Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Oct 2011
ReviewEpidemiology of lung cancer: smoking, secondhand smoke, and genetics.
The link between smoking and development of lung cancer has been demonstrated, not only for smokers but also for those exposed to secondhand smoke. Despite the obvious carcinogenic effects of tobacco smoking, not all smokers develop lung cancer, and conversely some nonsmokers can develop lung cancer in the absence of other environmental risk factors. A multitude of genetic factors are beginning to be explored that interact with environmental exposure to alter the risk of developing this deadly disease. By more fully appreciating the complex interrelationship between genetics and other risks the development of lung cancer can be more completely understood.
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Adjuvant therapy is commonly used in melanoma because recurrence after surgery usually results in the patient's eventual death. Surgeons have a profound influence on patients' decisions regarding adjuvant therapy, beginning with providing a clear understanding of the risk of specific types of recurrence. This review summarizes the potential oncologic benefits and relevant toxicities of adjuvant systemic therapies for melanoma that are currently available and under investigation.
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Several large case series and single-institution trials have shown that laparoscopy is feasible for rectal cancer. Pending the results of the UK CLASICC, COLOR II, Japanese JCOG 0404, and ACOSOG Z6051 trials, the oncologic and long-term safety of laparoscopic rectal cancer surgery is unclear and the technique is best used at centers that can effectively collect and analyze outcomes data. Robotic and endoluminal techniques may change our approach to the treatment of rectal cancer in the future. Training, credentialing, and quality control are important considerations as new and innovative surgical treatments for rectal cancer are developed.
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The incidence of esophageal adenocarcinoma (EAC) has increased dramatically in the western world, and there also appears to have been an increase in the incidence of Barrett's esophagus and gastroesophageal reflux disease in recent years. The contemporaneous increase in obesity has focused interest on whether obesity is a risk factor for EAC and its precursors. This article reviews current evidence for the role that overweight/obesity and body fat distribution have in development of the esophagitis metaplasia-dysplasia-adenocarcinoma sequence. Particular attention is paid to the stage at which adiposity may act to influence the risk of EAC, because this determines the importance of weight control and weight loss at each stage in the disease spectrum for the prevention of EAC.
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Surg. Oncol. Clin. N. Am. · Jul 2009
ReviewMedical treatment of Barrett's esophagus: can it prevent cancer?
The challenge of the title of this article is attention getting. How can medical therapy prevent cancer if anti-reflux surgery cannot prevent the neoplastic progression of Barrett's esophagus? Can anything short of esophagectomy prevent cancer? In the face of the increasing incidence of adenocarcinoma of the esophagus into the twenty-first century, the medical therapy of Barrett's esophagus and its potential role in preventing cancer are explored.