Management of the Unknown Primary in Head and Neck Cancer
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in Scott-Brown's Essential Otorhinolaryngology, 2022
Recent changes to the TNM staging system published in the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual included changes to CUP staging. A T0 category is no longer assigned to p16– OPSCC and other non-HR HPV cancers (e.g. larynx, oral cavity, and hypopharynx). This is because, in these tumours, an exact primary site is by definition unable to be established. In contrast, cytology specimens from an enlarged lymph node in which the presence of metastatic carcinoma is confirmed can be tested for HPV and Epstein-Barr virus (EBV) status, which safely allows the primary site to be determined as either oropharynx or nasopharynx, respectively. Therefore, classification systems for p16+ OPSCC and nasopharyngeal cancer maintain T0 categories.
Gastrointestinal Cancer and Complementary Therapies
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
Traditional treatment options for patients vary depending on the type of cancer and staging based on the American Joint Committee for Cancer staging (Greene et al., 2006) through the determination of the size of the primary tumor, regional lymph node involvement, and the presence of metastasis. Treatment options include chemotherapy, radiation, combination chemotherapy, and radiation and surgery. Each treatment modality poses risks for developing nutrition impact symptoms, ultimately affecting nutrition status. Stent placement, laser therapy, and electrocoagulation are also available; however, these therapies tend to be used more for palliation in esophageal cancer (Mawhinney and Glasgow, 2012).
Doctor–patient communication
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
The first cusp applies to most patients from the time of the first visit to the clinic when the surgeon imparts the probable diagnosis and discusses with the patient the plan of action to achieve staging and hopefully removal of the tumor. It is rare to feel totally confident that a tumor is incurable before surgery; one may suspect it, but rarely can one know until the histology is confirmed and the staging completed. An honest appraisal of the possibilities is required, coupled with a plan of action. This should include date of surgery, length of time in hospital, and when final and definitive histological and cytological reports will become available. It is almost always possible to achieve these results within 2 to 4 weeks of the first visit to the clinic. The patients thus know they will have a good idea of where they stand by a specific date. The concept of cancer staging should be explained, and that the stage and type of tumor will influence the necessity for further treatment with radiotherapy or chemotherapy. We usually explain that if we achieve treatment by surgery alone there is a presumption of cure. This, however, can only be confirmed by the passage of time, and the longer all remains well, the higher is the likelihood that cure has been achieved. A high level of positivity and a buoyant approach are usually applicable both before and after surgery for those with complete resection of tumor, although the need for careful follow-up and the possibility of relapse should be discussed. This step-by-step approach can be utilized throughout the care of the patient and helps the patient to understand that the whole of care cannot be determined at the first visit. Constant and regular communication is the hallmark of good care.
Merkel cell carcinoma expresses the immunoregulatory ligand CD200 and induces immunosuppressive macrophages and regulatory T cells
Published in OncoImmunology, 2018
Maria Rita Gaiser, Cleo-Aron Weis, Timo Gaiser, Hong Jiang, Kristina Buder-Bakhaya, Esther Herpel, Arne Warth, Ying Xiao, Lingling Miao, Isaac Brownell
Paraffin-embedded MCC and SCLC samples were obtained from the Departments of Dermatology and the tissue bank of the National Center for Tumor Diseases (NCT, Heidelberg, Germany) in accordance with the regulations of the tissue bank and the approval of the ethics committee of the Heidelberg University. Clinical data sets for the MCC samples included patient age and sex, immunohistological features, tumor stage, disease course, disease specific survival (DSS), and progression-free survival (PFS). Tumor stages were classified according to AJCC 7th edition Cancer Staging Manual. Fresh-frozen MCC tumor samples were collected as bisected biopsy specimens from patients treated at the National Institutes of Health (NIH) Clinical Center (Bethesda, MD, USA) between 2015 and 2016. Diagnoses were verified histopathologically and immunohistochemically on paraffin-embedded samples from all tumors. All procedures were performed according to the principle of the Declaration of Helsinki and approved by the local medical ethics committee (S570/2013, Heidelberg) and (15-C-0012, National Cancer Institute, NIH).
Prognostic significance of soluble major histocompatibility complex class I-related chain A (sMICA) in gastric cancer
Published in British Journal of Biomedical Science, 2018
P Zhao, D Chen, H Cheng
From March 2008 to January 2013, 196 patients (with histologically confirmed gastric carcinomas from surgically resected tissues) attending the Affiliated Hospital of Qingdao University were enrolled. Exclusion criteria were other carcinomas, inflammatory disease and autoimmune disease (wherein sMICA levels are elevated [11]). Histopathology was evaluated by independent pathologists who were blinded to the clinical details of the patients. Tumour node metastasis (TNM) stage was defined according to the 7th edition of American Joint Committee on Cancer staging system. Serum from 46 healthy individuals and 74 patients without gastric cancer (but with minimal gastritis [n = 41], gastric ulcers [n = 7] or normal appearance of the gastric mucosa on gastroscopic examination [n = 26]) was also obtained. Clinicopathologic characteristics were obtained, and survival analyses were conducted for the 146 patients who were followed up for at least 5 years. This study conformed to the ethical guidelines of the Declaration of Helsinki and has been approved by the Institutional Review Board of the Affiliated Hospital of Qingdao University, China. Written informed consent, as required by the institutional review board, was obtained from all subjects.
Influence of various assumptions for the individual TNM components on the TNM stage using Nordic cancer registry data
Published in Acta Oncologica, 2023
Gerda Engholm, Frida E. Lundberg, Simon M. Kønig, Elínborg Ólafsdóttir, Tom B. Johannesen, David Pettersson, Lina S. Mørch, Anna L. V. Johansson, Søren Friis
Cancer staging using tumor size (T), nodal spread (N) and distant metastasis (M), known as the TNM stage classification, is an important tool in the management of cancer patients and one of the most important predictors for cancer survival [1,2]. Moreover, information on TNM-staging is a valuable tool in empirical research, e.g., epidemiological cancer surveillance studies based on cancer registry data [1]. The TNM stage is cancer site-specific and derived from three components: T (main values 1–4), describing the extent of the primary tumor, N (0–3) denoting the absence or presence and extent of regional lymph node metastases, and M (0,1) denoting absence or presence of distant metastases. The TNM stage can be assessed and registered as a clinical classification, cTNM, or a postsurgical histopathological classification, pTNM. Manuals for TNM-staging are updated regularly and provide specifics at the cancer site-specific level on how each component, i.e., T, N, and M, should be assessed and the final TNM stage determined [1].
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