm) margin of normal skin plus primary repair should be done. Partial incisional biopsy is acceptable if the lesion is large or if total excision would require reconstructive surgery. Punch biopsy, incisional biopsy, or saucerization are all appropriate as long as a full-thickness specimen is obtained. Thorough pathologic study is essential.

15. Do melanomas spontaneously regress or even disappear?

Rarely melanomas can regress or even disappear. Remarkably, such patients have a poor prognosis despite the fact that the primary lesion has regressed or even sloughed off because metastatic disease to the lymph nodes and viscera may have already occurred.

Breslow and Clark classifications of melanoma invasion

2006-06-26T21:13:00.000-07:00

16. What are the Breslow and Clark classifications of melanoma invasion?
Clark selected five levels of melanoma
thickness in the skin:

Level I-intradermal melanoma that does not
metastasize; may be better termed atypical melanotic hyperplasia: a benign lesion
Level II-melanoma that penetrates the basement membrane into the papillary dermis
Level III-melanoma that fills the papillary dermis and encroaches on the reticular dermis in a pushing fashion
Level IV-melanoma that invades the reticular dermis
Level V-melanoma that works its way into the
subcutaneous fat

The Breslow method requires an optical micrometer fitted to the ocular position of a standard microscope. This technique is a more exact determination of tumor invasion. Lesions are classified as follows:

≤ 0.75 mm
0.76-1.5 mm
1.51-3.99 mm
≥ 4.0 mm

Lesions < 1 mm include melanoma in situ and thin invasive tumors.
The cure rate in the latter is over 95% with excision. Tumors of 1.0-4.0 mm are called intermediate but involve risk of metastasis.
Lesions > 4.0 mm are high-risk lesions with a poor cure rate. All melanomas should be checked by both methods because some tumors may show a low Breslow measurement with a deeper Clark level, indicating a great risk of recurrence and spread. Measurement of thickness is important, and the tumor should be measured from the total height of the lesion vertically at the point of maximal thickness. In addition, if ulceration is present, the measurement should be from the bottom of the ulcer crater down to the deepest margin of the lesion.

staging system for melamoma

2006-06-24T21:19:00.000-07:00

17. What is the TNM staging system for melamoma?

The TNM (primary tumor, regional nodes, metastasis) staging system is the most comprehensive classification of melanoma. Using established risk factors for advanced disease, it stratifies patients based on the thickness of the melanoma, ulceration, micrometastases or nodal metastastes, and distant metastatic disease. Recently revised, it more accurately predicts prognosis and the need for further treatment.

18. What are the chances of nodal and systemic spread of the various degrees of melanoma invasion?

Regional node metastases occur in about 2% of melanomas < 0.76 mm in depth; the distant spread approaches 0%. In tumors 0.76-1.5 mm thick, nodes are cancerous in 25% and distant spread is 8%. In tumors 1.5-4.0 mm thick, node metastasis occurs in 57% and distant spread in 15%. In tumors > 4 mm, node metastasis occurs in ≤ 62% and distant spread is about 72%.

19. What are the characteristics of a subungual melanoma?

Subungual lesions are often mistaken for a chronic inflammatory process; therefore, most patients present quite late. They are usually older than patients with other forms of cutaneous melanoma. The great toe is the most common site of origin. Amputation at or proximal to the metatarsal phalangeal joint and regional sentinel lymph node biopsy are advised by most authors. The primary lesions are usually deeply invasive, and the lymph nodes are positive for cancer in the majority of cases, either at the time of the original diagnosis or at subsequent follow-up.

20. Describe the technique of sentinal lymph node (SLN) biopsy.

The SLN biopsy is based on the theory that lymph from a solid neoplasm initially drains to a central, culprit sentinel node (SN). These SNs are the first nodes at risk for metastatic disease. The nodes can be biopsied and examined with serial sectioning and immunohistochemical staining. The SLN identification technique requires the cooperation of a surgeon, radiologist, and pathologist. Lymphoscintigraphy with the injection of radioactive technetium sulfur colloid (99mTeSC) is performed around the site of the primary melanoma. Scans are then performed in 15 minutes. The SLN is located and the overlying skin is marked. Four hours later, the patient is taken to the operating room for intradermal injection of blue contrast dye (lymphazurin 1%) around the primary site. A hand-held gamma probe identifies the hot spot, and a small incision is made over this area for removal of the SLN. A combination of blue contrast dye and radiocolloid provides the highest yield of SN identification

What are the characteristics of a subungual melanoma?

2006-06-20T09:51:00.000-07:00

Subungual lesions are often mistaken for a chronic inflammatory process; therefore, most patients present quite late. They are usually older than patients with other forms of cutaneous melanoma. The great toe is the most common site of origin. Amputation at or proximal to the metatarsal phalangeal joint and regional sentinel lymph node biopsy are advised by most authors. The primary lesions are usually deeply invasive, and the lymph nodes are positive for cancer in the majority of cases, either at the time of the original diagnosis or at subsequent follow-up.

Does elective lymph node dissection (ELND) improve cure rates in patients with melanoma?

2006-06-19T09:58:00.000-07:00

The Mayo Clinic trial and World Health Organization melanoma group trial have not shown a benefit for ELND for stage I and II melanoma involving the extremities and trunk. The Intergroup Melanoma Trial demonstrated that for patients younger than 60 years with tumors 1.1-2.0 mm thick, there was a significant improvement in 5-year survival (96% versus 84%). However, beginning with the work of Morton et al., who used lymphoscintigraphy to identify routes of lymph drainage and SLN identification, SLN biopsy has come to the fore. In this approach, the first-echelon node is removed. If it is negative for metastasis, further node dissection is not performed. (If the SLN is positive for metastasis, surgical lymph node dissection is completed at a separate time.)

axillary lymph node treatment for breast cancer of therapeutic value

2006-06-18T22:55:00.000-07:00

Those who believe that axillary lymph node dissection confers only information about tumor behavior rather than a therapeutic benefit usually cite the National Surgical Adjuvant Breast and Bowel Program (NSABP) B-04 trial. There was no statistically significant difference in survival curves between patients whose axilla was treated initially and patients who received delayed treatment to the axilla. In addition to other problems, however, the study lacked the power to prove the point. To have a 90% chance of detecting a 7% survival difference between the treatment groups, the National Surgical Adjuvant Breast and Bowel Program (NSABP) should have enrolled 2000 patients (not just 550) in each arm. Hence, a substantial survival advantage caused by axillary dissection might not have been recognized. The study was not designed to prove that the two approaches were equivalent, and it has been "overinterpreted." It takes a much larger trial to prove equivalence than to show a difference. Indeed, subsequent randomized trials in the management of breast cancer, as well as evaluation of patterns of care, demonstrate an independent survival advantage conferred by treatment of the axilla. This experience with breast cancer reinforces the importance of actually understanding clinical trials.

Diagnostic Investigation Of Lymphadenopathy

2006-06-15T01:18:00.000-07:00

What historical information helps to direct the diagnostic investigation of lymphadenopathy?

It is unusual for a patient older than 40 years to have nonspecific lymphadenopathy; over 70% of enlarged cervical lymph nodes in this age group are malignant. Patients younger than 40 years are more likely to have a nonspecific or infectious cause, although the mean age of Hodgkin's lymphoma diagnosis is 32 years.
The duration of adenopathy helps with the diagnosis. A newly enlarged lymph node is more suggestive of infection, although an enlarging lymph node can undergo internal hemorrhage with a rapid increase in size. Travel and occupation history, exposure to pets, geographic area of residence, and sexual history provide clues to infectious agents. A history of smoking is associated with lung, upper gastrointestinal, and head and neck malignancy.
Systemic symptoms, including fever, weight loss, night sweats, and pruritus, are present in 30% of patients with Hodgkin's and 10% of patients with non-Hodgkin's lymphoma.

Types of Benign Parotid Tumors And Malignant Tumors And List Their Frequency.

2006-05-15T12:08:00.000-07:00

List the types of benign parotid tumors and their frequency.

Mixed tumor (pleomorphic adenoma) is most common(80%) and, although benign, has some local malignant potential.
Warthin's tumor: 14%
Benign lymphoepithelial lesion: 1%
Oxyphil adenoma, oncocytoma, and other rare lesions:< 1% each

Describe the types of malignant tumors and list their frequency. In the parotid region, the presence of pain, rapid enlargement of a nodule, skin involvement, or facial nerve paralysis is highly suggestive of a malignancy.

Mucoepidermoid carcinoma: 44% (the low-grade variety of this tumor is "almost benign")
Malignant mixed tumor: 17%
Acinic cell carcinoma: 17%
Adenocarcinoma: 10%
Adenoid cystic carcinoma: 9%
Epidermoid carcinoma: 7%

Differential Diagnosis Of Lymphadenopathy

2006-05-13T01:37:00.000-07:00

What is the differential diagnosis of lymphadenopathy?

The significance of cervical, axillary, or inguinal lymphadenopathy depends on the characteristics of the lymph nodes and associated symptoms. Infection, autoimmune disease,Endocrine,Lipid storage disease and Malignant are all included in the differential diagnosis.
Lymphadenopathy can be a manifestation of a drug reaction with Dilantin being a classic example of pseudo-lymphoma. Metastatic tumors tend to have characteristic lymph nodes that are rock hard and fixed. Lymph nodes involved with lymphoma or Hodgkin’s Disease are rubbery, non-tender and non-fixed. Lymph nodes that are involved with infectious disorders tend to be inflamed; hence, they tend to be tender to palpation. Any lymph node which enlarges with observation or does not respond to empiric antibiotics from a presumed infectious source should be biopsied.

Clinical Differences Hodgkin's and non-Hodgkin's lymphoma

2006-05-12T21:41:00.000-07:00

Hodgkin's lymphoma usually presents with either a neck or a mediastinal mass. It arises first in the lymph nodes and rarely involves extranodal sites initially. It tends to spread contiguously to adjacent nodal stations rather than "skipping" to distant sites. Most patients present with early stage I or II disease. Epitrochlear, popliteal, or mesenteric nodal involvement is unusual. There is a bimodal age distribution with an early peak in the 20s and a later peak in the 60s.
Non-Hodgkin's lymphomas originate from lymphocytes and also are called lymphocytic lymphomas. The incidence of these tumors has increased over the past 20 years. Some of this increase has occurred because of an association with AIDS, but this is not the whole story.
In contrast to Hodgkin's lymphoma, non-Hodgkin's lymphomas are often extranodal and spread noncontiguously. They rarely present as localized disease; bone marrow and liver involvement is common. Non-Hodgkin's lymphoma involves epitrochlear, popliteal, and mesenteric lymph nodes as well as Waldeyer's ring. It accounts for almost all gastrointestinal lymphomas. Most patients present with advanced-stage disease

Hodgkin's Lymphoma Treated

2006-05-11T21:49:00.000-07:00

Stage I and IIA disease may be treated with radiation alone if the tumor is not bulky and the prognostic factors are favorable. More advanced disease requires adjuvant chemotherapy. Combinations include three or more of the following: mechlorethamine, vincristine, procarbazine, prednisone (MOPP), doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

What is the risk of a second cancer in patients successfully treated for Hodgkin's lymphoma?
It is higher. The more common of these second cancers are lung, breast, sarcoma, leukemia, and non-Hodgkin's lymphoma. Patients who received radiation therapy to the cervical area require annual thyroid function testing to detect radiation-induced hypothyroidism. Young women who received thoracic radiation require screening for breast cancer. Annual mammography should be started 10 years after treatment but no later than age 40 years.