1. The following alterations are critical for malignant
cancer growth: self-sufficiency of growth signals, insensitivity
to growth-inhibitory signals, evasion of apoptosis, potential for
limitless replication, angiogenesis, and invasion and metastasis.
2. Understanding cancer biology is essential to successfully implement
personalized cancer therapy.
3. Modern cancer therapy is multidisciplinary, involving coordinated
care by surgeons, medical oncologists, radiation oncologists, reconstructive
surgeons, pathologists, radiologists, and primary care physicians.
As the population ages, oncology is becoming a larger portion
of surgical practice. The surgeon often is responsible for the initial diagnosis
and management of solid tumors. Knowledge of cancer epidemiology,
etiology, staging, and natural history is required for initial patient
assessment, as well as to determination of the optimal surgical
Modern cancer therapy is multidisciplinary, involving the coordinated
care of patients by surgeons, medical oncologists, radiation oncologists,
reconstructive surgeons, pathologists, radiologists, and primary
care physicians. Primary (or definitive) surgical
therapy refers to en bloc resection of tumor with adequate
margins of normal tissues and regional lymph nodes as necessary. Adjuvant
therapy refers to radiation therapy and systemic therapies,
including chemotherapy, immunotherapy, hormonal therapy, and, increasingly,
biologic therapy. The primary goal of surgical and radiation therapy
is local and regional control. On the other hand, the primary goal
of systemic therapy is systemic control by treatment of distant
foci of subclinical disease to prevent distant recurrence. Surgeons
must be familiar with adjuvant therapies to coordinate multidisciplinary
care and to determine the best sequence of therapy.
Recent advances in molecular biology are revolutionizing medicine. Nowhere
has basic biology had a greater and more immediate impact than in
oncology. New information is being translated rapidly into clinical
use, with the development of new prognostic and predictive markers
and new biologic therapies. It is therefore essential that surgeons
understand the principles of molecular oncology to appropriately
interpret these new contributions and incorporate them into practice.
of Cancer Epidemiology
The term incidence refers to the number of new
cases occurring; incidence usually is expressed as the number of
new cases per 100,000 persons per year. Mortality refers
to the number of deaths occurring and is expressed as the number
of deaths per 100,000 persons per year. Incidence and mortality
data are usually available through cancer registries. Mortality
data are also available as public records in many countries where
deaths are registered as vital statistics, often with the cause
of death. In areas where cancer registries do not exist, mortality
data are used to extrapolate incidence rates. However, these numbers
are likely to be less accurate than registry data, because the relationship
between incidence and cause-specific death is likely to vary significantly
among countries owing to the variation in health care delivery.
The incidence of cancer varies by geography. This is due in part
to genetic differences and in part to differences in environmental
and dietary exposures. Epidemiologic ...