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Diagnosis and Management of Cancer
Ashok Mehta, SC Bansal
ONE:
The Nature of Cancer and Principles of Diagnosis
THE NATURE OF CANCER
IS CANCER AUTONOMOUS?
Understanding on the Development of Cancer
PATHOLOGICAL ASPECTS OF CANCER
GROWTH AND SPREAD OF CANCER
BIOLOGICAL ASPECTS OF CANCER
CLINICAL PRESENTATION
DIAGNOSTICS AND CANCER
Laboratory Medicine
Imaging
Nuclear Medicine
ROLE OF SURGICAL PATHOLOGIST
CURRENT CONCEPTS IN THE MANAGEMENT OF CANCER
SURGICAL TREATMENT AND ITS EVOLUTION
RADIATION THERAPY
Supportive Care of Patients Receiving Radiation Therapy
Emotional Assistance
Nutritional Support
Skin
Mucous Membranes
Tissue Support
CHEMOTHERAPY
Toxicity of Chemotherapy
Hypersensitivity
Drug Extravasation
Cardiac Toxicity
Cystitis
Neurotoxicity and Gonadal Dysfunctions
Miscellaneous Effects
HORMONAL THERAPY
BIOLOGICAL THERAPY
NORMAL TISSUE PROTECTION
THE PROBLEM OF CANCER CONTROL
TWO:
Cancer of the Breast
EPIDEMIOLOGICAL AND ETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Carcinoma in situ
Ductal Carcinoma in situ (DCIS)
Lobular Carcinoma in situ
Invasive Carcinomas
Infiltrating Duct Carcinoma (not otherwise specified—NOS)
Medullary Carcinoma
Colloid or Mucinous Carcinoma
Infiltrating Papillary Carcinoma
Lobular Carcinoma
NATURAL HISTORY AND PATTERNS OF SPREAD
Local Spread
Regional Spread
Axillary Lymph Nodes
Internal Mammary Lymph Nodes
Supraclavicular Lymph Nodes
Systemic Spread
BIOLOGICAL CONSIDERATIONS
DIAGNOSIS
Clinical
Imaging
Mammography
Ultrasonography
Chest Radiography
Hepatic Imaging
Bone Scan
Evaluation of Breast in vivo
Laboratory Investigations
Biopsy of Palpable Breast Mass
Fine-Needle Aspiration Cytology
Technique of FNAC
Core or Needle Biopsy
Frozen Section Examination (One Step Procedure)
Excisional Biopsy (Two Step Procedure)
Incisional Biopsy
MAMMOGRAPHICALLY DETECTED ABNORMALITIES
STAGING
CHANGING PRINCIPLES AND CONCEPTS IN BREAST CANCER
PROGNOSTIC FACTORS
Patient Related Factors
Age
Pregnancy
Tumour Related Factors
Stage
Steroid Receptors
Genetics
SURGERY IN LOCOREGIONAL CONTROL OF PRIMARY BREAST CANCER
ADJUVANT THERAPY
Summary of Current Treatment Recommendations for Operable Breast Cancer
Adjuvant Polychemotherapy
Adjuvant Hormonal Therapy
Adjuvant Postmastectomy Radiotherapy
TREATMENT OF LOCALLY ADVANCED BREAST CANCER (STAGE III)
METASTATIC BREAST CANCER (STAGE IV)
Hormone Therapy—The Changing Role
Immunotherapy
TREATMENT OF COMPLICATIONS
SPECIAL CONSIDERATIONS
THREE:
Cancer of the Cervix
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
NATURAL HISTORY AND PATTERNS OF SPREAD
DIAGNOSIS
CLINICAL STAGING
TREATMENT
Surgery
Wertheim's Operation
Role of Pelvic Lymphadenectomy
Para-aortic Lymph Nodes
Role of Pelvic Exenteration
Radiation Therapy
Intraoperative Radiation Therapy (IORT)
Postoperative Radiation Therapy
Complications of Radiation Therapy
Chemoradiation Therapy
Post-treatment Surveillance
Chemotherapy
RECURRENT CERVICAL CANCER
CARCINOMA OF THE CERVICAL STUMP
CERVICAL CANCER IN PREGNANCY
MANAGEMENT OF LATE EFFECT OF CANCER OF THE CERVIX
TREATMENT OF UNCOMMON TYPES OF CERVICAL MALIGNANCY
PROGNOSIS
FOUR:
Cancer of the Corpus Uteri
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
BIOLOGICAL CHARACTERISTICS
SPREAD OF TUMOUR
DIAGNOSIS
STAGING
Surgical Staging
RISK FACTORS—PROGNOSIS AND INFLUENCE ON TREATMENT
TREATMENT
SURGERY
Radiation Therapy
Preoperative Radiation Therapy
Postoperative Radiation Therapy
Radiation Therapy as the Sole Therapy for Endometrial Carcinoma57,60
Hormonal Therapy
Endometrial Hyperplasia
Oestrogen Replacement Therapy (ERT)
Chemotherapy
RESULTS
SARCOMAS OF CORPUS UTERI
FIVE:
Cancer of the Ovary
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
CLASSIFICATION
GENETIC ASPECTS OF OVARIAN CANCER
SPREAD OF OVARIAN TUMOURS
DIAGNOSIS
STAGING
PROGNOSTIC FACTORS
TREATMENT
Primary Surgical Therapy
Incision
Adhesions
Peritoneal Washing and Ascites
Exploration of the Abdominal Cavity
Omentectomy
Lymphadenectomy
Surgical Restaging
Minimal Surgery for Ovarian Carcinoma
Cytoreductive Surgery
Interval Cytoreduction
RADIATION THERAPY
CHEMOTHERAPY
TREATMENT STRATEGY
SECOND-LOOK LAPAROTOMY
SALVAGE DRUG THERAPY
PALLIATIVE SURGERY
MANAGEMENT OF SEROUS EFFUSION
METASTATIC CARCINOMA OF THE OVARY FROM OTHER PRIMARY SITES
SCREENING FOR OVARIAN CANCER: IS EARLY DETECTION POSSIBLE?
GERM CELL TUMOURS
Treatment
Surgery
Chemotherapy in Dysgerminoma
Chemotherapy in Tumours other than Dysgerminoma
SIX:
Cancer of the Vulva and Vagina
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Malignant Lesions of the Vulva
Malignant Lesions of the Vagina
SPREAD AND NATURAL HISTORY
STAGING
DIAGNOSIS
TREATMENT—CANCER OF VULVA
Notes on Surgical Procedures in Carcinoma of Vulva
Total Vulvectomy
Radical Vulvectomy
Inguinal-Femoral Node Dissection
Preservation of Saphenous Vein Decreases Postoperative Morbidity
Lymphatic Mapping and Sentinel Node Identification
Radiation Therapy
Miscellaneous Issues
Verrucous Carcinomas of Vulva
Melanoma of the Vulva
TREATMENT—CANCER OF VAGINA
PROGNOSIS
SEVEN:
Tumours of the Trophoblast
EPIDEMIOLOGICAL CONSIDERATIONS
BIOLOGICAL CONSIDERATIONS
CLASSIFICATION
DIAGNOSTIC CONSIDERATIONS IN TROPHOBLASTIC DISEASE
STAGING
TREATMENT
SURGERY
CHEMOTHERAPY
Recommendations for HM and Invasive Mole
Chemotherapy for Choriocarcinoma
Low Risk Patients with Choriocarcinoma
High Risk Patients with Choriocarcinoma
Central Nervous System
Followup Examination
PROGNOSIS
EIGHT:
Malignant Tumours of Soft Tissues
EPIDEMIOLOGY AND AETIOLOGICAL CONSIDERATIONS
CLASSIFICATION
Pathologic Description of Certain Specific STS
Fibromatosis
Dermatofibrosarcoma Protuberans
Fibrosarcoma
Malignant Fibro-histiocytoma (MFH)
Liposarcoma
Rhabdomyosarcoma
Leiomyosarcoma
Neural Sarcomas
Vascular Sarcomas
Miscellaneous Sarcomas
Kaposi's Sarcoma
Morphologic Description of Soft Tissue Sarcomas
Spindle Cell
Pleomorphic
Round Cell
STAGING AND GRADING OF SOFT TISSUE SARCOMA
NATURAL HISTORY AND SPREAD
DIAGNOSIS
Clinical
Imaging
Radiological Examination
Computed Tomography
Magnetic Resonance Imaging (MRI)
Miscellaneous Studies
Biopsy
Fine-Needle Aspiration Cytology
Needle Biopsy
Wedge Biopsy
Excisional Biopsy
TREATMENT
Surgery
Intracapsular Excision
Marginal Excision
Wide Excision
Radical Excision
Technical Tips for Surgical Excision of Sarcomas
Wide Excision
Radical Local Resection
Amputation
Radiation Therapy (RT)
External Beam Radiation Therapy
Brachytherapy
Chemotherapy
Locally Recurrent Soft Tissue Sarcomas
Resection of Pulmonary Metastases
TREATMENT OF INDIVIDUAL SOFT TISSUE TUMOURS
RETROPERITONEAL TUMOURS
PROGNOSIS AND FUTURE PERSPECTIVES
NINE:
Malignant Bone Tumours
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
CLASSIFICATION
SPREAD OF BONE SARCOMAS
DIAGNOSTIC CONSIDERATIONS
Clinical
Imaging
Plain Radiography
Computed Axial Tomography
Magnetic Resonance Imaging
Scintigraphy
Laboratory Investigations
Biopsy
Closed Biopsy (Aspiration Biopsy)
Open Biopsy
STAGING SYSTEMS
TREATMENT
Principles of Treatment
Self-Limiting Lesions (IA Surgical Grouping)
Locally Aggressive Benign Lesions (IB Surgical Grouping)
Low-Grade Malignant Tumours (IIA Surgical Grouping)
High-Grade Malignant Tumours (IIB Surgical Grouping)
Surgical Management
Curettage (Intra-lesional excision)
Marginal Resection
Wide Excision
Radical Excision
Amputation
Minimally Invasive Surgical Procedures
Conservative Resection and Reconstruction in Malignant Tumours of the Extremities
Limb Salvage Procedures in the Upper Extremity
A Limb Salvage Procedures in the Lower Extremity
Internal Hemipelvectomy
Palliative Procedures
Radiation Therapy
Chemotherapy
OVERVIEW OF COMMON MALIGNANT TUMOURS OF THE BONES AND THEIR TREATMENT
Osteosarcoma
Chondrosarcoma
Ewing's Sarcoma
Fibrosarcoma and Desmoplastic Fibroma
Multiple Myeloma
Giant Cell Tumour (Osteoclastoma)
Lymphoma (Large Cell Lymphoma)
Malignant Hemangioendothelioma (Synonyms-Epithelioid hemangioendothelial sarcoma)
Post-radiation Sarcoma of Bone
Paget's Disease
Metastatic Carcinoma
PROGNOSIS
Rehabilitation
Follow-up Evaluation
TEN:
Hodgkin's Disease and Non-Hodgkin's Lymphomas
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
HODGKIN'S DISEASE
PATHOLOGICAL CONSIDERATIONS
DIAGNOSIS OF HODGKIN'S DISEASE
SPREAD AND STAGING OF HODGKIN'S LYMPHOMA
DIAGNOSTIC WORK-UP FOR STAGING HODGKIN'S DISEASE
TREATMENT OF HODGKIN'S DISEASE
Radiation Therapy47–49
Chemotherapy Schedules
High Risk Disease
MISCELLANEOUS ISSUES
PROGNOSTIC OBSERVATIONS AND FOLLOW-UP IN HODGKIN'S DISEASE
NON-HODGKIN'S MALIGNANT LYMPHOMA
CLINICAL PRESENTATION OF NHL
DIAGNOSIS OF NON-HODGKIN'S LYMPHOMAS
STAGING OF NHL
PROGNOSTIC FACTORS
TREATMENT OF NON-HODGKIN'S LYMPHOMAS
Radiation Therapy
Chemotherapy
Low-Grade Histology
Intermediate Grade Histology
High-Grade Histology
CNS Prophylaxis
IMMUNOTHERAPY IN NHL
FOLLOW-UP OF PATIENTS CURED OF MALIGNANT LYMPHOMAS
RELAPSED AND RESISTANT LYMPHOMAS
SPECIFIC ISSUES AND SITES—MANAGEMENT
Discordant Histology Lymphomas
Primary Mediastinal Diffuse Large B-cell Lymphoma
Cutaneous T-cell Lymphoma (CTCL)
NHL and Elderly Patient
HTLV-1 Related Lymphomas
Post-transplant and AIDS-associated Lymphomas
Primary Parenchymal CNS Lymphoma
Eye Lymphoma
CONDITIONS THAT MIMIC MALIGNANT LYMPHOMAS
ELEVEN:
Cancer of the Skin
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
GENETICS
CLASSIFICATION
KERATOACANTHOMA (KA)
ACTINIC KERATOSIS (AK)
BOWEN'S DISEASE AND ITS VARIANT (ERYTHROPLASIA OF QUEYRAT)
LEUKOPLAKIA
PAGET'S DISEASE
SQUAMOUS CELL CARCINOMA (SCC)
BASAL CELL CARCINOMA (BCC)
STAGING OF NON-MELANOMA SKIN LESIONS
PROPHYLACTIC MEASURES IN NON-MELANOMA SKIN LESIONS
TREATMENT MODALITIES FOR NON-MELANOMA SKIN LESIONS
FOLLOW-UP
MALIGNANT MELANOMA (MM)
Diagnosis
Treatment for Melanoma
Sentinel Lymph Node Mapping in Malignant Melanoma
Prophylactic Measures
Surgery
Mohs' Micrographic Surgery
Lymph Node Dissection
Interferon Alpha
Management of Metastatic Melanoma
Radiation Therapy
Immunotherapy
CUTANEOUS LYMPHOMAS
KAPOSI'S SARCOMA (KS)
TWELVE:
Tumours of Salivary Glands
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
Parotid Gland
Facial Nerve (VII N)
Greater Auricular Nerve
Auriculotemporal Nerve
Submandibular Salivary Gland
Sublingual Gland
Minor Salivary Glands
PATHOLOGICAL CONSIDERATIONS
Histogenesis and Genetics
Pathological and Clinical Features of Common Salivary Gland Tumours
Mixed Tumour (Pleomorphic Adenoma)
Warthin's Tumour (Papillary Cystadenoma Lymphomatosum)
Myoepithelioma
Oncocytoma
Mucoepidermoid Carcinoma
Adenocarcinoma Not Otherwise Specified (NOS)
Adenoid Cystic Carcinoma
Cystadenocarcinoma
Polymorphous Low-grade Adenocarcinoma
Myoepithelial Carcinoma
Epidermoid Carcinoma
Metastatic Tumours
PATTERN OF SPREAD
STAGING
PROGNOSTIC FACTORS
DIAGNOSIS
Clinical
Imaging Studies
X-rays
Sonography
CT Scan or MRI
Positron Emission Tomography (PET) Scan
Radionuclide Scanning
Tissue Diagnosis
Fine-Needle Aspiration Cytology (FNAC)
Trucut Needle Biopsy and Open Biopsy
Frozen Section
Biological Markers
TREATMENT
SURGERY IN SALIVARY GLAND TUMOURS
Benign Tumours
Parotid
Submandibular Salivary Gland
Minor Salivary Gland
Malignant Tumours
Parotid
Submandibular
Minor Salivary Glands
Management of Lymph Node Metastasis
OPERATIVE TECHNIQUE
Complications of Parotid Surgery
Facial Nerve Paralysis
Salivary Fistula
Local Recurrences
Cosmetic Deformity
Frey's Syndrome (Gustatory Sweating)
Management of Facial Nerve in Parotid Cancer
Direct Primary Repair of Injured Facial Nerve
Free Grafts of Facial Nerve
Secondary Repair
Dynamic Muscle Slings and Free Muscle Transfers
RADIATION THERAPY
CHEMOTHERAPY
SPECIAL CONSIDERATIONS
PROGNOSIS
THIRTEEN:
Tumours of the Thyroid and Parathyroid Glands
TUMOURS OF THE THYROID GLANDS
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
SURGICAL ANATOMY THYROID GLAND
PATHOLOGICAL CONSIDERATIONS
DIAGNOSIS
Clinical
Imaging
Routine Radiological Examination
Ultrasonography
Thyroid Scanning
Tumour Markers
Thyroglobulin (TG)
Thyrocalcitonin (TC)
Biopsy
Fine-Needle Aspiration Cytology (FNAC)
Frozen Section
STAGING
PROGNOSTIC FACTORS
TREATMENT
Surgery
Papillary Thyroid Carcinomas
Follicular Thyroid Carcinomas (FTC)
Anaplastic Thyroid Carcinoma (ATC)
Medullary Thyroid Carcinoma (MTC)
Solitary Thyroid Nodule
Radiation Therapy
Radioactive Iodine (I131)
Chemotherapy
Hormonal Therapy
SURGICAL PROCEDURES FOR THYROID CARCINOMA
SPECIAL CONSIDERATIONS
THYROID CARCINOMA IN CHILDREN
TUMOURS OF THE PARATHYROID GLANDS
FOURTEEN:
Cancer of the Oral Cavity and Oropharynx
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PREMALIGNANT CONDITIONS
PATHOLOGICAL CONSIDERATIONS
DIAGNOSIS
Clinical
Imaging
Biopsy
Cytology
Fine Needle Aspiration Cytology
STAGING
TREATMENT
Surgery in Oral Cancer
Marginal Mandibulectomy
Mandibular Swing
Segmental Mandibulectomy
Resection of the Ascending Ramus of Mandible
Resection of Anterior Arch of Mandible
Composite Resection
Surgery in Oropharyngeal Cancer
Total Glossectomy
Management of Neck in Oral Cancers
Management of Neck in Oropharyngeal Cancers
Primary Reconstruction
Forehead Flap (McGregor)
Deltopectoral Flap (Bakamjian)
Pectoralis Major Myocutaneous Flap (Ariyan)
Free Flaps
Reconstruction of the Mandible
Radiation Therapy (RT)
Treatment Options of Surgery (S), RT and Combination of S and RT
Dental Care
Chemotherapy
Neoadjuvant or Anterior Chemotherapy
Salvage Chemotherapy
REHABILITATION
PROGNOSIS
FIFTEEN:
Cancer of the Nasal Cavity and Paranasal Sinuses
AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Benign Lesions
Papillomas
Osteomas22
Others
Malignant Lesions
Squamous Cell Carcinoma
Adenocarcinoma
Adenoid Cystic Carcinoma (ACC)
Mucoepidermoid Carcinoma
Haemangiopericytoma30
Melanoma7,17
Olfactory Neuroblastoma or Esthesioneuroblastoma
Lymphoma33,34
Extramedullary Plasmacytoma17,35,36
Others
Metastatic Tumours
DIAGNOSIS
Clinical
Imaging
Radiological
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Biopsy
STAGING CLASSIFICATION
TREATMENT
Surgery
Partial Maxillectomy
Total Maxillectomy
Surgical Technique
Management of Orbital Contents60
Resection of Nasoethmoidal-sphenoidal Complex (NES)
Nasal Septum
Nasal Cavity
Endoscopic Sinonasal Surgery
Management of Lymph Node Metastases
Complications of Surgery
Radiation Therapy (RT)
Chemotherapy
PROGNOSIS
SIXTEEN:
Cancer of the Nasopharynx
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
CLASSIFICATION
DIAGNOSIS
Clinical
Imaging
Conventional Radiology
Computed Tomography (CT) and MRI
Biopsy
STAGING
TREATMENT
Radiation Therapy
Chemotherapy
Surgery
PROGNOSIS
SEVENTEEN:
Cancer of the Larynx
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Spread of Laryngeal Cancer
DIAGNOSIS
Clinical
Symptoms
Clinical Examination
Imaging
Biopsy
STAGING
TREATMENT
Principles
GLOTTIC CANCER
SUPRAGLOTTIC CANCER
SUBGLOTTIC CANCER
OPERATIVE PROCEDURES
Rehabilitation Following Laryngectomy
RADIATION THERAPY IN LARYNGEAL CANCER
Laryngeal Preservation with Chemoradiation Therapy56
PROGNOSIS
EIGHTEEN:
Cancer of the Oesophagus
EPIDEMIOLOGY AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CLASSIFICATION
NATURAL HISTORY AND SPREAD
DIAGNOSIS
Clinical
Imaging
Barium Examination
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Endoscopic Ultrasonography (EUS)
Endoscopy and Oesophageal Brush Biopsy
Laparoscopy and Thoracoendoscopy
Screening Endoscopy for High Risk Individuals
STAGING
TREATMENT
Localized Disease
Locally Advanced or Metastatic Disease
SURGERY AND SURGICAL TECHNIQUES
RADIATION THERAPY
CHEMOTHERAPY
PALLIATION FOR CANCER OF THE OESOPHAGUS
Palliative Radiation Therapy
Surgery for Palliation
Intraluminal Intubation
Dilatation
Laser Therapy and Electrofulguration
Photodynamic Therapy (PDT)
ADENOCARCINOMA OF THE OESOPHAGUS
Adenocarcinoma in Barrett's Oesophagus (BE)
Adenocarcinoma of the Lower Oesophagus and Cardia
PROGNOSIS
NINTEEN:
Cancer of the Stomach
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Precancerous Lesions
Gastritis
Gastric Polyps
Early Gastric Cancer (EGC)
NATURAL HISTORY AND SPREAD
GENETIC CONSIDERATIONS IN CARCINOGENESIS AND PROGNOSIS
DIAGNOSIS
STAGING
TREATMENT
Treatment of Early Gastric Cancer (EGC)
Endoscopic Mucosal Resection
Follow-up
Treatment of Gastric Cancer
Proximal Gastric Lesions
Mid Stomach Lesions
Distal Third Lesions
Extended Lymphadenectomy in Gastric Cancer—What it Means
Palliative Resection
Chemotherapy
Timing of Chemotherapy
Adjuvant Chemotherapy in Stomach Cancer
Chemoimmunotherapy
Neoadjuvant Chemotherapy
Chemotherapy for Residual and Advanced Disease
Radiation Therapy
PROGNOSTIC FACTORS
GASTRIC LYMPHOMA
GASTRIC SARCOMAS
GASTRIC CARCINOID
TWENTY:
Cancer of the Small Intestine
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
DIAGNOSIS
EPITHELIAL TUMOURS
CARCINOID TUMOURS
PRIMARY LYMPHOMAS
PROGNOSIS
TWENTY ONE:
Cancer of the Colon and Rectum
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
MOLECULAR CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
NATURAL HISTORY AND SPREAD OF CANCER
DIAGNOSIS
Imaging
Radiological Examinations
Contrast Radiography
Ultrasound
Computed Tomography
Laboratory Investigations
Liver Function Studies
Carcinoembryonic Antigen (CEA)
Biopsy
STAGING
TREATMENT
SURGERY
RADIATION THERAPY
CHEMOTHERAPY
Recurrent Colorectal Cancer
PROGNOSIS
TWENTY TWO:
Tumours of the Anal Canal
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
NATURAL HISTORY AND SPREAD
STAGING
DIAGNOSIS
TREATMENT
SURGERY
RADIATION THERAPY
CHEMORADIATION
PERIANAL CANCER
MELANOMA
PROGNOSIS
TWENTY THREE:
Cancer of the Liver
HEPATOCELLULAR CARCINOMA
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
STAGING
DIAGNOSIS
Clinical
Paraneoplastic Syndromes and HCC
Imaging
Laboratory Investigations
Alpha-fetoprotein (AFP)
Laparoscopy
Biopsy
TREATMENT
Surgical Therapy
Radiofrequency Ablation (RFA)
Microwave Coagulation
Hepatic Artery Ligation (HAL)
Transplantation in HCC and Other Malignant Tumours
Radiation Therapy
Chemotherapy
Other Forms of Therapies
Immunotherapy
Hepatic Cryosurgery
PROGNOSIS
PREVENTION
HEPATOBLASTOMA
LIVER RESECTION FOR PRIMARY AND METASTATIC TUMOURS
Liver Resection for HCC
Liver Resection for Bile Duct Cancer
Liver Resection in Metastatic Colorectal Carcinoma
TWENTY FOUR:
Cancer of the Gallbladder and Extrahepatic Bile Duct
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
NATURAL HISTORY AND MODE OF SPREAD
STAGING
DIAGNOSIS
Clinical
Laboratory Investigations
Imaging
Plain X-ray Abdomen
Oral Cholecystogram
Ultrasonography and CT Scan Studies
Cholangiography
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Magnetic Resonance Cholangiopancreatography (MRCP)
Percutaneous Transhepatic Cholangiography (PTC)
Biopsy and Cytology
Angiography
Laparoscopic Surgery
MANAGEMENT OF CANCER OF THE GALLBLADDER
Surgical Management
Stage I (Intramucosal Disease)
Stage II Disease
Stage III and IV Disease
Radiation Therapy
Chemotherapy
MANAGEMENT OF CANCER OF THE HILAR AND INTRAHEPATIC BILE DUCTS
MANAGEMENT OF THE EXTRAHEPATIC BILE DUCT CANCER
Cancer of the Proximal Duct56–58
Cancer of the Mid and Distal Bile Duct
Surgical Therapy
Radiation Therapy
PROGNOSIS
ENDOSCOPIC MANAGEMENT OF MALIGNANT BILE DUCT STRICTURE65—A BRIEF NOTE
TWENTY FIVE:
Cancer of the Pancreas
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
STAGING
DIAGNOSIS
Clinical
Imaging
Ultrasonography (US)
Endoscopic Ultrasound (EUS)28
Intraoperative Ultrasonography (IOUS)30
Computed Tomography (CT)
MRI/Magnetic Resonance Cholangio-pancreatography (MRCP)
Selective Celiac and Superior Mesenteric Angiography
Endoscopic Retrograde Cholangio-pancreaticography (ERCP)
Percutaneous Transhepatic Cholangiogram
Biopsy
Laboratory Investigations
MANAGEMENT OF PANCREATIC CANCER
Surgery
Preoperative Assessment and Preparation
Selection of Patients for Operation
Cancer in the Head of the Pancreas
Cancer of the Body and Tail of the Pancreas
Surgical Techniques
Standard Whipple Operation
Total Pancreaticoduodenectomy
Regional Pancreatectomy
Complications of Pancreatectomy
Early Complications
Late Complications
Long-Term Management of the Total Pancreatectomized Patient
Radiation Therapy
Chemotherapy
Combined Modality
PALLIATION FOR SPECIFIC SYMPTOMS DUE TO PANCREATIC CANCER
FACTORS AFFECTING RESULTS AND PROGNOSIS
UNCOMMON TUMOURS OF THE EXOCRINE PANCREAS
TUMOURS OF THE ENDOCRINE PANCREAS
TWENTY SIX:
Cancer of the Lung and Pleura
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS AND SPREAD OF LUNG CANCER
CLASSIFICATION
DIAGNOSIS
Significance of Some Common Symptoms and Signs
Haemoptysis
Clubbing
Hypertrophic Pulmonary Osteoarthropathy
Hormonal Hypersecretion
Eosinophilia
Neuromyopathies
Pancoast Syndrome
Superior Vena Cava (SVC) Syndrome
Radiological Examination
Routine
Computed Tomography (CT) Scan
Cytological Examination of the Sputum
Endoscopic Examination
Bronchoscopy
Biopsy
Percutaneous Needle Aspiration Biopsy
Scalene Node Biopsy
Mediastinoscopy
Mediastinotomy
Thoracoscopy
Diagnostic Application of Monoclonal Antibody and Electron Microscopy25
STAGING
TREATMENT
Surgery
Preoperative Preparation
Pulmonary Function Tests (Surgical Significance)
Operative Risk
How much lung tissue should be resected?
Limited Resection
Lobectomy
Pneumonectomy
Sleeve Resection
Mediastinal Lymphadenectomy
Radiation Therapy (RT)
Preoperative Radiation Therapy
Postoperative Radiation Therapy
Definitive “curative” Radiation
Palliative RT
Endobronchial Brachytherapy
Chemotherapy
Treatment of Small Cell Carcinoma of the Lung (SCCL)
Alternating Non-cross Resistant Chemotherapy
Intensity of Therapy
Late Intensification
Duration of Treatment
Prophylactic Cranial Irradiation in SCLC
Thoracic Irradiation (TI)
Malignant Pleural Effusion
Laser Treatment
SPECIAL CONSIDERATION
PROGNOSIS
MESOTHELIOMAS
TWENTY SEVEN:
Neoplasms of the Mediastinum
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS—CLINICAL CORRELATION
DIAGNOSIS
Clinical
Imaging
Plain Radiography and Conventional Tomography
Computed Tomography
Magnetic Resonance Imaging (MRI)
Laboratory Investigations
Biopsy
Percutaneous Transthoracic Needle Biopsy
Mediastinoscopy
Chamberlain Procedure
TREATMENT
TWENTY EIGHT:
Malignant Tumours of the Kidney
CLASSIFICATION
AETIOLOGICAL CONSIDERATIONS
DIAGNOSIS
Imaging
Routine Radiology
Intravenous Urography (IVU)
Retrograde Ureteropyelogram
Ultrasonography (USG)
Computed Tomography (CT)
Renal Angiography
IVC Venography
Nuclear Scan
Laboratory Investigations
STAGING
PROGNOSTIC FACTORS
TREATMENT OF RENAL CELL CARCINOMA
Surgery
Others
Special Considerations
Thrombus in Inferior Vena Cava
Large Primary Tumour
Tumour in the Solitary Kidney
Surgery in Metastatic Renal Cancer
Radiation Therapy
Medical Therapy
Chemotherapy
Hormonal Therapy
Biological Therapy
SARCOMAS OF THE KIDNEY
TRANSITIONAL CELL CARCINOMA (Renal Pelvis and Ureter)
TREATMENT OF WILMS' TUMOUR
RESULTS
TWENTY NINE:
Cancer of the Urinary Bladder
AETIOLOGICAL AND EPIDEMIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATION
NATURAL HISTORY
DIAGNOSIS
Clinical
Diagnostic Procedures
Cytology
Urinary Flow Cytometry
Imaging
Intravenous Urography (IVU)
Computed Tomography (CT)
Ultrasonography
STAGING
TREATMENT
Carcinoma in situ
Superficial Bladder Cancer
Adjuvant Intravesical Therapy
Thiotepa
Mitomycin C
Doxorubicin
BCG
Photodynamic Phototherapy
Cystectomy
Management of Invasive Bladder Cancer (Stages B, C and D1)
Radical Cystectomy and Pelvic Lymph Node Dissection (PLND)
External-beam Radiation Therapy (EBRT)
Bladder Salvage
Neoadjuvant Chemotherapy
Combined Modality
Urinary Diversion
Uretero-sigmoidostomy
Ileal Conduits
Continent Urinary Diversions
Other Techniques
Management of Metastatic Disease (Stage D2)
Palliative Radiation Therapy
Control of Haemorrhage
PROGNOSIS
THIRTY:
Cancer of the Prostate
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL AND PHYSIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Prostatic Intraepithelial Neoplasia
GRADING
GENETICS CONSIDERATIONS
NATURAL HISTORY AND PATTERNS OF SPREAD
STAGING
DIAGNOSIS
Clinical
Imaging
Routine Radiological Examination
Ultrasonography (US)
Computed Tomography (CT)
Radionuclide Studies
Laboratory Investigations
Acid Phosphatase
Alkaline Phosphatase
Prostate Specific Antigen
Biopsy
Needle (Core) Biopsy
Fine Needle Aspiration Biopsy
Transurethral Resection (TUR)
Prostatic Fluid
TREATMENT
Expectant Management of Prostate Cancer
Surgery
Radical Prostatectomy
Laparoscopic Radical Prostatectomy
Radiation Therapy
Results of External Beam Radiotherapy as Primary Treatment
Results of Brachytherapy as Primary Treatment
Hormonal Therapy
Rationale
Bilateral Orchiectomy
Bilateral Adrenalectomy
Hypophysectomy
Oestrogens
Luteinising Hormone Releasing Hormone Analogues
Luteinising Hormone Releasing Hormone Antagonists
Antiandrogens
Miscellaneous Drugs
Maximum Androgen Ablation
Chemotherapy
MANAGEMENT OF LOCALISED PROSTATE CANCER
MANAGEMENT OF ADVANCED PROSTATE CANCER
PROGNOSIS
THIRTY ONE:
Cancer of the Testis
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
CLASSIFICATION
NATURAL HISTORY AND SPREAD
DIAGNOSIS
Clinical
Laboratory Investigations
Tumour Markers
Alpha Fetoprotein (AFP)
Human Chorionic Gonadotropin (hCG)
LDH and Enzymes
Imaging
Biopsy and Diagnostic Orchiectomy
STAGING
PROGNOSIS
TREATMENT
Treatment of Primary Testicular Tumour
TREATMENT OF SEMINOMAS
Management of Stage I Seminomas
Prophylactic Radiation Therapy
Surveillance
Management of Stage II Seminomas
Management of Stage III Seminomas
Assessment of Response and Follow-up of Treatment
TREATMENT OF NON-SEMINOMATOUS GERM CELL TUMOURS (NSGCT)
Management of Stage I NSGCT
Radiation Therapy in Stage I NSGCT
Surveillance in Stage I NSGCT
Management of Stage II NSGCT
Management of Stage III NSGCT
SALVAGE CHEMOTHERAPY
CHEMOTHERAPY TOXICITY
Acute Toxicity
Chronic Toxicity (Organ Related)
Fertility in Testicular Cancer Patients
Tumours in Undescended Testis
THIRTY TWO:
Cancer of the Penis
EPIDEMIOLOGICAL AND AETIOLOGICAL CONSIDERATIONS
ANATOMICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Precancerous Lesions
Leucoplakia
Giant Condyloma Acuminatum and Verrucous Carcinoma (Buschke-Lowenstein tumours)
Carcinoma-in situ17
Erythroplasia of Queyrat
Bowen's Disease
Invasive Carcinoma
Squamous Cell Cancer of the Penis
NATURAL HISTORY AND SPREAD
DIAGNOSIS
Clinical
Imaging
Biopsy
Assessment of Lymph Node Metastasis
STAGING
TREATMENT
Local Control
Low Burden Disease (Jackson stage 1; AJCC T1s, Ta, T1)
Locally Advanced Disease (Jackson stage II or AJCC TA bulky lesion, T2–4)
Regional Control (Inguinal node dissection)
Postoperative Lymphoedema
Unilateral or Bilateral Node Dissection
Recurrent Penile Cancer
Radiation Therapy
Chemotherapy
PROGNOSIS
THIRTY THREE:
Primary Retroperitoneal Tumours
CLINICAL PRESENTATION
PREOPERATIVE EVALUATION
SPECIFIC ISSUES
INCIDENTAL RETROPERITONEAL MASS—AT LAPAROSCOPY OR LAPAROTOMY
TREATMENT
Surgery
Radiation Therapy
TUMOURS OF THE ADRENAL GLAND
Pheochromocytoma
Adrenal Cortical Cancer
Neuroblastoma
THIRTY FOUR:
Carcinoma of the Hypopharynx
ANATOMY
EPIDEMIOLOGICAL CONSIDERATIONS
PATHOLOGICAL CONSIDERATIONS
Fixity of Vocal Cord
Assessment of Postradiation Patients
STAGING
DIAGNOSIS
Clinical
Imaging
TREATMENT
Selection of Treatment Modalities
Management of Lymph Nodes
Reconstructive Surgery of the Hypopharynx and Cervical Oesophagus
Microvascular Jejunal Transfer
Laryngeal Preservation with CT/RT
Conservation Surgery (CS)
CO2 Laser Microsurgery (Minimal Invasive Surgery)
PROGNOSIS
INDEX
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