Oncology Ny
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Epithelial ovarian cancer comprises a heterogeneous group of tumors. The four most common subtypes are serous, endometrioid, clear cell, and mucinous carcinoma. Less common are transitional cell tumors, including transitional cell carcinoma and malignant Brenner tumor. ⋯ High-grade serous carcinoma often has a transitional cell pattern, and adequate sampling in most cases shows more typical areas of serous carcinoma. Immunohistochemical markers are routinely employed in the diagnosis of epithelial ovarian carcinomas. However, molecular testing of these tumors, unlike in endometrial carcinoma, is not routinely used in clinical practice.
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These American College of Radiology consensus guidelines were formed from an expert panel on the appropriate use of adjuvant therapy in vulvar cancer after primary treatment with surgery. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. ⋯ The panel reviewed the pertinent literature in vulvar cancer and voted on three variants to establish appropriate use of imaging, adjuvant radiation, including dose, fields, and technique, as well as adjuvant chemotherapy. This report will aid clinicians in selecting appropriate patients for adjuvant treatment and will provide guidelines for the optimal delivery of adjuvant radiation therapy and chemotherapy.
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Neoadjuvant chemotherapy has become the standard of care for patients with locally advanced breast cancer, large tumors, certain biologic subtypes of breast cancer, or locally inoperable disease, and for patients who desire breast conservation. It has the advantage of downstaging the tumor, thereby allowing for conversion from mastectomy to breast conservation, and perhaps decreasing the need for axillary lymph node dissection (ALND). ⋯ With neoadjuvant chemotherapy, some patients exhibit a complete clinical axillary response, which may make them candidates for sentinel lymph node biopsy (SNLB) rather than ALND, with its associated morbidities. While there is widespread use of SLNB in the treatment of breast cancer, its use following neoadjuvant chemotherapy remains widely debated.