Cancer control: journal of the Moffitt Cancer Center 04/2011; 18(2):80-1.
ABSTRACT: Adrenal lesions are commonly identified in patients with extra-adrenal cancer. When lesions are present, it is important to identify if the lesion is a metastasis of the primary cancer or a primary adrenal neoplasm. If primary, the adrenal lesion must be evaluated for hypersecretion and its malignant potential determined for appropriate treatment planning.
Recent literature was reviewed that focused on the normal investigation of adrenal lesions including radiographic imaging and hormonal evaluations as well as specific focused therapeutic options available for isolated metastatic adrenal lesions.
This review presents a pathway approach in investigating these lesions and also discusses various potential treatment options.
A proper investigative workup of an adrenal lesion in a cancer patient is critical for proper management. Isolated adrenal metastatic lesions in the cancer patient should be surgically removed when possible, but other options can be considered. In patients who do not have metastasis from extra-adrenal cancer, the decision for surgical resection is dependent on functionality of the tumor and it's potential for malignancy. Observation plays a key role in those tumors that are nonfunctioning and have a low risk of malignancy.
Cancer control: journal of the Moffitt Cancer Center 04/2011; 18(2):113-26.
ABSTRACT: Although most thyroid cancer patients have an excellent prognosis, 10% of low-risk cancers and 25% of high-risk cancers recur, with mortality rates in excess of 50% at 3 years for aggressive thyroid cancer. Traditional paradigms including surgery, I¹³¹ ablation, and TSH suppression do not offer additional therapeutic options for cancers that fail these interventions. Risk stratification and outcomes data are shifting the treatment paradigms to favor more individualized therapies based on risk, and new treatment targets have been identified with promise to treat more aggressive thyroid cancer.
The authors review the recent literature and published guidelines on thyroid cancer and summarize changing management paradigms and treatments of thyroid cancer.
Outcomes data and risk stratification have promoted changes to traditional paradigms. Total/near-total thyroidectomy improves outcomes in both recurrence and mortality. Central compartment lymph node dissection facilitates nodal status determination and likely improves outcomes, while low-risk patients with small tumors are not likely to benefit from I¹³¹ remnant ablation. Early-phase studies have demonstrated significant improvement in progression-free survival with multikinase inhibitors targeting MAPK and angiogenic pathways.
Risk stratification and outcomes data have modified treatment paradigms in thyroid cancer. Patients with progressive thyroid cancer that is no longer surgically resectable or iodine avid should be considered for treatment with multikinase inhibitors, preferably by enrollment in a therapeutic treatment trial.
Cancer control: journal of the Moffitt Cancer Center 04/2011; 18(2):96-103.