Diagnosing and Treating Adult Cancers and Associated Impairments (2021) / Chapter Skim
Currently Skimming:
7 Selected Topics in Other Cancers
7 Selected Topics in Other Cancers
Pages 193-218
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From page 193... ...
Given the prevalence of these other cancers and the committee's task of providing "an overview of the current status of the diagnosis, treatment, and prognosis of adult cancers including, but not limited to, breast cancer and lung cancer," this chapter presents epidemiologic and other new information for the following selected cancers: • Gastrointestinal cancers -- colorectal cancer, pancreatic cancer, and liver and bile duct cancers; • Hematologic cancers -- leukemias, lymphomas, and multiple my eloma/plasma cell cancers; • Ovarian cancer; • Head and neck cancers; and • Melanoma. This chapter does not attempt to review comprehensively the epidemiology, diagnosis, treatment, and prognosis for all the cancers for which SSA receives large numbers of claims, but rather focuses on those cancers 193
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From page 194... ...
The three most common types of gastrointestinal cancer are colorectal cancer, pancreatic cancer, and liver and bile duct cancers, and each of these cancer types is represented in the 10 most frequent cancer diagnoses seen in SSA disability claims (see Chapter 2)
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Whether an individual is presenting for a positive screening test or for symptoms, most colorectal cancers are diagnosed with biopsy during a colonoscopy or flexible sigmoidoscopy. Once a diagnosis of colon or rectal cancer is confirmed, staging is performed with a computed tomography (CT)
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From page 196... ...
Patients with cancer recurrence identified during surveillance can be evaluated for additional surgery for curative intent, and at least some patients will have long-term, cancer-free survival without ever undergoing surgery. Morbidities related to the treatment of nonmetastatic colon and rectal cancers include adverse effects of the chemotherapy, surgery, and radiation.
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From page 197... ...
. There are no effective general population screening approaches for pancreatic cancer, and most pancreatic cancers are diagnosed at an advanced stage, where distant metastasis or local encasement of major abdominal blood vessels renders surgical resection infeasible.
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From page 198... ...
Following successful pancreatic cancer surgery, adjuvant chemotherapy can help reduce the risk of cancer recurrence. Patients who are candidates for pancreatic cancer resection are increasingly treated with neoadjuvant chemotherapy.
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Bile duct cancer, or cholangiocarcinoma, is another form of cancer that can affect the liver and the bile duct system. While bile duct cancers share similar risk factors with hepatocellular cancers, they are treated differently (ACS, 2019b)
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. Because bile duct cancers are adenocarcinomas, like many other solid tumors, it can be difficult to distinguish intrahepatic bile duct cancers from liver metastases arising from an occult tumor site; this makes intrahepatic bile duct cancer a diagnosis of exclusion when liver tumors are found in the absence of another suspected primary cancer site.
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From page 201... ...
cancers include leukemias, lymphomas, and myelomas. Leukemias and lymphomas account for a significant proportion of disability claims for cancer, at 5% each, while myelomas are not among the top 10 cancers for which SSA receives disability claims (see Chapter 2)
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Leukemia is among the 10 most commonly diagnosed cancers in the United States (3.5% of all newly diagnosed cancers in 2019)
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From page 203... ...
In the latter case it is recommended that patients undergo HSCT after receiving treatment for their relapse so that the bone marrow has minimal or no leukemia cells present prior to HSCT. The goals of HSCT are to replace a patient's unhealthy bone marrow cells with a donor's healthy bone marrow and to allow the donor's healthy cells to attack and remove microscopic leukemia cells that may remain in a patient's system after the transplant.
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From page 204... ...
As CLL often is associated with a relapsing and remitting disease course, the development of new drugs may result in better long-term survival; however, there are few data on the long-term and late-onset effects of these newer agents. Lymphomas Lymphomas may best be classified into non-Hodgkin lymphoma (NHL)
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. Hodgkin lymphoma, in contrast to NHL, is most commonly diagnosed in adults aged 20 to 34 years (the median age at diagnosis is 39.5 years old)
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. Despite the excellent survival rates, however, Hodgkin lymphoma survivors are at risk for the development of significant late-onset effects as they may live for decades after their cancer diagnosis.
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OVARIAN CANCER Ovarian cancer is relatively rare and is not among the estimated 10 most frequently diagnosed cancers in 2020 for U.S. women (SEER, n.d.-k)
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. MELANOMA The committee included melanoma of the skin in this chapter because, although it is not among the most common cancers for which SSA receives disability claims, there are advances in new therapies that are improving mortality and increasing the likelihood that some survivors with incurable, metastatic melanoma will be able to resume many of their daily activities.
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2. Most pancreatic cancers are diagnosed at an advanced stage, mak ing surgery infeasible.
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Conclusion 1. In addition to the improvements previously described in the treat ment of breast and lung cancer, there have been important im provements in the treatment of other common cancers for which SSA receives disability claims.
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2020b. Non-Hodgkin lymphoma causes, risk factors, and prevention.
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From page 212... ...
2015. FOLFOXIRI plus bevacizumab versus FLOFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: Updated overall survival and molecu lar subgroup analyses of the open-label, phase 3 TRIBE study.
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2019. Niraparib in patients with newly diagnosed advanced ovarian cancer.
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2014. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3)
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2019. NCCN clinical practice guidelines in oncology: Ovarian cancer including fallopian tube cancer and primary peritoneal cancer, version 1.2019.
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n.d.-g. Cancer stat facts: Liver and intrahepatic bile duct cancer.
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2016. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study.
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2017. Neoadjuvant chemotherapy versus primary debulking surgery in advanced epithelial ovarian cancer: A meta-analysis of peri-operative outcome.
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