Integrated Cancer Management: Surgery, Medical Oncology, and Radiation Oncology PDF

Preface

Cancer is a devastating disease process with the potential to exert clinical effects at the local, regional, and systemic levels. Extensive physical, metabolic, nutritional, immunological, and psychological alterations occur in cancer patients that may adversely affect clinical outcome and functional recovery. Critical endpoints such as tumor remission rates, disease-free and overall survival, toxicity of antineoplastic therapy, surgical morbidity and mortality, and quality of life are influenced by these physiological and functional abnormalities. To achieve optimal outcome results, the cancer patient requires an integrated, multidisciplinary approach to treat local, regional, and distant disease. This fundamental concept in cancer therapy is explored throughout this book, Integrated Cancer Management: Surgery, Medical Oncology, and Radiation Oncology.

This book is a unique, state-of-the-art reference that emphasizes the clinical approach to the cancer patient—it is neither a treatise on cancer research nor a compendium of published literature. Effective integration of multidisciplinary management of cancer is the unifying theme throughout this text, and most chapters are coauthored by a surgeon, medical oncologist, and radiation oncologist with recognized clinical expertise in cancer therapy. Clear, concise, and pertinent summaries of oncological therapy are presented, with an emphasis on critical decision points in the management of cancer patients. Tumor biology is discussed in terms of clinical relevance as it impacts on the formation of a multidisciplinary treatment plan. Surgical treatment options are fully described along with insightful comparisons and critical distinctions among surgical alternatives based on tumor stage and biology. Systemic treatment with chemotherapy, hormone therapy, and other agents is reviewed, with analysis of clinical prognostic factors, treatment indications, toxicity, and tumor response. Radiation therapy techniques, treatment planning, dose and duration of therapy, morbidity, and results are also critically reviewed.

My concept of the disease-management approach to cancer is the basis for the organization of this text. Treatment of breast, esophageal, gastric, small intestine, appendiceal, colorectal, and anal carcinomas is thoroughly reviewed. The clinical management of pancreatic and periampullary cancers, hepatic and biliary tumors, and endocrine tumors, which include carcinoids and pancreatic, adrenal, thyroid, and parathyroid tumors, is clearly summarized. Lymphomas, soft-tissue sarcomas, melanomas, lung and pleural tumors, mediastinal tumors, oncological emergencies, tumor vaccines, nutrition, and molecular biology are critically reviewed. The chapters of this book are organized according to clinical classification based on tumor biology, anatomy, pathophysiology, and prognostic factors relevant to making therapeutic decisions. For example, proximal gastric tumors are categorized with esophageal tumors but separate from mid and distal gastric tumors. This particular clinical classification is based on common treatment strategies designed for proximal gastric and esophageal tumors, in accordance with similarities in regional anatomy, local/regional recurrence, and metastatic potential; different diagnostic and treatment strategies exist for the management of patients with mid and distal gastric tumors. Similar clinical and biological considerations are used to classify pancreatic adenocarcinomas, with obstructing periampullary tumors, liver tumors with proximal biliary tumors, and pancreatic endocrine tumors in a separate category. Clinical relevance is the key determinant in the organization of this text and provides a rational framework for understanding cancer therapy based on clinical tumor biology.

Effective management of the cancer patient is complex and requires the coordinated and integrated efforts of the surgeon, medical oncologist, radiation oncologist, and many other physicians and health care providers. The aim of this text is to provide practicing clinicians with comprehensive management strategies for offering the highest quality of care to cancer patients. Great progress has been made in the treatment of cancer over the past 50 years. Current cancer therapy is summarized in this text by expert clinicians who will lead us into the next millennium when exciting discoveries in molecular biology and innovative technology are anticipated to treat, cure, and eventually prevent cancer.