Latest Updates

Lobular Breast Cancer

    • Recognition of invasive lobular cancer as a biologically unique entity from invasive ductal cancer
    • Identification of novel mutations more frequently identified in invasive lobular cancers in The Cancer Genome Analysis (TCGA) study
    • Multimodality treatment approaches with an emphasis on tumor biology
    • Consensus guidelines for negative margins at lumpectomy and applicability to lobular cancers
    • Impact and utility of neoadjuvant chemotherapy and neoadjuvant endocrine therapy in lobular cancers

Understanding the Genetics of Pancreatic Adenocarcinoma

    • Whole genome/exome sequencing
    • RNA expression analysis
    • Genome-wide association studies

Small Intestine: Adenocarcinoma

    • Genetic pathways implicated in small bowel adenocarcinoma (APC, TP53, β-catenin, SMAD4, microsatellite instability, K-ras) are similar to colorectal adenocarcinoma but less well understood.
    • Advanced endoscopy or enteroscopy can be used to obtain preoperative diagnosis.
    • Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may offer improved survival for a subset of patients with peritoneal metastasis.

Small Intestine: Adenocarcinoma

    • Genetic pathways implicated in small bowel adenocarcinoma (APC, TP53, β-catenin, SMAD4, microsatellite instability, K-ras) are similar to colorectal adenocarcinoma but less well understood.
    • Advanced endoscopy or enteroscopy can be used to obtain preoperative diagnosis.
    • Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may offer improved survival for a subset of patients with peritoneal metastasis.

Small Intestine: Neuroendocrine and Miscellaneous Tumors

    • Functional PET/CT with gallium-68 dotatate provides improved sensitivity and resolution compared with traditional imaging methods.
    • Hepatic transarterial embolizations can improve carcinoid-related symptoms in patients who are not surgical candidates or have unresectable disease.
    • Somatostatin analogues remain the mainstay of systemic therapy for carcinoid, whereas targeted agents and cytotoxic chemotherapy are areas of active investigation.

Management of Recurrent Retroperitoneal Sarcoma

    • Better understanding of the patterns of failure such that patients at high risk for relapse are identified
    • Improved understanding of the molecular basis of sarcomas impacting our ability to diagnose and predict the biologic behavior and to further inform management algorithms
    • Successful completion of a randomized clinical trial to determine the effects of preoperative radiation therapy on local recurrence in primary resectable retroperitoneal sarcoma 

Small Intestine: Neuroendocrine and Miscellaneous Tumors

    • Functional PET/CT with gallium-68 dotatate provides improved sensitivity and resolution compared with traditional imaging methods.
    • Hepatic transarterial embolizations can improve carcinoid-related symptoms in patients who are not surgical candidates or have unresectable disease.
    • Somatostatin analogues remain the mainstay of systemic therapy for carcinoid, whereas targeted agents and cytotoxic chemotherapy are areas of active investigation.

Management of Recurrent Retroperitoneal Sarcoma

    • Better understanding of the patterns of failure such that patients at high risk for relapse are identified
    • Improved understanding of the molecular basis of sarcomas impacting our ability to diagnose and predict the biologic behavior and to further inform management algorithms
    • Successful completion of a randomized clinical trial to determine the effects of preoperative radiation therapy on local recurrence in primary resectable retroperitoneal sarcoma 
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