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Cancer-Related Anemia

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Cancer-Related Anemia

Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.

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Hospital Physician: Hematology-Oncology (11)2
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Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.

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Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.

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Hospital Physician: Hematology-Oncology (11)2
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Management of Plasma Cell Disorders

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Management of Plasma Cell Disorders

The plasma cell disorders are a spectrum of conditions that include asymptomatic precursor conditions—monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM)—as well as symptomatic multiple myeloma (MM) and solitary plasmacytoma. Other plasma cell disorders include immunoglobulin light chain amyloidosis and POEMS syndrome, which are characterized by a unique set of end-organ manifestations. There are other related plasma cell and B-cell proliferations, such as light chain deposition disease and cryoglobulinemia, that are beyond the scope of this review but are relevant to the hematologist/oncologist and have been reviewed in detail elsewhere.

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The plasma cell disorders are a spectrum of conditions that include asymptomatic precursor conditions—monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM)—as well as symptomatic multiple myeloma (MM) and solitary plasmacytoma. Other plasma cell disorders include immunoglobulin light chain amyloidosis and POEMS syndrome, which are characterized by a unique set of end-organ manifestations. There are other related plasma cell and B-cell proliferations, such as light chain deposition disease and cryoglobulinemia, that are beyond the scope of this review but are relevant to the hematologist/oncologist and have been reviewed in detail elsewhere.

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The plasma cell disorders are a spectrum of conditions that include asymptomatic precursor conditions—monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM)—as well as symptomatic multiple myeloma (MM) and solitary plasmacytoma. Other plasma cell disorders include immunoglobulin light chain amyloidosis and POEMS syndrome, which are characterized by a unique set of end-organ manifestations. There are other related plasma cell and B-cell proliferations, such as light chain deposition disease and cryoglobulinemia, that are beyond the scope of this review but are relevant to the hematologist/oncologist and have been reviewed in detail elsewhere.

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Hospital Physician: Heamtology-Oncology (11)1
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Management of Bleeding Complications in Patients with Cancer

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Management of Bleeding Complications in Patients with Cancer

Patients with cancer can have many hematologic complications. One of the most serious is bleeding, which can range in severity from laboratory abnormalities to life-threatening hemorrhage. The bleeding can be due to complications of the cancer, its therapy, or treatment for complications of cancer such as thrombosis. This manual discusses an approach to the cancer patient with bleeding, with a specific focus on issues such as coagulation defects, thrombocytopenia, and platelet dysfunction. Bleeding complications of specific cancers and their treatment will be discussed as well.

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Patients with cancer can have many hematologic complications. One of the most serious is bleeding, which can range in severity from laboratory abnormalities to life-threatening hemorrhage. The bleeding can be due to complications of the cancer, its therapy, or treatment for complications of cancer such as thrombosis. This manual discusses an approach to the cancer patient with bleeding, with a specific focus on issues such as coagulation defects, thrombocytopenia, and platelet dysfunction. Bleeding complications of specific cancers and their treatment will be discussed as well.

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Patients with cancer can have many hematologic complications. One of the most serious is bleeding, which can range in severity from laboratory abnormalities to life-threatening hemorrhage. The bleeding can be due to complications of the cancer, its therapy, or treatment for complications of cancer such as thrombosis. This manual discusses an approach to the cancer patient with bleeding, with a specific focus on issues such as coagulation defects, thrombocytopenia, and platelet dysfunction. Bleeding complications of specific cancers and their treatment will be discussed as well.

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Hospital Physician: Hematology-Oncology (10)6
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Metastatic Prostate Cancer: A Case Study

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Metastatic Prostate Cancer: A Case Study

Prostate cancer remains the second leading cause of death in men in the United States as of 2012. It is estimated that prostate cancer affected more than 241,000 new men in 2012, with 15% of these patients presenting with advanced disease. As one would expect, compared to localized prostate cancer, metastatic disease remains the more challenging type to treat. In 1941 Huggins and Hodges demonstrated the dependence of prostatic tissues on androgens and from this work hormonal therapy was developed as the primary treatment for metastatic prostate cancer. Since then, significant progress has been made in the treatment of metastatic prostate cancer, including advances in androgen deprivation therapy and in the treatment of castrationresistant prostate cancer (CRPC), with many advances yet to come. CPRC has been an exciting topic for recent research and advancement, as our understanding of how prostate cancer utilizes very low levels of androgen has evolved considerably.

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Prostate cancer remains the second leading cause of death in men in the United States as of 2012. It is estimated that prostate cancer affected more than 241,000 new men in 2012, with 15% of these patients presenting with advanced disease. As one would expect, compared to localized prostate cancer, metastatic disease remains the more challenging type to treat. In 1941 Huggins and Hodges demonstrated the dependence of prostatic tissues on androgens and from this work hormonal therapy was developed as the primary treatment for metastatic prostate cancer. Since then, significant progress has been made in the treatment of metastatic prostate cancer, including advances in androgen deprivation therapy and in the treatment of castrationresistant prostate cancer (CRPC), with many advances yet to come. CPRC has been an exciting topic for recent research and advancement, as our understanding of how prostate cancer utilizes very low levels of androgen has evolved considerably.

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Prostate cancer remains the second leading cause of death in men in the United States as of 2012. It is estimated that prostate cancer affected more than 241,000 new men in 2012, with 15% of these patients presenting with advanced disease. As one would expect, compared to localized prostate cancer, metastatic disease remains the more challenging type to treat. In 1941 Huggins and Hodges demonstrated the dependence of prostatic tissues on androgens and from this work hormonal therapy was developed as the primary treatment for metastatic prostate cancer. Since then, significant progress has been made in the treatment of metastatic prostate cancer, including advances in androgen deprivation therapy and in the treatment of castrationresistant prostate cancer (CRPC), with many advances yet to come. CPRC has been an exciting topic for recent research and advancement, as our understanding of how prostate cancer utilizes very low levels of androgen has evolved considerably.

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Stage III Non–Small Cell Lung Cancer

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Stage III Non–Small Cell Lung Cancer

Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Each year approximately 228,000 Americans will be diagnosed with lung cancer, and 159,000 will die of this disease. An estimated 85% of lung cancer cases are non–small cell lung cancer (NSCLC), more than 50% of NSCLC is comprised of adenocarcinoma, the median age at diagnosis is 71 years, and 25% of patients with this diagnosis present with stage III disease. In 2010 the seventh edition of the American Joint Committee on Cancer (AJCC) TNM staging system for lung cancer was released, and several changes were made which affect the patient population designated as having stage III disease.

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Hospital Physician: Hematology/Oncology (10)5
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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Each year approximately 228,000 Americans will be diagnosed with lung cancer, and 159,000 will die of this disease. An estimated 85% of lung cancer cases are non–small cell lung cancer (NSCLC), more than 50% of NSCLC is comprised of adenocarcinoma, the median age at diagnosis is 71 years, and 25% of patients with this diagnosis present with stage III disease. In 2010 the seventh edition of the American Joint Committee on Cancer (AJCC) TNM staging system for lung cancer was released, and several changes were made which affect the patient population designated as having stage III disease.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Each year approximately 228,000 Americans will be diagnosed with lung cancer, and 159,000 will die of this disease. An estimated 85% of lung cancer cases are non–small cell lung cancer (NSCLC), more than 50% of NSCLC is comprised of adenocarcinoma, the median age at diagnosis is 71 years, and 25% of patients with this diagnosis present with stage III disease. In 2010 the seventh edition of the American Joint Committee on Cancer (AJCC) TNM staging system for lung cancer was released, and several changes were made which affect the patient population designated as having stage III disease.

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Metastatic Brain Tumors

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Metastatic Brain Tumors

Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Systemic cancer can affect the central nervous system in several different ways, including direct tumor metastasis and indirect remote effects. Intracranial metastasis can involve the skull, dura, and leptomeninges (arachnoid and pia mater), as well as the brain parenchyma. Of these, parenchymal brain metastases are the most common and have been found in as many as 24% of cancer patients in autopsy studies. It has been reported that metastatic brain tumors outnumber primary brain tumors 10 to 1.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Systemic cancer can affect the central nervous system in several different ways, including direct tumor metastasis and indirect remote effects. Intracranial metastasis can involve the skull, dura, and leptomeninges (arachnoid and pia mater), as well as the brain parenchyma. Of these, parenchymal brain metastases are the most common and have been found in as many as 24% of cancer patients in autopsy studies. It has been reported that metastatic brain tumors outnumber primary brain tumors 10 to 1.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Systemic cancer can affect the central nervous system in several different ways, including direct tumor metastasis and indirect remote effects. Intracranial metastasis can involve the skull, dura, and leptomeninges (arachnoid and pia mater), as well as the brain parenchyma. Of these, parenchymal brain metastases are the most common and have been found in as many as 24% of cancer patients in autopsy studies. It has been reported that metastatic brain tumors outnumber primary brain tumors 10 to 1.

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Hospital Physician: Hematology/Oncology (10)4
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Management of Gastroenteropancreatic Neuroendocrine Tumors

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Management of Gastroenteropancreatic Neuroendocrine Tumors

Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Neuroendocrine tumors (NETs) are a rare, heterogeneous group of neoplasms that arise from neuroendocrine cells located throughout the body. These tumors are characterized by variable but most often indolent biologic behavior. They are also classically characterized by their ability to secrete peptides, resulting in distinctive hormonal syndromes. Although NETs have been considered rare, recent studies suggest that they are more common than previously suspected. An analysis of the Surveillance, Epidemiology, and End Results (SEER) database demonstrated a significant increase in the incidence of NETs over time with an age-adjusted annual incidence in the United States of 5.25 cases per 100,000 population. The increase in incidence is likely attributable to increasing awareness, improved diagnostic strategies, and possibly other undetermined environmental and genetic factors.

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Hospital Physician: Hematology/Oncology (10)3
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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Neuroendocrine tumors (NETs) are a rare, heterogeneous group of neoplasms that arise from neuroendocrine cells located throughout the body. These tumors are characterized by variable but most often indolent biologic behavior. They are also classically characterized by their ability to secrete peptides, resulting in distinctive hormonal syndromes. Although NETs have been considered rare, recent studies suggest that they are more common than previously suspected. An analysis of the Surveillance, Epidemiology, and End Results (SEER) database demonstrated a significant increase in the incidence of NETs over time with an age-adjusted annual incidence in the United States of 5.25 cases per 100,000 population. The increase in incidence is likely attributable to increasing awareness, improved diagnostic strategies, and possibly other undetermined environmental and genetic factors.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Neuroendocrine tumors (NETs) are a rare, heterogeneous group of neoplasms that arise from neuroendocrine cells located throughout the body. These tumors are characterized by variable but most often indolent biologic behavior. They are also classically characterized by their ability to secrete peptides, resulting in distinctive hormonal syndromes. Although NETs have been considered rare, recent studies suggest that they are more common than previously suspected. An analysis of the Surveillance, Epidemiology, and End Results (SEER) database demonstrated a significant increase in the incidence of NETs over time with an age-adjusted annual incidence in the United States of 5.25 cases per 100,000 population. The increase in incidence is likely attributable to increasing awareness, improved diagnostic strategies, and possibly other undetermined environmental and genetic factors.

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Hospital Physician: Hematology/Oncology (10)3
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Myelodysplastic Syndromes

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Myelodysplastic syndromes (MDS) are a spectrum of clonal myeloid disorders characterized by ineffective hematopoiesis, cytopenias, qualitative disorders of blood cells, clonal chromosomal abnormalities, and the potential for clonal evolution to acute myeloid leukemia (AML). In this review, we discuss the various pathogenic conditions included in the spectrum of MDS and the associated risk stratification for these conditions. We further discuss the treatment recommendations based on the risk status and the expected prognosis.

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Myelodysplastic syndromes (MDS) are a spectrum of clonal myeloid disorders characterized by ineffective hematopoiesis, cytopenias, qualitative disorders of blood cells, clonal chromosomal abnormalities, and the potential for clonal evolution to acute myeloid leukemia (AML). In this review, we discuss the various pathogenic conditions included in the spectrum of MDS and the associated risk stratification for these conditions. We further discuss the treatment recommendations based on the risk status and the expected prognosis.

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Myelodysplastic syndromes (MDS) are a spectrum of clonal myeloid disorders characterized by ineffective hematopoiesis, cytopenias, qualitative disorders of blood cells, clonal chromosomal abnormalities, and the potential for clonal evolution to acute myeloid leukemia (AML). In this review, we discuss the various pathogenic conditions included in the spectrum of MDS and the associated risk stratification for these conditions. We further discuss the treatment recommendations based on the risk status and the expected prognosis.

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Primary Brain Tumors

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Primary Brain Tumors

Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Primary central nervous system tumors are relatively rare, but they can cause significant morbidity. They are also among the most lethal of all neoplasms. Brain tumors are the second most common cause of death due to intracranial disease, second only to stroke. The estimated annual incidence of primary brain tumors is approximately 21 per 100,000 individuals in the United States. The incidence of brain tumors varies by gender, age, race, ethnicity, and geography and has increased over time. Gliomas and germ cell tumors are more common in men, whereas meningiomas are twice as common in women. The only validated environmental risk factor for primary brain tumors is exposure to ionizing radiation.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Primary central nervous system tumors are relatively rare, but they can cause significant morbidity. They are also among the most lethal of all neoplasms. Brain tumors are the second most common cause of death due to intracranial disease, second only to stroke. The estimated annual incidence of primary brain tumors is approximately 21 per 100,000 individuals in the United States. The incidence of brain tumors varies by gender, age, race, ethnicity, and geography and has increased over time. Gliomas and germ cell tumors are more common in men, whereas meningiomas are twice as common in women. The only validated environmental risk factor for primary brain tumors is exposure to ionizing radiation.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Primary central nervous system tumors are relatively rare, but they can cause significant morbidity. They are also among the most lethal of all neoplasms. Brain tumors are the second most common cause of death due to intracranial disease, second only to stroke. The estimated annual incidence of primary brain tumors is approximately 21 per 100,000 individuals in the United States. The incidence of brain tumors varies by gender, age, race, ethnicity, and geography and has increased over time. Gliomas and germ cell tumors are more common in men, whereas meningiomas are twice as common in women. The only validated environmental risk factor for primary brain tumors is exposure to ionizing radiation.

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Cutaneous Melanoma

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Cutaneous Melanoma

Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Melanoma is the sixth most common cancer in the United States and the leading cause of deaths among all cutaneous malignancies. In 2012, it was estimated that approximately 75,000 individuals were diagnosed with melanoma and more than 9000 died. The incidence of melanoma is rising the fastest among all major malignancies, and the lifetime risk of melanoma among men and women now exceeds 1 in 68, as compared with 1:1500 in 1930.4 The incidence of melanoma is predicted to continue increasing, and there has been no corresponding decrease in mortality. This case-based review summarizes the etiology, risk factors, clinical presentation, and management of cutaneous melanomas, which comprise the majority of melanoma cases. The biology and management for other noncutaneous melanomas (such as mucosal or ocular melanomas) are beyond the scope of this review.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Melanoma is the sixth most common cancer in the United States and the leading cause of deaths among all cutaneous malignancies. In 2012, it was estimated that approximately 75,000 individuals were diagnosed with melanoma and more than 9000 died. The incidence of melanoma is rising the fastest among all major malignancies, and the lifetime risk of melanoma among men and women now exceeds 1 in 68, as compared with 1:1500 in 1930.4 The incidence of melanoma is predicted to continue increasing, and there has been no corresponding decrease in mortality. This case-based review summarizes the etiology, risk factors, clinical presentation, and management of cutaneous melanomas, which comprise the majority of melanoma cases. The biology and management for other noncutaneous melanomas (such as mucosal or ocular melanomas) are beyond the scope of this review.

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Series Editor: Arthur T. Skarin, MD, FACP, FCCP

Melanoma is the sixth most common cancer in the United States and the leading cause of deaths among all cutaneous malignancies. In 2012, it was estimated that approximately 75,000 individuals were diagnosed with melanoma and more than 9000 died. The incidence of melanoma is rising the fastest among all major malignancies, and the lifetime risk of melanoma among men and women now exceeds 1 in 68, as compared with 1:1500 in 1930.4 The incidence of melanoma is predicted to continue increasing, and there has been no corresponding decrease in mortality. This case-based review summarizes the etiology, risk factors, clinical presentation, and management of cutaneous melanomas, which comprise the majority of melanoma cases. The biology and management for other noncutaneous melanomas (such as mucosal or ocular melanomas) are beyond the scope of this review.

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