NEJM â Collection Updates for Oncology

EDITORIAL: Preoperative Biliary Stents in Pancreatic Cancer â Proceed with Caution

Todd H. Baron, M.D., and Richard A. Kozarek, M.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

Pancreatic cancer is a common and deadly disease that is diagnosed in more than 40,000 patients annually in the United States, where it is the fourth leading cause of cancer-related...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2010 â A 75-Year-Old Man with Hypertension, Hyperglycemia, and Edema

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Dr. Jennifer L. Lyons (Medicine): A 75-year-old man was admitted to this hospital because of the recent onset of hypertension, hyperglycemia, and edema.

The patient had been in his usual state...

ORIGINAL ARTICLE: Preoperative Biliary Drainage for Cancer of the Head of the Pancreas

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Background: The benefits of preoperative biliary drainage, which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head, are unclear.

Methods:...

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

Laura McGevna, M.D. and Zarry Tavakkol, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis....

CLINICAL PROBLEM-SOLVING: Painful Purple Toes

Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 57-year-old man presented to the emergency department with painful purple toes. On the day of presentation, he had first been seen in another hospital but left against medical advice...

IMAGES IN CLINICAL MEDICINE: Radiation Pneumonitis after Radiotherapy for Breast Cancer

Edwin BÃ¶lke, M.D. and Christiane Matuschek, M.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

A 58-year-old woman with a history of stage I cancer in the right breast (T1N0M0, according to the tumorânodeâmetastasis classification) presented with a 2-week history of shortness of breath and...

PERSPECTIVE: Ending End-of-Life Phobia â A Prescription for Enlightened Health Care Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Reform is coming to U.S. health care. A sense of urgency regarding the redesign of policies prevailed well before Barack Obama was elected president under the banner of change. A...

VIDEOS IN CLINICAL MEDICINE: Endometrial Biopsy

Paul Gordon, M.D., M.P.H. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

...

CLINICAL PRACTICE: Barrett's Esophagus

Prateek Sharma, M.D. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

A 56-year-old obese man with long-standing gastroesophageal reflux who recently received a diagnosis of Barrett's esophagus presents for a follow-up visit. He has been taking omeprazole at a dose of...

PERSPECTIVE: Cervical-Cancer Screening â New Guidelines and the Balance between Benefits and Harms

Thu, 24Â DecÂ 2009 00:00:00 -05:00

One of the greatest challenges in developing cancer-screening guidelines is devising strategies that maximize screening benefits and minimize screening harms. The benefits of cancer screening â decreased cancer-related morbidity and...

INTERACTIVE MEDICAL CASE: Painful Purple Toes

Thu, 17Â DecÂ 2009 00:00:00 -05:00

A 57-year-old man presented to the emergency department with painful purple toes. He had first noted pain and discoloration in his left great toe 2 weeks earlier. One week before...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2009 â A 28-Year-Old Pregnant Woman with Acute Cardiac Failure

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Dr. Brad W. Butcher (Medicine): A 28-year-old woman was admitted to this hospital 2 days post partum because of cardiac failure.

The patient had been well, except for gestational diabetes mellitus,...

EDITORIAL: Volume CT for Diagnosis of Nodules Found in Lung-Cancer Screening

James L. Mulshine, M.D., and David M. Jablons, M.D. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

Lung cancer, the most lethal type of cancer, accounted for more than 159,000 deaths in 2009 in the United States alone,1 and the annual number of new cases is expected...

ORIGINAL ARTICLE: Management of Lung Nodules Detected by Volume CT Scanning

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: The use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding...

ORIGINAL ARTICLE: Identification of a Novel Antibody Associated with Autoimmune Pancreatitis

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Background: Autoimmune pancreatitis is characterized by an inflammatory process that leads to organ dysfunction. The cause of the disease is unknown. Its autoimmune origin has been suggested but never proved,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Hedgehog Pathway and Pancreatic Cancer

Manuel Hidalgo, M.D., and Anirban Maitra, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

Aberrant activation of the hedgehog pathway has been observed in multiple human cancers, including pancreatic cancer. For this reason, several small-molecule inhibitors of the pathway have been advanced to clinical...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2009 â A 23-Year-Old Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Dr. David T. Ting (Medical Oncology): A 23-year-old man was transferred to this hospital because of cough, hoarseness, fever, and abnormalities on chest imaging.

The patient had been well until 1...

EDITORIAL: Human Papillomavirus Vaccine for Cancer Prevention

Olivera J. Finn, Ph.D., and Robert P. Edwards, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

Cancer immunoprevention has become synonymous with the vaccines that have been approved for the prevention of infection with highly transmissible strains of human papillomavirus (HPV) that establish chronic infection and...

CLINICAL PROBLEM-SOLVING: A Bloody Mystery

Thu, 05Â NovÂ 2009 00:00:00 -05:00

A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower-right second molar. She had undergone the procedure 5 hours before arriving at...

REVIEW ARTICLE: Myelodysplastic Syndromes

Ayalew Tefferi, M.D., and James W. Vardiman, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

According to the 2008 World Health Organization (WHO) classification system for hematologic cancers, the primary myelodysplastic syndromes are one of five major categories of myeloid neoplasms (Table 1).1 The main...

ORIGINAL ARTICLE: Vaccination against HPV-16 Oncoproteins for Vulvar Intraepithelial Neoplasia

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Background: Vulvar intraepithelial neoplasia is a chronic disorder caused by high-risk types of human papillomavirus (HPV), most commonly HPV type 16 (HPV-16). Spontaneous regression occurs in less than 1.5% of...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Index Lesion and the Origin of Prostate Cancer

Hashim Uddin Ahmed, M.R.C.S., B.M., B.Ch. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Prostate cancer is a perplexing type of malignant disease. Its long natural history means that men who receive the diagnosis in their 50s or 60s do not necessarily require treatment....

ORIGINAL ARTICLE: Cisplatin versus Cisplatin plus Doxorubicin for Standard-Risk Hepatoblastoma

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: Preoperative cisplatin alone may be as effective as cisplatin plus doxorubicin in standard-risk hepatoblastoma (a tumor involving three or fewer sectors of the liver that is associated with an...

INTERACTIVE MEDICAL CASE: A Bloody Mystery

Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower right second molar. She had undergone the procedure 5 hours before presentation,...

VIDEOS IN CLINICAL MEDICINE: Bone Marrow Aspiration and Biopsy

Thu, 08Â OctÂ 2009 00:00:00 -05:00

...

EDITORIAL: Micromanaging Cancer

Judy Lieberman, M.D., Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

The discovery of RNA interference triggered a âsilentâ revolution that overturned our understanding of how gene expression is regulated.1 The previous model was that gene expression was activated during transcription,...

REVIEW ARTICLE: DNA Damage, Aging, and Cancer

Jan H.J. Hoeijmakers, Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

DNA damage has emerged as a major culprit in cancer and many diseases related to aging. The stability of the genome is supported by an intricate machinery of repair, damage...

ORIGINAL ARTICLE: MicroRNA Expression, Survival, and Response to Interferon in Liver Cancer

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Background: Hepatocellular carcinoma is a common and aggressive cancer that occurs mainly in men. We examined microRNA expression patterns, survival, and response to interferon alfa in both men and women...

IMAGES IN CLINICAL MEDICINE: Diagnostic Finding in the Iris

Bogomil Voykov, M.D. and Emmanuella Guenova, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

A 51-year-old woman was found to have a small, pinkish tumor of the left iris (Panels A and B, arrows). The visual acuity was not affected, and the intraocular pressure...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2009 â A 77-Year-Old Man with Recurrent Transitional-Cell Carcinoma of the Ureter

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Dr. Donald S. Kaufman: A 77-year-old man with a history of transitional-cell carcinoma of the right ureter was seen in the multidisciplinary urologic oncology clinic of this hospital because of...

EDITORIAL: Following the Hedgehog to New Cancer Therapies

Andrzej A. Dlugosz, M.D., and Moshe Talpaz, M.D. — Thu, 17Â SepÂ 2009 00:00:00 -05:00

Two studies in this issue of the Journal12 describe a new drug, GDC-0449, that inhibits the hedgehog signaling pathway. This pathway orchestrates numerous processes throughout embryogenesis, and although the pathway...

ORIGINAL ARTICLE: Treatment of Medulloblastoma with Hedgehog Pathway Inhibitor GDC-0449

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Medulloblastoma is the most common malignant brain tumor in children. Aberrant activation of the hedgehog signaling pathway is strongly implicated in the development of some cases of medulloblastoma. A 26-year-old...

ORIGINAL ARTICLE: Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Background: Mutations in hedgehog pathway genes, primarily genes encoding patched homologue 1 (PTCH1) and smoothened homologue (SMO), occur in basal-cell carcinoma. In a phase 1 clinical trial, we assessed the...

EDITORIAL: Cancer Genomes â Continuing Progress

James R. Downing, M.D. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

Cancer is believed to result from the acquisition of mutations and epigenetic changes that work collaboratively to induce the malignant growth of a cell. The field of cancer genomics has...

ORIGINAL ARTICLE: Screening for Epidermal Growth Factor Receptor Mutations in Lung Cancer

Thu, 03Â SepÂ 2009 00:00:00 -05:00

Background: Activating mutations in the epidermal growth factor receptor gene (EGFR) confer hypersensitivity to the tyrosine kinase inhibitors gefitinib and erlotinib in patients with advanced nonâsmall-cell lung cancer. We evaluated...

ORIGINAL ARTICLE: Gefitinib or CarboplatinâPaclitaxel in Pulmonary Adenocarcinoma

Thu, 03Â SepÂ 2009 00:00:00 -05:00

Background: Previous, uncontrolled studies have suggested that first-line treatment with gefitinib would be efficacious in selected patients with nonâsmall-cell lung cancer.

Methods: In this phase 3, open-label study, we randomly assigned...

EDITORIAL: Personalized Medicine and Inhibition of Signaling in Lung Cancer

Adi F. Gazdar, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

The concept underlying much of cancer therapy is that patients with specific types and stages of cancer should be treated according to standardized, predetermined protocols. However, recent advances in drug...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Finding the Weakness in Cancer

Julian Downward, Ph.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

By the time the sequencing of the human genome was completed 6 years ago, expectations were huge that this knowledge would soon have an impact on our ability to treat...

EDITORIAL: Synthetic Lethality â A New Direction in Cancer-Drug Development

J. Dirk Iglehart, M.D., and Daniel P. Silver, M.D., Ph.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

In this issue of the Journal, Fong et al. report the results of a phase 1 trial of a new cancer therapy involving 60 patients (ClinicalTrials.gov number, NCT00516373).1 Readers may...

CLINICAL PRACTICE: Screening for Ovarian Cancer

Daniel L. Clarke-Pearson, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

A 56-year-old woman presents to her physician, requesting screening for ovarian cancer. She reports the recent death of a friend from ovarian cancer at the age of 65 years. The...

ORIGINAL ARTICLE: Inhibition of Poly(ADP-Ribose) Polymerase in Tumors from Mutation Carriers

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Background: The inhibition of poly(adenosine diphosphate [ADP]âribose) polymerase (PARP) is a potential synthetic lethal therapeutic strategy for the treatment of cancers with specific DNA-repair defects, including those arising in carriers...

ORIGINAL ARTICLE: Preoperative Staging of Lung Cancer with Combined PETâCT

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: Fast and accurate staging is essential for choosing treatment for nonâsmall-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission...

EDITORIAL: Cancer Genomes on a Shoestring Budget

Jay Shendure, M.D., Ph.D., and Colin J. Stewart, M.B., Ch.B. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

In a remarkably short time, the use of massively parallel technologies has greatly reduced the cost of DNA sequencing.1 Already, these technologies have permitted the whole-genome sequencing of several persons234...

ORIGINAL ARTICLE: Mutation of in Granulosa-Cell Tumors of the Ovary

Thu, 25Â JunÂ 2009 00:00:00 -05:00

Background: Granulosa-cell tumors (GCTs) are the most common type of malignant ovarian sex cordâstromal tumor (SCST). The pathogenesis of these tumors is unknown. Moreover, their histopathological diagnosis can be challenging,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A New Target for Tumor Therapy

Rakesh K. Jain, Ph.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

Vascular normalization, or restoration of the normal structure and function in blood vessels, has emerged as a strategy to treat cancer and other vascular disorders.1 Mazzone et al.2 have recently...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2009 â A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Dr. Stephanie Heon (HematologyâOncology): A 63-year-old woman was seen in the Cancer Center at this hospital for management of adenocarcinoma of the gastroesophageal junction.

The patient had been well until approximately...

CLINICAL THERAPEUTICS: Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

Jean-Luc Harousseau, M.D., and Philippe Moreau, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

A previously healthy 59-year-old man presents with persistent pain in his lower back and fatigue. A complete blood count reveals a hemoglobin level of 9.8 g per deciliter. A monoclonal...

EDITORIAL: Androgen Deprivation in Prostate Cancer â Step by Step

Peter Albertsen, M.D., M.S. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

Clinicians and researchers have debated the relative efficacy and timing of androgen deprivation since 1941, when Charles B. Huggins and Clarence V. Hodges reported that androgen deprivation reduced testosterone levels...

ORIGINAL ARTICLE: Duration of Androgen Suppression in the Treatment of Prostate Cancer

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: The combination of radiotherapy plus long-term medical suppression of androgens (â¥2 years) improves overall survival in patients with locally advanced prostate cancer. We compared the use of radiotherapy plus...

EDITORIAL: A Common Genetic Mechanism in Malignant Bone Marrow Diseases

Ross L. Levine, M.D., and Martin Carroll, M.D. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

The myelodysplastic syndromes, myeloproliferative disorders, and acute myeloid leukemia (AML) are seemingly unrelated diseases except for their origin in hematopoietic precursor cells in bone marrow. A principal feature of the...

EDITORIAL: Radiofrequency Ablation â Great for Some or Justified for Many?

Jacques J.G.H.M. Bergman, M.D., Ph.D. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

In the past four decades, the incidence of esophageal adenocarcinoma has increased by 500%, paralleled by a similar increase in the rate of death associated with this often fatal disease.12...

ORIGINAL ARTICLE: Mutation in in Myeloid Cancers

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Background: The myelodysplastic syndromes and myeloproliferative disorders are associated with deregulated production of myeloid cells. The mechanisms underlying these disorders are not well defined.

Methods: We conducted a combination of molecular,...

ORIGINAL ARTICLE: Radiofrequency Ablation in Barrett's Esophagus with Dysplasia

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Background: Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma. We assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's...

IMAGES IN CLINICAL MEDICINE: White Tongue

Mohiba Tareen, M.D. and Marc E. Grossman, M.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

A 55-year-old male nonsmoker with multiple myeloma refractory to chemotherapy was admitted to the hospital for autologous stem-cell transplantation. Palifermin was to be administered before and after the transplantation. On...

IMAGES IN CLINICAL MEDICINE: Extravasation of Epirubicin

Sergio Vano-Galvan, M.D. and Pedro Jaen, M.D., Ph.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

A 63-year-old woman with a diagnosis of infiltrative ductal carcinoma of the breast (stage T2N1M0[IIB], according to the tumorânodeâmetastasis staging system) that was estrogen receptorânegative and HER2-negative was referred for...

CORRECTION:

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Multidisciplinary Management of Lung Cancer (January 22, 2004;350:379-92) N Engl J Med 2004January22 350 11 379392 . In Table 4 (page 387), in the Conclusions or Results column, the therapeutic...

BOOK REVIEW:

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Pancreatic Cancer is the latest title in the M.D. Anderson Solid Tumor Oncology Series from Springer. It is the second book in the series to address pancreatic cancer; the first...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2009 â A 36-Year-Old Man with Chest Pain, Dysphagia, and Pleural and Mediastinal Calcifications

Henning A. Gaissert, M.D., Nitra Piyavisetpat, M.D., and Eugene J. Mark, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 36-year-old man was admitted to the hospital because of chest pain, dysphagia, dyspnea, and pleural and mediastinal calcifications.

He had been well until approximately 6 years before admission, when a...

BOOK REVIEW:

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Clinical endocrine oncology is an unusual hybrid specialty in that it involves both oncology and endocrinology, two disciplines that differ vastly. In fact, endocrinologists seldom appear to be interested in...

PERSPECTIVE: Screening for Prostate Cancer

Thu, 26Â MarÂ 2009 00:00:00 -05:00

In two large randomized trials, researchers examined the effect of annual prostate-specificâantigen (PSA) screening on the rate of death from prostate cancer and found that it was small and was...

EDITORIAL: Screening for Prostate Cancer â The Controversy That Refuses to Die

Michael J. Barry, M.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

In the United States, most men over the age of 50 years have had a prostate-specificâantigen (PSA) test,1 despite the absence of evidence from large, randomized trials of a net...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2009 â A 23-Year-Old Woman with an Abnormal Papanicolaou Smear

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Dr. Naana Afua Jumah (Student, Harvard Medical School): A 23-year-old woman was seen in the gynecology clinic of this hospital because of a high-grade squamous intraepithelial lesion seen on pathological...

ORIGINAL ARTICLE: Screening and Prostate-Cancer Mortality in a Randomized European Study

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Background: The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specificâantigen (PSA) testing on death rates from...

ORIGINAL ARTICLE: Mortality Results from a Randomized Prostate-Cancer Screening Trial

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Background: The effect of screening with prostate-specificâantigen (PSA) testing and digital rectal examination on the rate of death from prostate cancer is unknown. This is the first report from the...

BOOK REVIEW:

Thu, 12Â MarÂ 2009 00:00:00 -05:00

In 1925, a patient who was being treated by Alfred S. Warthin told him she was terrified she would die of âcancer of my female organs or bowels,â which she...

BOOK REVIEW:

Thu, 12Â MarÂ 2009 00:00:00 -05:00

If multiple authorship is a mark of quality, this book is a must-read. With 189 authors covering the oncology of the gastrointestinal tract from the esophagus to the anus, as...

BOOK REVIEW:

Thu, 05Â MarÂ 2009 00:00:00 -05:00

This book for pediatric surgeons, fellows, residents, and pediatric oncologists reflects the extensive experience of its editors and authors in caring for children with cancer. It is well written, well...

BOOK REVIEW:

Thu, 26Â FebÂ 2009 00:00:00 -05:00

It is estimated that more than 1.4 million people in the United States will receive a diagnosis of cancer in 2009 (excluding in situ carcinoma and nonmelanotic skin cancer), and...

REVIEW ARTICLE: Preservation of Fertility in Patients with Cancer

Jacqueline S. Jeruss, M.D., Ph.D., and Teresa K. Woodruff, Ph.D. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

The unique duality involved in confronting a life-threatening diagnosis while simultaneously considering the deeply human desire to have a child presents a struggle both for patients with cancer and for...

EDITORIAL: Metabolic Enzymes as Oncogenes or Tumor Suppressors

Craig B. Thompson, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

Whether mutations in metabolic pathways contribute to the pathogenesis of cancer is controversial.12 Cancer cells have long been noted to preferentially metabolize glucose through glycolysis, a discovery that has been...

ORIGINAL ARTICLE: and Mutations in Gliomas

Thu, 19Â FebÂ 2009 00:00:00 -05:00

Background: A recent genomewide mutational analysis of glioblastomas (World Health Organization [WHO] grade IV glioma) revealed somatic mutations of the isocitrate dehydrogenase 1 gene (IDH1) in a fraction of such...

HEALTH POLICY REPORT: Limits on Medicare's Ability to Control Rising Spending on Cancer Drugs

Peter B. Bach, M.D., M.A.P.P. — Thu, 05Â FebÂ 2009 00:00:00 -05:00

Fifteen years ago, the only commonly used cancer drug on the market that cost more than $2,500 per month was paclitaxel (Taxol, Bristol-Myers Squibb), which Chabner and Roberts labeled the...

CORRESPONDENCE: Excess Iodine from an Unexpected Source

Seth M. Arum, M.D., Xuemei He, M.D., and Lewis E. Braverman, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

To the Editor: It is standard practice to induce a decrease in the body's iodine stores before treatment with radioiodine for thyroid cancer. Such patients should avoid an iodine-rich diet,12...

CORRESPONDENCE: Treatment of Growing Teratoma Syndrome

Thu, 22Â JanÂ 2009 00:00:00 -05:00

To the Editor: Growing teratoma syndrome consists of an enlarging mature teratoma arising during or after chemotherapy for a nonseminomatous germ-cell tumor, with normal serum levels of alpha-fetoprotein and human...

BOOK REVIEW:

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Viruses are responsible for 20% of malignant conditions in humans, including some of the most common cancers worldwide, and are especially common in immunosuppressed patients. The identification of viruses associated...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Crossroads of Oncogenesis and Metastasis

Isidro SÃ¡nchez-GarcÃa, M.D., Ph.D. — Thu, 15Â JanÂ 2009 00:00:00 -05:00

The treatment of cancer is generally based on histologic grade, resectability, and the presence or absence of metastasis. Because interventions after the manifestation of metastasis are notoriously ineffective for most...

CORRESPONDENCE: Glycemic Control in Patients with Insulinoma Treated with Everolimus

Matthew H. Kulke, M.D., Emily K. Bergsland, M.D., and James C. Yao, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

To the Editor: Management of refractory hypoglycemia due to malignant insulinoma is challenging. Currently available treatments include dietary modification, diazoxide, and, in patients with resistant disease, the use of intravenous...

BOOK REVIEW:

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Hope and Suffering is an apt title for this dense, encyclopedic, and riveting book. It includes narratives from patients and their family members that detail the hope, suffering, and despair...

CORRESPONDENCE: Reports of Esophageal Cancer with Oral Bisphosphonate Use

Diane K. Wysowski, Ph.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

To the Editor: Between the time of the initial marketing of alendronate in October 1995 through mid-May 2008, the Food and Drug Administration (FDA) received reports of 23 patients in...

REVIEW ARTICLE: Molecular Basis of Metastasis

Anne C. Chiang, M.D., Ph.D., and Joan MassaguÃ©, Ph.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

Metastasis is the end product of an evolutionary process in which diverse interactions between cancer cells and their microenvironment yield alterations that allow these cells to transcend their programmed behavior....

CORRESPONDENCE: Small-Cell Lung Cancer and Necrolytic Migratory Erythema

Thu, 18Â DecÂ 2008 00:00:00 -05:00

To the Editor: Necrolytic migratory erythema is a rare inflammatory dermatosis, first described by Becker et al.,1 which occurs in 70% of patients with the glucagonoma syndrome.2 Its clinical features...

EDITORIAL: MicroRNA in Cancer Prognosis

Frank J. Slack, Ph.D., and Joanne B. Weidhaas, M.D., Ph.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

Ovarian cancer is the leading cause of deaths from gynecologic cancer, and although there are nomograms that use pathological variables to predict outcome for advanced-stage disease,1 few if any molecular...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2008 â A 51-Year-Old Woman with Splenomegaly and Anemia

Jeremy S. Abramson, M.D., Manjil Chatterji, M.D., Aliyah Rahemtullah, M.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

Dr. Jeffrey A. Barnes (HematologyâOncology): A 51-year-old woman was admitted to this hospital because of anemia and splenomegaly. The patient was in her usual state of health until approximately 2...

ORIGINAL ARTICLE: Mutation and Congenital Erythrocytosis with Paraganglioma

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Prolyl hydroxylase domain (PHD) proteins play a major role in regulating the hypoxia-inducible factor (HIF) that induces expression of genes involved in angiogenesis, erythropoiesis, and cell metabolism, proliferation, and survival....

ORIGINAL ARTICLE: Dicer, Drosha, and Outcomes in Patients with Ovarian Cancer

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Background: We studied Dicer and Drosha, components of the RNA-interference machinery, in ovarian cancer.

Methods: We measured messenger RNA (mRNA) levels of Dicer and Drosha in specimens of invasive epithelial ovarian...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Dr. Abner Louissaint (Pathology): A 58-year-old man with hemophilia was admitted to this hospital because of hepatitis C infection, hepatocellular carcinoma, and recurrent bleeding.

A diagnosis of hemophilia A (factor VIII...

BOOK REVIEW:

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Lung cancer is the leading cause of cancer-related deaths in North America, with an estimated 213,380 new cases and 160,390 deaths anticipated in 2008. Since the publication of the previous...

BOOK REVIEW:

Thu, 04Â DecÂ 2008 00:00:00 -05:00

In 1969, the young surgeon Judah Folkman made a clinical observation that elevated the study of angiogenesis to a scientific discipline and led to new therapies for cancer, eye diseases,...

CORRESPONDENCE: Osteosarcoma Derived from Donor Stem Cells Carrying the Norrie's Disease Gene

Thu, 04Â DecÂ 2008 00:00:00 -05:00

To the Editor: There have been few reports of osteosarcoma after allogeneic bone marrow transplantation.1 We report the development of osteosarcoma in a recipient 17 years after stem-cell transplantation.

A 23-month-old...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2008 â A 17-Year-Old Boy with a Pituitary Tumor and Skull Abnormalities

Thu, 27Â NovÂ 2008 00:00:00 -05:00

A 17-year-old boy was seen at this hospital because of a pituitary tumor and radiologic evidence of bony abnormalities in the skull. The patient was well until approximately 12 years...

BOOK REVIEW:

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Supportive care for patients with cancer is not a new concept â the Multinational Association of Supportive Care in Cancer had its 21st international symposium earlier this year. However, both...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2008 â A 65-Year-Old Man with Confusion and Memory Loss

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Dr. Roy N. Alcalay (Neurology): A 65-year-old right-handed man was transferred to this hospital because of confusion and memory loss. He had been well until approximately 4 weeks before...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2008 â A 65-Year-Old Man with Confusion and Memory Loss

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Dr. Roy N. Alcalay (Neurology): A 65-year-old right-handed man was transferred to this hospital because of confusion and memory loss. He had been well until approximately 4 weeks before...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2008 â A 65-Year-Old Man with Confusion and Memory Loss

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Dr. Roy N. Alcalay (Neurology): A 65-year-old right-handed man was transferred to this hospital because of confusion and memory loss. He had been well until approximately 4 weeks before admission,...

REVIEW ARTICLE: Inherited Susceptibility to Common Cancers

William D. Foulkes, M.B., B.S., Ph.D. — Thu, 13Â NovÂ 2008 00:00:00 -05:00

Rare, large families with multiple cases of early-onset cancer affecting several generations provide clear evidence that inherited factors are important causes of cancer.1 The range of cancers, the age at...

EDITORIAL: Recurrence of Hepatocellular Carcinoma

Morris Sherman, M.B., B.Ch., Ph.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Although the treatment of hepatocellular carcinoma is evolving, hepatic resection remains the treatment of choice for many patients. Resection is associated with a 5-year survival rate of 50% but also...

ORIGINAL ARTICLE: Gene Expression in Fixed Tissues and Outcome in Hepatocellular Carcinoma

Thu, 06Â NovÂ 2008 00:00:00 -05:00

Background: It is a challenge to identify patients who, after undergoing potentially curative treatment for hepatocellular carcinoma, are at greatest risk for recurrence. Such high-risk patients could receive novel interventional...

CORRESPONDENCE: Antiemetic Properties of the Antiepileptic Drug Levetiracetam

Thu, 23Â OctÂ 2008 00:00:00 -05:00

To the Editor: Chemotherapy-induced nausea and vomiting is an important problem in patients with brain tumors. Because of the high prevalence of seizures, most patients are given antiepileptic drugs. Motivated...

EDITORIAL: Polymorphisms and the Risk of Invasive Fungal Infections

Eric G. Pamer, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

Allogeneic hematopoietic stem-cell transplantation is a potentially lifesaving cancer therapy that, at least temporarily, renders patients highly immunocompromised and vulnerable to infection. Aspergillus fumigatus, a common environmental fungus that causes...

IMAGES IN CLINICAL MEDICINE: What Lies Beneath?

Darren M. Mylotte, M.B. and Anthony O'Regan, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

A 74-year-old male smoker was hospitalized for a transurethral resection of the prostate. His medical history was notable for the insertion of a dual-chamber pacemaker to treat symptomatic bradycardia 10...

ORIGINAL ARTICLE: Toll-like Receptor 4 Polymorphisms and Aspergillosis in Stem-Cell Transplantation

Thu, 23Â OctÂ 2008 00:00:00 -05:00

Background: Toll-like receptors (TLRs) are essential components of the immune response to fungal pathogens. We examined the role of TLR polymorphisms in conferring a risk of invasive aspergillosis among recipients...

CORRESPONDENCE: Problems Associated with the Use of Thyrogen in Patients with a Thyroid Gland

Thu, 16Â OctÂ 2008 00:00:00 -05:00

To the Editor: Juweid et al. (September 18 issue)1 describe the administration of thyrotropin alfa (Thyrogen) to a patient with thyroid cancer who still has a thyroid gland. Genzyme, the...

BOOK REVIEW:

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Renal-cell carcinoma actually comprises a heterogeneous group of diseases with varying clinical presentations, all of which require a multidisciplinary approach to treatment, with contributions from urologists, pathologists, medical oncologists, radiologists,...

IMAGES IN CLINICAL MEDICINE: New-Onset Clubbing Associated with Lung Cancer

Bryan A. Faller, M.D. and John P. Atkinson, M.D. — Thu, 25Â SepÂ 2008 00:00:00 -05:00

A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the...

EDITORIAL: Ezetimibe and Cancer â An Uncertain Association

Thu, 25Â SepÂ 2008 00:00:00 -05:00

The randomized clinical trial is considered to be the most reliable tool to assess the efficacy and safety of new drugs. At times, however, randomized trials detect adverse events that...

REVIEW ARTICLE: Lung Cancer

Thu, 25Â SepÂ 2008 00:00:00 -05:00

Lung cancer is the leading cause of cancer deaths in the United States1 and worldwide. The two major forms of lung cancer are nonâsmall-cell lung cancer (about 85% of all...

SPECIAL ARTICLE: Analyses of Cancer Data from Three Ezetimibe Trials

Thu, 25Â SepÂ 2008 00:00:00 -05:00

Background: Five years of statin therapy lowers low-density lipoprotein (LDL) cholesterol substantially and, over a 5-year period, results in reductions in the incidence of cardiovascular events. The Simvastatin and Ezetimibe...

CORRESPONDENCE: Diagnosis of Poorly Differentiated Thyroid Cancer with Radioiodine Scanning after Thyrotropin Alfa Stimulation

Malik Juweid, M.D., Thomas O'Dorisio, M.D., and Mohammed Milhem, M.D. — Thu, 18Â SepÂ 2008 00:00:00 -05:00

To the Editor: Poorly differentiated thyroid cancers are rare and can be difficult for surgeons, endocrinologists, and pathologists to identify.1 These cancers fall into two main histologic categories: insular and...

REVIEW ARTICLE: Recent Advances in Head and Neck Cancer

Robert I. Haddad, M.D., and Dong M. Shin, M.D. — Thu, 11Â SepÂ 2008 00:00:00 -05:00

More than half a million patients receive the diagnosis of squamous-cell carcinoma of the head and neck worldwide each year. In this disease, which primarily affects the oropharynx, oral cavity,...

ORIGINAL ARTICLE: Platinum-Based Chemotherapy plus Cetuximab in Head and Neck Cancer

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Background: Cetuximab is effective in platinum-resistant recurrent or metastatic squamous-cell carcinoma of the head and neck. We investigated the efficacy of cetuximab plus platinum-based chemotherapy as first-line treatment in patients...

IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma Manifesting as a Cutaneous Horn

Sergio Vano-Galvan, M.D. and Alberto Sanchez-Olaso, Ph.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A healthy 84-year-old woman presented with a 6-month history of a slowly growing asymptomatic lesion on the dorsum of her right hand. Physical examination revealed a keratotic cutaneous horn â...

CORRESPONDENCE: Scrotal Cutaneous Side Effects of Sunitinib

Thu, 28Â AugÂ 2008 00:00:00 -05:00

To the Editor: Sunitinib is an oral, multitargeted kinase that blocks the receptors for vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and stem-cell factor (c-kit). Sunitinib was approved...

EDITORIAL: Treatment of Myeloma â Are We Making Progress?

Brian G.M. Durie, M.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

In this issue of the Journal, San Miguel et al.1 describe the benefit of combining bortezomib with melphalan plus prednisone, as compared with melphalan plus prednisone alone, as initial therapy...

IMAGES IN CLINICAL MEDICINE: The StewartâTreves Syndrome

Laura B. Pincus, M.D. and Lindy P. Fox, M.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A 67-year-old woman with a history of cancer of the right breast, treated with a modified radical mastectomy, radiation, and chemotherapy in 1990, presented with a 6-month history of an...

ORIGINAL ARTICLE: Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple Myeloma

Thu, 28Â AugÂ 2008 00:00:00 -05:00

Background: The standard treatment for patients with multiple myeloma who are not candidates for high-dose therapy is melphalan and prednisone. This phase 3 study compared the use of melphalan and...

BOOK REVIEW:

Thu, 14Â AugÂ 2008 00:00:00 -05:00

More than 218,000 new cases of prostate cancer are diagnosed every year in the United States. Great improvements in diagnosis and treatment have been made over the past two decades,...

BOOK REVIEW:

Thu, 14Â AugÂ 2008 00:00:00 -05:00

This textbook is an informative resource concerning core principles and practices in gastrointestinal oncology. It covers a wide range of practice areas, with good examples of pathology and radiologic images...

CORRESPONDENCE: Glucagon-like Peptide 1âReceptor Scans to Localize Occult Insulinomas

Thu, 14Â AugÂ 2008 00:00:00 -05:00

To the Editor: The precise localization of some insulinomas (islet-cell adenomas that secrete insulin) with the use of conventional imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI),...

REVIEW ARTICLE: Chromosomal Abnormalities in Cancer

Stefan FrÃ¶hling, M.D., and Hartmut DÃ¶hner, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

Cytogenetic abnormalities are a characteristic attribute of cancer cells. To date, clonal chromosome aberrations have been found in all major tumor types from more than 54,000 patients (http://cgap.nci.nih.gov/Chromosomes/Mitelman), and their...

BOOK REVIEW: