Cancer control : journal of the Moffitt Cancer Center
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Patients with malignancy comprise a unique group for whom transfusions play an important role. Because the need for transfusions may span a long period of time, these patients may be at risk for more adverse events due to transfusion than other patient groups. ⋯ Every transfusion carries risks of immediate and delayed adverse events. Therefore, oncologists should prescribe transfusion for patients with cancer only when absolutely necessary.
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Well-characterized biochemical, structural, and physiological changes occur when red blood cells (RBCs) are stored for a period of time and are collectively called the storage lesion. ⋯ The clinical significance of storing RBCs is controversial, although new data from randomized controlled trials of neonates and patients undergoing cardiac surgery suggest that the duration of RBC storage is not associated with adverse clinical outcomes in these patient populations.
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Castleman disease is an uncommon lymphoproliferative disorder characterized as either unicentric or multicentric. Unicentric Castleman disease (UCD) is localized and carries an excellent prognosis, whereas multicentric Castleman disease (MCD) is a systemic disease occurring most commonly in the setting of HIV infection and is associated with human herpesvirus 8. MCD has been associated with considerable morbidity and mortality, and the therapeutic landscape for its management continues to evolve. ⋯ UCD and MCD constitute uncommon but well-defined clinicopathologic entities. Although UCD is typically well controlled with local therapy, MCD continues to pose formidable challenges in management. We address historical chemotherapy-based approaches to this disease as well as recently developed targeted therapies, including rituximab and siltuximab, that have improved the outcome for newly diagnosed patients. Ongoing research into the management of MCD is needed.
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Complication avoidance is paramount to the success of any surgical procedure. In the case of spine tumor surgery, the risk of complications is increased because of the primary disease process and the radiotherapy and chemotherapeutics used to treat the disease. If complications do occur, then life-saving adjuvant treatment must be delayed or withheld until the issue is resolved, potentially impacting overall disease control. ⋯ Because patients with spinal tumors are normally treated with a multidisciplinary approach, emphasis should be placed on the recognition of surgical complications beyond the surgical setting.
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Lung cancer is the leading cause of cancer death in the United States. Results from the National Lung Screening Trial (NLST) have shown that low-dose computed tomography (CT) is capable of detecting lung neoplasms in individuals at high risk. However, whether it is advantageous to perform lung cancer screening on these patients is a significant concern, as are the potential adverse outcomes from screening. ⋯ Lung cancer screening is controversial, but the NLST has demonstrated that such testing may reduce lung cancer deaths in high-risk individuals when performed with low-dose CT rather than chest radiography. Guidelines should be established to not only help identify an appropriate screening population, but also develop standards for radiological testing.