Editors: Richard S. Pieters, MD and James Liebmann, MD
Associate Editor: Maryann Bishop-Jodoin, MEd
Assistant Editors: Jean Boucher, PhD, RN, NP; Andrew Chen, MD; Ediz Cosar, MD; Lisa A. Palmer, MSLS; Patricia Webster, MS, RT(T)
Established by the Department of Radiation Oncology and the Department of Medicine, Division of Hematology Oncology at the University of Massachusetts Medical School
Cancer Concepts Table of Contents:
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- Epidemiology and the Cancer Problem
- The Pathology of Cancer
- Environmental and Infectious Causes of Malignancy
- Familial Cancer Syndromes
- Cancer Prevention and Screening
- Nutrition and Cancer
- Cancer Biology
- Oncologic Imaging
- Staging of Cancer
- Oncologic Emergencies and Urgencies
- Principles of Multidisciplinary Management
- Principles of Surgical Oncology
- Principles of Radiation Oncology
- Principles of Medical Oncology
- Cancer Treatment Drugs
- Pediatric Oncology Principles
- Cancer as a Chronic Disease
- Treatment of Cancer Pain
Image credit: The Cancer Concepts logo is adapted from DNA replication split by Madeline Price Ball published under a CC0 license.
Funding Statement: This project has been funded in whole or in part with federal funds from the National Library of Medicine, National Institutes of Health, under Contract No. HHSN276201100010C with the University of Massachusetts, Worcester.
Beth Herrick, James Liebmann, and Richard S. Pieters
Cancers which were once fatal are increasingly able to be managed as chronic diseases. While most metastatic cancers in adults may not be curable, they often can be controlled for long periods of time with a succession of treatments. In this chapter in Cancer Concepts: A Guidebook for the Non-Oncologist, we will examine those cancers with longer natural histories and those with extended survivals due to therapeutic advances. Finally, several cases will be presented that exemplify this new paradigm of cancer as a chronic disease.
Chi Young Ok, Bruce A. Woda, and Elizabeth Kurian
Patients and physicians depend on pathologists to make the diagnosis of cancer and of the specific type of cancer. Pathologists are expert in pattern recognition and in the natural history of diseases, including cancers. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe the pathology of cancer.
Catherine W. Carr, Maryann Bishop-Jodoin, and Richard S. Pieters
Information is exploding at an exponential rate. Because there is a flood of medical information on the Internet, it can be difficult to wade through the many resources to determine what information is best to use in practice. The intent of this chapter in Cancer Concepts: A Guidebook for the Non-Oncologist is to help the health care provider find reliable online cancer information. To help inform clinical decision making, health science librarians continue to address this rapidly growing body of literature by analyzing resources and identifying the highest quality information available on the Internet.
The concept of Evidence-Based Medicine (EBM) is important to understand, as well as the process needed to find literature supporting EBM. Why EBM? EBM is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
Making evidence-based clinical decisions is not about intuition, but finding reliable, up-to-date literature and using it in combination with clinical expertise and patient choice. Once a source for free online quality literature is located, a health care provider can consider the best current evidence to thoroughly answer clinical questions.
Current treatments of cancer are imperfect and entail risks. For many malignancies, the best “treatment” is to prevent the cancer from ever appearing in the first place. Cancer prevention refers to interventions that reduce the incidence of cancer. Such interventions can include reduction of exposure to known carcinogens (e.g., tobacco), treatment with drugs that lower cancer risk (chemoprevention), vaccination against infectious agents that cause cancer, surgery to remove organs at high risk of developing cancer in individuals with familial cancer syndromes, or the adoption of a “healthy lifestyle” that modifies cancer risk. Cancer screening shares some concepts with cancer prevention. A screening test like colonoscopy that results in the removal of polyps that have the potential of progressing to cancer can be a form of cancer prevention. Cancer screening is also utilized to find an established cancer at an early, treatable stage. Cancer screening tests are employed in healthy, asymptomatic patients so it is imperative that these tests are safe and effective. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will provide a brief review of cancer prevention and screening.
Richard S. Pieters, Linda Ding, Harry Bushe, and Jesse N. Aronowitz
This chapter in Cancer Concepts: a Guidebook for the Non-Oncologist describes the principles of Radiation Oncology. Radiation Oncology utilizes ionizing radiation to treat cancer (and occasionally a few benign conditions). Radiotherapy or radiation therapy (RT) was initially developed in conjunction with diagnostic radiology, but has evolved into a separate specialty. Currently, more than fifty percent of cancer patients undergo RT at some point during the course of their cancer. Most receive treatment with curative intent (radical therapy); however, patients with incurable disease receive shorter, gentler courses of therapy to relieve cancer-induced symptoms.
Mark Dershwitz and Richard S. Pieters
Pain is one of the first concerns most cancer patients express when newly diagnosed or meeting a new physician. They are concerned about how much pain they presently have, how much pain they are likely to experience, and their physicians’ commitment to treating cancer pain. The reality is that many cancer patients will never experience pain during their course and for those that do, the great majority can be well-managed with the tools described in this chapter in Cancer Concepts: A Guidebook for the Non-Oncologist. It is incumbent on every physician to understand the mechanisms of cancer pain and the fundamentals of treating it.
Giles F. Whalen
Surgery is a branch of medicine that developed primarily around the management of wounds, infections, and bladder stones. Along the way, it also became the primary treatment modality for malignant solid tumors. For many cancers, surgical resection remains the foundation of curative treatment. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist aims to introduce the history of cancer surgery, to answer the question of “What is a surgical oncologist?”, and to discuss the different categories of cancer surgery.
James Liebmann and Richard S. Pieters
Medical oncologists are internists specializing in the care of the adult cancer patient. They frequently function as a primary care physician for patients with cancer. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will review the practice of medical oncology and some general principles followed in the use of chemotherapy. Concepts including goals of chemotherapy treatment, evaluation of the effects of chemotherapy, integration of chemotherapy with other cancer treatments, and use of combinations of chemotherapy drugs will be covered.
Bruce A. Woda, James Liebmann, and Elizabeth Kurian
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist focuses on DNA mutations that cause cancer, abnormal regulation of cell growth and death, and metastasis.
Updated March 2016 version posted March 28, 2017.
Richard J. Horner
Over eighty different compounds have been approved to treat cancer. Their mechanisms of action, effectiveness against specific cancers, and potential toxicity vary greatly. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe, in terms of mechanism of action, the most important classes of cytotoxic and targeted therapies as well as their most characteristic side effects and clinical uses. A table summarizing the classes of drugs and representative members of those classes is included at the end of the chapter. Rather than an encyclopedia, this will be a schematic diagram or roadmap to more detailed knowledge that you will acquire during your clinical training and subsequent experience.
John J. Shim and Andrew Chen
Imaging is an integral part of the multidisciplinary management of cancer. Radiographic techniques are indispensable for proper staging of cancers and evaluation of the response of tumors to treatment. A wide variety of imaging modalities is available to clinicians. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will introduce the role of radiology in the diagnosis and treatment of cancer.
Beverly N. Hay
While the majority of cancers are not inherited, there are a number of well described collections of cancers that occur within families. These cancer syndromes were initially identified based on observation of the family history and subsequently the molecular mechanisms have been elucidated. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist is intended to allow the reader to recognize when a pattern of cancers occurs in an individual or their family, and to generate an investigation into potential cancer syndromes. With the rapidly expanding understanding of the molecular basis of cancers at the cellular and constitutional levels, appropriate preventive care may be offered and tailored treatment holds great promise.
Richard S. Pieters and James Liebmann
This chapter in Cancer Concepts: a Guidebook for the Non-Oncologist describes the principles of multi-disciplinary management, meaning multi-specialty physician management of malignancies. Tumor Boards are the model for multi-disciplinary management. They may be site specific or include the entire spectrum of malignancy. At Tumor Boards, staging workup and treatment recommendations are made collectively, and then the treatments are delivered by the respective modality specialists and their individual teams. Improved clinical decision making leading to superior survival for patients with some diseases and better quality of life has been documented with multi-disciplinary management. Just like curative patients, palliative patients require multi-disciplinary management.
Jeffrey A. Gordon, Elizabeth Kurian, Arash Bedayat, Ali Akalin, Karl Uy, and Richard S. Pieters
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of lung cancer and mesothelioma, including epidemiology, etiology, screening, pathology, staging, and treatment.
Mary Linton Peters, Richard S. Pieters, and James Liebmann
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents a summary of the most relevant causative agents of cancer. Exposure to many environmental agents is associated with an increased incidence of certain malignancies, although causation is usually difficult to prove. Certain chemicals, infections (parasitic, viral, and bacterial) and ionizing radiation are known carcinogens. Variable genetic susceptibility to carcinogenesis is apparent. Up to 2/3 of human cancers are believed to have an environmental component.
Epidemiology is the study of populations using defined research methods to confirm the patterns and causes of disease and applying this information to improve the health of the populations. This branch of science is the basis for understanding the spread of diseases in a defined area or group of people. Epidemiologic studies have been instrumental in improving outcomes by establishing preventive and therapeutic measures for the incidence, prevalence and mortality from cancers. The incidence of malignancy in a country or in our world defines the magnitude of the cancer problem. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will introduce the role of epidemiology in the diagnosis and treatment of cancer.
Paul R. Sturrock, James Liebmann, Adib R. Karam, Richard S. Pieters, and Elizabeth Kurian
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of colorectal cancer, including etiology, screening, pathology, staging, and treatment.
Christopher P. Keuker
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of childhood cancer, including the incidence, distribution, diagnosis, treatment, and survivorship.
Maria Giulia Cicchetti, James Liebmann, Andrew Chen, Carolynn DeBenedectis, and Elizabeth Kurian
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of breast cancer, including etiology, screening, pathology, staging, and treatment.
Amanpreet Buttar, Laura A. Lambert, James Liebmann, and Richard S. Pieters
Cancers of unknown primary (CUP) are a heterogeneous group of histologically proven metastatic tumors whose primary site can't be determined after a standard diagnostic and pathologic work-up. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents provides an overview of cancers of unknown primary, including initial evaluation and principles of treatment.
Anne Garrison, Andrew H. Fischer, Adib R. Karam, Antonella Leary, and Richard S. Pieters
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents provides an overview of cervical cancer. The etiology, pathology, staging, and principles of treatment will be reviewed.
Richard S. Pieters, Joyce Rosenfeld, Andrew Chen, and James Liebmann
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents a discussion of the risks to cancer patients for oncologic and metabolic crises. These effects may be caused by the cancer, the treatment provided to cure or palliate the cancer, and/or other medical conditions. They may occur at initial presentation, as a first sign of disease or during the disease course. Oncologists divide these crises into emergencies and urgencies, depending on the severity of the consequences of delay in treatment. Every health care provider should be aware of the signs and symptoms of oncologic urgencies and emergencies and initial management.
Richard S. Pieters, Maryanne Bombaugh, Yuxin Liu, Gina Cunto-Amesty, Adib R. Karam, Elizabeth Kurian, and Sarah Huges
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist is about cancers of the endometrium and uterus, including the epidemiology, risk factors, diagnosis, genetic risk, histology, grading and type categorization, management, and prognosis.
Angela Beeler, Katherine Saunders, Alexis Penney, James Liebmann, and Richard S. Pieters
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents a summary of the nutritional concerns in oncology patients. Nutritional intake is frequently deficient in patients undergoing cancer treatment and should be assessed and treated. There are unique nutritional needs of the patient based on their site of cancer and effects of their particular treatment. There is little evidence that dietary manipulation or supplementation can produce a significant decrease in cancer risk.
Richard S. Pieters, Maryann Bishop-Jodoin, and James Liebmann
This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an introduction to the Guidebook, which developed from the Cancer Concepts course at the University of Massachusetts Medical School.
Mary Linton Peters, Richard S. Pieters, James Liebmann, and Geoffrey Graeber
The “stage” of a cancer is a short-hand way of describing the extent of cancer in a patient. Stage is based on macroscopic involvement of tissues by cancer. Staging of cancer occurs prior to the beginning of treatment, or at the first definitive surgery. Clinical staging, which includes radiography and exam findings, takes place initially. Pathologic staging, which is obtained from surgical specimens, can be acquired during the course of surgical treatment. Patients then carry either the clinical stage or the pathologic stage for the duration of their illness. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe principles of cancer staging.