ORIGINAL ARTICLE. The National Cancer Data Base Report on Cancer of the Head and Neck

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "ORIGINAL ARTICLE. The National Cancer Data Base Report on Cancer of the Head and Neck"

Transcription

1 ORIGINAL ARTICLE The National Cancer Data Base Report on Cancer of the Head and Neck Henry T. Hoffman, MD; Lucy Hynds Karnell, PhD; Gerry F. Funk, MD; Robert A. Robinson, MD; Herman R. Menck, MBA Background: The National Cancer Data Base (NCDB), a large sample of cancer cases accrued from hospitalbased cancer registries, is sponsored by the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The NCDB permits a detailed analysis of case-mix, treatment, and outcome variables. Objective: To provide an overview of the contemporary status of the subset of patients with head and neck cancer in the United States. Methods: The NCDB, which obtains data from US as well as Canadian and Puerto Rican hospitals, accrued cases of cancer between 1985 and Of these cases, (6.6%) originated in the head and neck. We address cases of head and neck cancer limited to the 50 United States and District of Columbia. Cases were segregated into an earlier group ( ) to permit 5-year follow-up and into a later group ( ) to analyze a more contemporary group. Comparison between both periods permits identification of trends. Results: The largest proportion of cases arose in the larynx (20.9%) and oral cavity, including lip (17.6%) and thyroid gland (15.8%). Squamous cell carcinoma (55.8%) was the most common histological finding, followed by adenocarcinoma (19.4%) and lymphoma (15.1%). Income level (low), race (African American), and tumor grade (poorly differentiated) were most notably associated with advanced stage. Treatment was most commonly surgery alone (32.4%), combined surgery with irradiation (25.0%), and irradiation alone (18.9%). Overall 5-year, disease-specific survival was 64.0%. Cancer of the lip demonstrated the best survival (91.1%) and cancer of the hypopharynx the worst survival (31.4%). Conclusions: This NCDB analysis of cancer of the head and neck provides a contemporary overview of head and neck cancer in the United States. It also serves to introduce a series of NCDB articles that address specific anatomical sites and histological types through separate, detailed analysis. Arch Otolaryngol Head Neck Surg. 1998;124: From the Departments of Otolaryngology Head and Neck Surgery (Drs Hoffman, Karnell, and Funk) and Pathology (Dr Robinson), University of Iowa Hospitals and Clinics, Iowa City; and National Cancer Data Base, Commission on Cancer of the American College of Surgeons, Chicago, Ill (Mr Menck). THE NATIONAL Cancer Data Base (NCDB) is a large sample of cancer cases accrued from hospital-based cancer registries in the United States. This database is jointly sponsored by the American College of Surgeons Commission on Cancer (COC) and the American Cancer Society. It is designed to provide descriptive information about the demographic, management, and outcome variables characterizing cancers involving all ethnic groups in all 50 states. National cancer registries have been functioning for many years in other countries. The most highly developed registries currently exist in European countries with small populations that include Sweden, Norway, and Denmark. 1-6 In 1988 the United States established its national clinical cancer registry with the creation of the NCDB. 7,8 Although there is no current system for gathering incidence data for the entire United States, a population-based registry termed the Surveillance, Epidemiology, and End Results program 9 exists to provide estimates of cancer-related incidence and mortality. This program, which was mandated by the National Cancer Act of 1971, currently surveys 14 distinct population groups representing approximately 14% of the population. 10 The Surveillance, Epidemiology, and End Results and the NCDB programs are separate cancer data systems that are designed for different purposes and rely on different methodologies. 11 The Surveillance, Epidemiology, and End Results program is a population-based registry that is intended to accurately sample a measurable segment of the US population. The NCDB is a hospital-based registry that monitors patterns from a much larger pa- 951

2 MATERIALS AND METHODS The NCDB data are collected yearly on a voluntary basis through a computerized format from hospital-based cancer registries. 7 The NCDB cancer registry data are coded according to schemata published in the Data Acquisition Manual, 14,15 the first through the fourth editions of the American Joint Committee on Cancer (AJCC) Manual for Staging of Cancer, and the second edition of the International Classification of Disease for Oncology (ICD-O 2). 20 The head and neck cancer data set was defined by the ICD-O 2 topography codes and included the lip, oral cavity, oropharynx, nasopharynx, hypopharynx, and major salivary glands (C ), sinonasal tract (C30.0, ), and larynx (C ). Although the lip is included with other subsites in the oral cavity according to AJCC staging, its behavior is sufficiently different from the remainder of the oral cavity that it was considered separately in this article. Other head and neck sites included in the head and neck data set were the middle ear (C30.1), trachea (C33.9), eye and ocular adnexa (C ), olfactory nerve (C72.2), thyroid gland (C73.9), parathyroid glands (C75.0), and other endocrine gland related structures (C75.2, C ), excluding the pineal and pituitary glands. Additional sites isolated to the head and neck included bones, joints, and articular cartilages (C ), peripheral nerves and autonomic nervous system (C47.0), connective, subcutaneous, and other soft tissues (C49.0), and lymph nodes (C77.0). The nonspecific sites within the head and neck classified as other and ill-defined (C76.0) were also included. The reporting hospitals provide only those cases that were diagnosed and/or treated at their institute as a primary cancer. Although patients are followed up longitudinally and recurrent disease is added to their record if identified, the NCDB does not collect records of patients who were identified at the reporting hospital with recurrent disease. To ensure that the database does not include more than 1 record for each patient (eg, a patient having received primary treatment at 2 different reporting hospitals), an algorithm based on patient and disease characteristics was used to identify and remove these duplicate records. Patterns of presentation and treatment across time are investigated by dividing the years of diagnosis into an earlier period ( ) and a later period ( ). Case-mix characteristics and treatment are stratified by anatomical site and extent of disease, when appropriate, to provide a more detailed analysis. Patients were classified by geographic regions that were organized by grouping individual states into 6 regions as previously reported. 7 Income was inferred for each patient based on the average family income of the ZIP code of residence. To compare the level of income of patients with head and neck cancer with the income of all patients with cancer within the NCDB, 3 income groups were created. These income groups were chosen to approximate the lowest 10%, the highest 10%, and intermediate incomes for all NCDB cases. 21 The low-income group included patients with annual incomes of less than $ that represented 11.2% of the NCDB data set. The high-income group included patients with annual incomes of $ or more, which represented 10.3% of the NCDB data set. Extent of disease was represented by combined stage that reflects pathologic staging (pajcc stage group) when it was available through the reporting cancer registrar s tient base derived from community hospitals, teaching hospitals, and cancer centers. 8 The goal of the NCDB is to improve cancer management through analysis of data characterizing a large proportion of all cases of cancer in the United States. To help achieve this goal, the NCDB has established the objective to collect 80% of all US incident cancers by the year The first call for data by the NCDB yielded an estimated 24% of all cancer cases diagnosed in This sample represented cases reported from 501 hospitals. The number of participating NCDB hospitals and cases accrued for the year 1994 increased to 1227 hospitals reporting cases, reflecting an estimated 57% of all cancer cases. This increase in reporting over the past 9 years has paralleled an increase in the number of hospital cancer registries that have become computerized. An additional impetus to increased reporting of cases is a mandate established by the COC. Since 1997, all hospitals participating in the COC s approvals program are required to submit data to the NCDB. Continued expansion in the accrual of cases is anticipated as more hospitals fulfill these requirements. Before 1997 the COC did not require reporting of data to the NCDB. The NCDB obtained reports on a voluntary basis from those institutions that elected to contribute data from their cancer registries. As a result, the database prior to 1997 must be considered a convenience sample with the potential to be affected by a selection bias that could skew the sampling of cases. Despite these potential limitations in data collection, the large numbers of cases accrued offer demographic, management, and outcome information from a broad spectrum of treating facilities in the United States. A recent comparison between NCDB and Surveillance, Epidemiology, and End Results data identified patterns that differed only marginally in the analysis of breast, colorectal, lung, and prostate cancers evaluated for the diagnostic year We address the subset of the NCDB cancer cases limited to the head and neck. Most cancers commonly grouped as head and neck malignancies arise from the mucosal lining of the upper aerodigestive tract and the adjacent salivary glands. Thyroid, parathyroid, sinonasal, and ocular cancers are also considered cancers of the head and neck. In addition to cancers arising in these sites, lymphomas and other less common tumors that arise from the adjacent soft tissue, bone, and cartilaginous structures in the head and neck region are considered in this article. Skin cancers that occur in the head and neck region are not included in this review. Brain malignancies are not generally classified as cancers of the head and neck and are also not considered herein. To date, reports from the NCDB of cancers of the head and neck have been limited to the larynx 12 and thyroid gland. 13 We present the first analysis of the NCDB providing a broad review of cancer of the head and neck. 952

3 review of the chart, and clinical stage (cajcc stage group) when pathologic stage was not recorded or not appropriate. Cases were broadly grouped into general histological categories according to the ICD-O 2 morphologic codes. These groups were carcinoma not otherwise specified (NOS) (M8010, M ), squamous cell carcinoma (M ), verrucous carcinoma (M8051), adenocarcinoma (M ), and lymphoma (M ). All other histological codes for these head and neck sites were combined into a category labeled other. A substantial proportion of thyroid cancers were categorized as papillary carcinoma, NOS (M8050), which is a subset of squamous cell carcinomas. Analysis of the database indicated that 99.6% of the papillary carcinoma, NOS cases were thyroid in origin. This classification of thyroid papillary carcinoma as a subset of squamous cell carcinoma was interpreted as a coding error. As a result, thyroid cancers coded as papillary carcinoma, NOS (M8050) were recoded as papillary adenocarcinoma, NOS (M8260). Although distinct grading schemes are used for cancers that differ by specific morphologic and anatomical site grouping, the NCDB uses the World Health Organization s 20 standard grading system. This system provides 4 separate grades (and the additional category unknown ) for all cancers except lymphomas and leukemias. Through review of pathology reports, hospital-based cancer registrars assign grade 1 (well differentiated), grade 2 (moderately differentiated, moderately well differentiated, or intermediate differentiation), grade 3 (poorly differentiated), grade 4 (undifferentiated or anaplastic), or grade unknown to all cases. According to this scheme, when chart review reveals 2 different degrees of grading, the higher code is used. As a result, a neoplasm considered poorly differentiated with areas that are undifferentiated would be considered grade 4 (undifferentiated or anaplastic). Cases without numeric grading but described as low grade or partially well differentiated are considered grades 1 to 2, and therefore are recorded as grade 2. Cases described as medium grade are considered to be grades 2 to 3, and therefore are coded as grade 3. Moderately differentiated or relatively undifferentiated cancers are considered grade 3 and coded as such. Cases listed as high grade are considered grades 3 to 4, and therefore are recorded as grade 4. 15,22 Treatment presented in this report is limited to the first course of cancer-directed therapy used to manage the primary tumor. This initial cancer-directed therapy may include a combination of modalities and may span many weeks or several months if irradiation or multiple cycles of chemotherapy are included in the original treatment plan. Subsequent therapy to address recurrences is not included herein. All analyses were performed using SPSS statistical software. 23 Survival analyses represent annual diseasespecific rates with the date of diagnosis as the starting point and the date of death with cancer as the end point. For the purposes of this survival analysis, it was assumed that the cause of death was cancer for those patients whose status at last follow-up was recorded as dead with cancer. 2 Statistics were performed on selected contingency tables and pairwise comparisons were performed on selected survival rates. Because of the large number of patients within this sample, all resultant P Therefore, no inferential statistics were reported. Instead, most data were presented in stratified form (eg, cross-tabulations) so that clinically relevant associations could be directly assessed. RESULTS Cancers of the head and neck represented 6.6% of all NCDB cases between 1985 and 1995 (range, 6.1%-7.6% per year) (Figure 1). From these overall counts, cases from reporting hospitals outside the United States (ie, Canada and Puerto Rico) were excluded from analysis, dropping the total number to Approximately 25% of the patients with cancer of the head and neck were accrued from smaller community hospitals, 33% from larger community hospitals, 33% from teaching and National Cancer Institute designated institutes, and the remaining 9% from other types of hospitals (eg, freestanding cancer programs). Year Figure 1. Reported cancers by diagnosis year All Cases Cases of Head and Neck Cancer PATIENT CHARACTERISTICS Demographic data were segregated into cases from the earlier period ( ) and cases from the more current period ( ). Age distribution remained stable across the years, with the 60- to 69-year-old cohort representing the largest percentage of cases (27.0%) (Table 1). Males outnumbered females at a ratio of approximately 1.5:1 that remained stable across the periods studied. The proportion of patients considered non-hispanic African American increased from 8.0% to 8.8% from the earlier to the later period. There was a concurrent decrease from 4.4% to 4.0% in patients labeled other/unknown. Reporting from the 6 regions of the United States was lowest from the Mountain region ( cases) and highest from the Midwest ( cases). Income groupings were designed to broadly classify patients according to an approximation of the lowest and highest 10% of annual family incomes in the United States. Patients with cancer of the head and neck were disproportionately overrepresented in the lowerincome group (13.8%) and underrepresented in the higher-income group (9.6%). The income grouping of 953

4 Table 1. Patient Characteristics by Diagnostic Year for Cancers of the Head and Neck* Characteristic Total Age, y (6.8) (6.4) (6.5) (6.9) (7.7) (7.4) (10.5) (11.7) (11.2) (19.3) (18.1) (18.6) (28.2) (26.2) (27.0) (20.2) (20.8) (20.6) (7.9) (8.9) (8.5) Unknown 293 (0.2) 426 (0.2) 719 (0.2) Sex Male (60.5) (59.6) (60.0) Female (39.3) (40.3) (39.8) Unknown 236 (0.2) 251 (0.1) 487 (0.2) Race/ethnicity White non-hispanic (84.8) (83.8) (84.3) African American, non-hispanic 9426 (8.0) (8.8) (8.5) Hispanic (any race) 3314 (2.8) 5975 (3.4) 9289 (3.1) Other/unknown 5159 (4.4) 7080 (4.0) (4.1) Income Low, $ (13.8) (13.9) (13.8) Middle, $ (77.0) (76.3) (76.6) High, $ (9.2) (9.8) (9.6) Subtotal Known Income (100) (100) (100) Other/unknown 5483 (4.6) 9262 (5.2) (5.0) Total Geographic region Northeast (17.8) (19.5) (18.8) Southeast (17.2) (19.5) (18.6) Midwest (25.1) (23.5) (24.1) South (13.9) (17.2) (15.9) Mountain 7919 (6.7) 8773 (5.0) (5.7) Pacific (19.3) (15.3) (16.9) *All values are presented as number (percentage). Income grouping based on the lowest ( $20 000) and highest ( $47 000) 10% of all patients with cancer from the National Cancer Data Base data set. Percentages based on total cases. Table 2. Anatomical Site by Income for Patients With Cancer of the Head and Neck (All Years)* Income Level Site Cases Low Middle High Unknown Lip Oral cavity Oropharynx Nasopharynx Hypopharynx Pharynx, NOS Larynx Major salivary gland Thyroid gland Sinonasal Eye and adnexa Other *Income grouping based on the lowest ( $20 000) and highest ( $47 000) 10% of all patients with cancer on the National Cancer Data Base data set. All data are presented as percentages. NOS indicates not otherwise specified. patients varied substantially according to the anatomical site of the cancer (Table 2). Except for those patients with nasopharyngeal cancer, more than 15% of all patients with pharyngeal cancer were considered low income. The sites with the greatest proportion of patients in the high-income category were the thyroid gland (12.8%), other (10.6%), and major salivary glands (9.8%). DISEASE CHARACTERISTICS The largest number of tumors arose in the larynx (20.8%) and was followed in decreasing order by the oral cavity, including lip (17.6%), thyroid gland (15.8%), and the oropharynx (12.3%) (Table 3). The major salivary glands, which include the submandibular, sublingual, and parotid glands, were the site of origin in 4.5% of cases. The predominant histological type was squamous cell carcinoma, which represented 55.8% of all cases. Adenocarcinomas demonstrated the largest proportional change in histological types across the 2 periods; the increase from 18.2% to 20.3% represented an 11.5% proportional change 954

5 Table 3. Disease Characteristics by Diagnostic Year for Cancers of the Head and Neck* Characteristic Total Site Lip 4375 (3.7) 5899 (3.3) (3.5) Oral cavity (14.7) (13.7) (14.1) Oropharynx (12.2) (12.4) (12.3) Nasopharynx 3069 (2.6) 4488 (2.5) 7557 (2.6) Hypopharynx 5225 (4.4) 7356 (4.2) (4.3) Pharynx, NOS 1918 (1.6) 2475 (1.4) 4393 (1.5) Larynx (21.5) (20.5) (20.8) Major salivary glands 5160 (4.4) 8025 (4.5) (4.5) Thyroid gland (14.5) (16.7) (15.8) Sinonasal 3611 (3.1) 5321 (3.0) 8932 (3.0) Eye and adnexa 3383 (2.9) 5977 (3.4) 9360 (3.2) Other (14.4) (14.4) (14.4) Histological findings Squamous cell carcinoma (57.6) (54.5) (55.8) Adenocarcinoma (18.2) (20.3) (19.4) Verrucous cancer 739 (0.6) 971 (0.5) 1710 (0.6) Carcinoma, NOS 3104 (2.6) 4687 (2.7) 7791 (2.6) Lymphoma (14.7) (15.4) (15.1) Other 7435 (6.3) (6.6) (6.5) Combined stage (2.9) 3735 (2.6) 5748 (2.7) I (35.8) (36.2) (36.1) II (19.0) (19.4) (19.2) III (17.5) (16.1) (16.5) IV (24.8) (25.7) (25.4) Subtotal Known Stage (100) (100) (100) Unknown stage (40.8) (18.3) (27.3) Total Grade, differentiation 1, Well (26.8) (24.2) (25.3) 2, Moderate (43.1) (45.4) (44.5) 3, Poor (25.8) (25.9) (25.8) 4, Undifferentiated 2817 (4.3) 4463 (4.5) 7280 (4.4) Subtotal Known Grade (100) (100) (100) Unknown grade (44.7) (44.2) (44.4) Total Treatment Surgery only (32.2) (32.4) (32.4) RT only (20.2) (18.0) (18.9) Chemotherapy only 6498 (5.5) 9558 (5.4) (5.4) Surgery and RT (24.1) (25.6) (25.0) Surgery and chemotherapy 2283 (1.9) 3990 (2.3) 6273 (2.1) RT and chemotherapy 6501 (5.5) (6.3) (6.0) All (2.4) 4587 (2.6) 7378 (2.5) No treatment 7899 (6.7) (5.9) (6.2) Unknown 1759 (1.5) 2675 (1.5) 4434 (1.5) *NOS indicates not otherwise specified; RT, radiation therapy. All values are presented as number (percentage). Combined stage represents AJCC pathologic stage, augmented by clinical stage where pathologic stage is not available. Percentage based on total cases. in these 2 percentages. This increase paralleled a similar increase in the proportion of thyroid cancers. A smaller 4.8% increase in the proportion of cases that were lymphoma was noted between (14.7%) and (15.4%). A larger proportionate increase was noted for cases of lymphoma arising from the mucosal lining of the upper aerodigestive tract and adjacent salivary glands (data not shown). Among those cases that were staged, the distribution remained stable across the 2 periods. Most cases were stage I (36.2%). A marked decrease in the proportion of cases without known stage occurred between (40.8%) and (18.3%). There was virtually no change across these years in the proportion of cases with unknown grade. Degree of differentiation was recorded as unknown in 44.7% of cases and in 44.2% of cases. The most common initial management strategies used were surgery alone (32.4%), surgery combined with irradiation (25.0%), and irradiation alone (18.9%). In gen- 955

6 Table 4. Anatomical Site by Histological Features for Cancers of the Head and Neck (All Years)* Site No. of Cases SCC Adenocarcinoma Verrucous Carcinoma, NOS Lymphoma Other Lip Oral cavity Oropharynx Nasopharynx Hypopharynx Pharynx, NOS Larynx Major salivary gland Thyroid gland Sinonasal Eye and adnexa Other *SCC indicates squamous cell carcinoma; NOS, not otherwise specified. All values are presented as percentage. eral, there was no substantial change between and in type of treatment. However, a notable increase in combined radiotherapy and chemotherapy was identified across the 2 periods. This combined modality approach accounted for 5.5% of patients treated in the earlier period and 6.3% of patients treated in the more current period, reflecting a proportionate increase of 14.5%. Most cancers arising from mucosal surfaces of the upper aerodigestive tract (lip, oral cavity, pharynx, and larynx) were squamous cell carcinoma (Table 4). Adenocarcinoma was the most common histological type among thyroid gland (92.0%) and major salivary gland (55.4%) malignancies. Lymphoma comprised 79.8% of the cases originating in the site termed other, which includes lymph nodes of the head, face, and neck. The proportion of lymphoma cases arising at designated sites was greatest for eye and ocular adnexa (18.0%), major salivary glands (13.9%), sinonasal (12.0%), and nasopharynx (10.2%). Although lymphoma represented only 6.8% of cases in the oropharynx, this site was second only to other in the absolute number of lymphoma cases. The number of cases classified as carcinoma, NOS was greatest in the larynx and thyroid gland. Although the absolute number of these cases was smaller in the nasopharynx than the larynx or thyroid gland, the nasopharyx had the largest proportion (15.1%) of carcinoma, NOS cases. Verrucous carcinoma was most common in the oral cavity and larynx, where it constituted 2.0% and 1.0% of cases, respectively. PATIENT AND DISEASE CHARACTERISTICS Cross-tabulations of patient and disease characteristics by stage (Table 5) indicated that a greater proportion of advanced-stage cancers (stages III and IV) occurred among the lower-income group, the geographic region of the Southeast, and African Americans. Sex also was associated with differences in stage distribution. There were more advanced-stage cancers and fewer stage I cancers in the male group. These differences must be interpreted in the context of other sex differences. Thyroid cancer, which is dominated by early-stage disease, occurs in women more frequently than in men (data not shown). Stage I cancers were most common in the younger ( 40 years) patients. Stage IV cancers were more common among the middle-age (50-69 years) group. Grade was closely associated with extent of disease when grouped as early (stages I and II) and advanced (stages III and IV) disease. The ratio of early-to-advanced stage was 2.4:1 for well-differentiated cancers and 0.5:1 for poorly differentiated cancers. Laryngeal, thyroid, lip, salivary gland, and eye and ocular adnexa cancers were predominately localized (stages I and II), whereas cancers arising in the sinonasal and pharyngeal sites were more commonly advanced (stages III and IV). Cancers of the oral cavity were evenly divided between localized and advanced stages. Squamous cell carcinoma and carcinoma, NOS were most commonly stage IV. Adenocarcinoma, verrucous carcinoma, and lymphoma were most commonly stage I. TREATMENT The distribution of treatments varied by site (Table 6). Surgery was the most common treatment for cancers of the lip (85.2%), thyroid gland (54.8%), eye and ocular adnexa (50.6%), and oral cavity (46.2%). Irradiation was the most common treatment for cancers of the nasopharynx (37.5%), larynx (33.0%), and oropharynx (27.3%). Combined surgery with irradiation was the most common treatment for major salivary glands (42.4%) and hypopharyngeal cancer (29.9%). Combined chemotherapy and irradiation was used to treat 23.5% of nasopharyngeal, 13.2% of hypopharyngeal, and 11.4% of oropharyngeal cancers. Only 3.5% of patients with laryngeal cancers were treated with combined chemotherapy and irradiation. OUTCOME The overall median follow-up for all cases in the early period ( ) was 37 months compared with 10 months for the later ( ) period (Table 7). It is clear that survival analysis would cover a limited follow-up for patients accrued in the period. As a result, survival analysis was limited to cases accrued in the period. Through analysis that excludes the small number of patients with unknown sta- 956

7 Table 5. Patient and Disease Characteristics by Combined Stage for Cancers of the Head and Neck (All Years)* Characteristics Combined Stage 0 I II III IV No. of Staged Cases Unstaged Cases No. of Total Cases Age, y Sex Male Female Race/ethnicity White, non-hispanic African American, non-hispanic Hispanic (any race) Income Low Middle High Geographic region Northeast Southeast Midwest South Mountain Pacific Site Lip Oral cavity Oropharynx Nasopharynx Hypopharynx Pharynx, NOS Larynx Major salivary gland Thyroid gland Sinonasal Eye and adnexa Other Grade, differentiation 1, Well , Moderate , Poor , Undifferentiated Histological findings SCC Adenocarcinoma Verrucous Carcinoma, NOS Lymphoma Other *NOS indicates not otherwise specified; SCC, squamous cell carcinoma. All values are presented as percentages unless otherwise noted. Income groupings based on the lowest ( $20 000) and highest ( $47 000) 10% of all patients with cancer on the National Cancer Data Base data set. tus, 49.8% of patients diagnosed in the earlier period were dead at last contact (with or without known cancer). Among the patients who were alive at last follow-up, 62.5% were without evidence of recurrent cancer. The median follow-up time for those who were alive at last contact with cancer was 44 months. Five-year, disease-specific survival for all cases of head and neck cancers diagnosed from was 64.0%. When analyzed by site, patients with cancer of the lip demonstrated the highest survival rate (91.1%), whereas patients with cancer of the hypopharynx demonstrated the lowest survival rate (31.4%) (Figure 2 and Figure 3). When analyzed by histological findings (Figure 4), the highest 5-year survival was noted for patients with adenocarcinoma (87.6%) and verrucous carcinoma (78.6%). The lowest survival rate was noted for 957

8 Table 6. Anatomical Site by Treatment for Cancers of the Head and Neck (All Years)* Site No. of Cases Surgery Only RT Only CH Only Surgery and RT Surgery and CH RT and CH All 3 None Unknown Lip Oral cavity Oropharynx Nasopharynx Hypopharynx Pharynx, NOS Larynx Major salivary gland Thyroid gland Sinonasal Eye and adnexa Other *RT indicates radiation therapy; CH, chemotherapy; and NOS, not otherwise specified. All values are percentages unless noted otherwise. Table 7. Median Follow-up by Status at Last Contact by Diagnostic Year for Cancers of the Head and Neck* Status Cases Median, mo patients with carcinoma, NOS (47.4%) and squamous cell carcinoma (56.9%). COMMENT Cases Median, mo Dead, no cancer Dead with cancer Dead, cancer unknown Alive, no cancer Alive with cancer Alive, cancer unknown Unknown All cases *Follow-up is equivalent to the duration from date of diagnosis to date of last contact (or death, if applicable). The median follow-up for all cases, all years, is 13 months (N = ). To our knowledge, this report of cancer of the head and neck represents the largest to date. Although specific cancer management decisions cannot be made from such a broad survey, our analysis provides a background for more specific forthcoming analyses of the NCDB data set addressing individual histological types and sites. Statistics addressing head and neck neoplasms are often misinterpreted due to groupings of dissimilar cancers. For example, the oral cavity has frequently been reported as the most common site for malignancies of the head and neck. 24 An artificially high number of cancers of the oral cavity has been reported as a result of grouping cancers of the salivary glands, the oropharynx, and even the hypopharynx together with cancers of the oral cavity. 25,26 The proper grouping of cases according to site as defined by the 1992 edition of the AJCC staging manual more accurately reflects a lower proportion of cases arising in the oral cavity. 19 Analysis of the NCDB data using this AJCC classification identifies that laryngeal cancer is the most common head and neck malignancy in the United States and outnumbers cancers of the oral cavity (including cancers of the lip) at a ratio of 1.2:1. It is reasonable to expect that the vast majority of cancer cases arising in the thyroid gland, pharynx, larynx, oral cavity, and salivary glands are entered into a hospitalbased cancer registry on diagnosis. 27 In contrast, small cancers of the lip may be evaluated and treated in physician offices outside the hospital. If the analysis of the pathological findings from the biopsy or surgical excision of the lip cancer was not performed by a hospital-based pathologist, the case may not have been entered into a hospital registry. As a result, the sampling of lip cancer data may not be as complete as for the other sites of the head and neck. PATIENT CHARACTERISTICS It is noteworthy that cancer of the head and neck disproportionately affects the elderly and individuals in the lowerincome bracket. Males are also represented to a much greater degree in the database than females. This sex disparity reflects the greater prevalence of squamous cell carcinoma among males. Although cancers of the thyroid and salivary glands affect females most commonly, the overall dominance of squamous cell carcinoma in the head and neck region is associated with a male predominance. Changes in demographic data across the 2 periods were noted. A 10.0% proportionate increase in African Americans (from 8.0% to 8.8%) and a 21.4% proportionate increase in Hispanic patients (from 2.8% to 3.4%) occurred in the NCDB composition. These changes may partially reflect changes in the population of the United States over the course of the study. It is likely that the changes noted are partly due to a true increase in the incidence of cancer of the head and neck among these minority groups. 9 Other studies 9,28-30 have noted the number of head and neck mucosal cancers to be disproportionately greater among African Americans than whites and to be increasing in this minority group. DISEASE CHARACTERISTICS An 11.5% proportionate increase in the histological group adenocarcinoma occurred between (18.2%) and (20.3%). This increase in adenocarcino- 958

9 Alive, % 50 Alive, % Lip Larynx Oral Cavity Nasopharynx Oropharynx Hypopharynx Thyroid Gland Eye and Adnexa Major Salivary Glands Other Sinonasal Year Site Cases Lip Larynx Oral Cavity Nasopharynx Oropharynx Hypopharynx Figure 2. Five-year, disease-specific survival by site (mucosal surface of aerodigestive tract) for cases of head and neck cancers Year Site Cases Thyroid Gland Eye and Adnexa Major Salivary Glands Other Sites Sinonasal Figure 3. Five-year, disease-specific survival by site (other) for cases of head and neck cancers. mas paralleled a 13.2% proportionate increase in cases of thyroid cancer (from 14.5% in to 16.7% in ). An increase in thyroid cancer worldwide has been identified. Although the artifact of improved record keeping has been implicated, it is likely that other factors also account for this increase. 31 A large number of children were subjected to therapeutic radiotherapy for conditions such as acne and adenoid enlargement before The aging of this population who had been exposed to therapeutic irradiation in childhood has been cited as a primary cause for the increase in thyroid cancers. 32 The development of more advanced diagnostic methods has also been cited as instrumental in increasing the identified number of thyroid cancers. 33 The increased use of sophisticated radiographic imaging as well as expanded use of fine-needle aspirate biopsies may identify small, previously undetectable cancers. A 17.2% proportionate increase in eye and ocular adnexal cancers occurred between (2.9%) and (3.4%). The largest component of this change was an increase in ocular lymphoma (data not shown). The proportion of lymphoma cases within the entire head and neck database also increased, from 14.7% in to 15.4% in This increase in lymphoma may result from an increase in the number of cases occurring in patients with immunodeficiency that parallels an increase in the prevalence of human immunodeficiency virus infection, transplant operations, and use of medical treatments (eg, chemotherapy) that affect the immune system. 34 Additionally, expanded use of immunocytochemistry, developed to permit greater precision in identifying lymphoma cases, may correctly identify patients who were previously assigned other diagnoses. 35 The risk of developing lymphoma increases with age. It has been proposed that some of the increase seen in the population may be associated with an increase in the proportion of the population who are elderly. Alive, % Adenocarcinoma Verrucous Lymphoma SCC Carcinoma, NOS Year Histological Features Cases Adenocarcinoma Verrucous Lymphoma Squamous Cell Carcinoma (SCC) Carcinoma, NOS Figure 4. Five-year, disease-specific survival by histological findings for cases of head and neck cancers. NOS indicates not otherwise specified. An increase was noted in the reporting of tumor stage during the more recent ( ) period. It is important to note that assignment of stage as unknown does not necessarily identify poor record keeping. Standardized AJCC staging criteria have not yet been established for all sites within the head and neck region. The high percentage of unstaged sinonasal cases (52.0%) likely results from the lack of AJCC staging criteria for all but the maxillary sinus subsite within this region. 19 The high proportion of unstaged eye and ocular adnexa cancers (48.9%) is also likely related to lack of a recommended stage grouping for carcinoma of the eyelid and conjunctiva. 959

10 It has been reported that appropriate AJCC staging is most often recorded for those cancers whose treatment is largely determined by stage. 36 Accurate staging has become more important in the management of squamous cell carcinoma at most sites in the head and neck with the expanded application of treatment protocols investigating use of chemotherapy and irradiation. These protocols usually have stage-dependent inclusion criteria. In contrast, management of cancers of the lip and salivary gland continues to be determined primarily by clinical and pathologic features rather than general stage groupings. 37 It is therefore not surprising that, among the sites with established staging criteria, patients with cancers of the lip and salivary gland represented the largest proportion of cases with unknown stage. The smaller degree of improvement noted in grading cases across the periods may reflect the ambiguity that persists regarding the importance of cancer grade. It is not widely accepted that tumor grade impacts on management decisions for most cancers of the head and neck. The improvement in reporting stage from the earlier to the more current period has been supported by the COC. As of 1998, it was mandated that continued hospital approval from the COC is dependent on complete staging by the treating physicians of all cancers that have AJCC staging schema. 36 The increased involvement of the hospitals across the country in central registries, cancer treatment protocols, and other programs that require or encourage AJCC staging will likely contribute to continued improvement in staging. The 16.3% of cases of squamous cell carcinoma recorded in the major salivary glands may represent an artificially high number. Although the NCDB designs its classification system by site of origin and not by site of metastatic disease, it is possible that a portion of the squamous cell carcinomas reported as salivary gland in origin actually represented metastases. It may be difficult to discriminate between metastatic disease to the parotid gland from an occult or previously treated skin cancer and squamous cell carcinoma arising de novo within the parotid gland. Using rigid criteria to exclude metastases to the parotid gland, a retrospective review by Gaughan et al 38 identified that only 1.9% of parotid malignancies were squamous cell carcinoma. Other reports 39 have identified squamous cell carcinoma to represent up to 9% of parotid malignancies and between 2.1% and 5.5% of submandibular malignancies. PATIENT AND DISEASE CHARACTERISTICS Advanced stage at the time of diagnosis was more common among patients in the low-income group and the African American racial category (Table 5). Other studies 25,28 have shown oral and pharyngeal cancers to be not only more prevalent but also more lethal among African Americans. It has been suggested that some of these racial differences are tied to economic disadvantage. The disproportionate cancer burden of minorities may be related to limited access to resources, which, coupled with unfavorable environmental and behavioral factors, leads to a greater risk of developing cancer and failing its treatment. 40 Walker et al 30 have called for a conjoined effort to combine clinical, epidemiological, and molecular research to identify both the social and biological factors responsible for the racial differences seen. Although a substantial proportion of the cases were without known grade (44.4%), the large number of cases for which grade was recorded permits evaluation of the data. A clear association between advanced stage and higher grade (lower degree of differentiation) is apparent. This finding supports the generally accepted tenet that, although the capacity to accurately assign prognosis for individual cases based on tumor grade may be limited, the behavior of cancer in a large group of patients can broadly be predicted by histological criteria. 22 TREATMENT A wide spectrum of treatments was used for cancers within individual sites (Table 6). It is apparent that management approaches are determined by factors other than anatomical site. Tumor histological findings, stage, and patient characteristics are additional critical determinants to management choices. Although there was little overall change in treatment patterns across time, the use of combined chemotherapy and radiation therapy expanded from 5.5% of cases in to 6.3% in This 14.5% proportionate increase resulted primarily from an expanded application of this combination therapy in the treatment of laryngeal and pharyngeal carcinoma (Table 3). Protocols developed to preserve the larynx, pharynx, or tongue with chemotherapy and irradiation rather than extirpative surgery have become increasingly popular over the last decade Whereas management of cancers at most sites with adjuvant chemotherapy has not improved cure rates, recent reports indicate that the addition of adjuvant chemotherapy may offer more effective treatment for nasopharyngeal carcinoma. OUTCOME The median follow-up for patients from the period who were alive without cancer at last contact was 66 months. Patients with the confirmed status of alive with cancer at last contact were followed up for a median of only 44 months. This substantially shorter duration of follow-up may indicate that a large proportion of patients recorded as being alive with cancer were lost to follow-up; it is reasonable to propose that some of those lost to follow-up died with cancer present. Had they not been lost to follow-up, they likely would have then been been classified as dead, with cancer. For patients with squamous cell carcinoma who fail treatment, recurrence is usually identified within the first 2 years following completion of initial treatment. 48 In the absence of identified recurrence after this period, the chance of control of the index cancer is sufficiently great that the focus of further cancer surveillance is shifted to the greater risk of a second primary cancer developing. 49 Although recurrence data were not included in this report, data were presented that addressed the interval from time of diagnosis to date of last contact or death (Figure 4). Most patients with squamous cell carcinoma 960

11 who died with disease within the 5-year follow-up period did so within 2 years of diagnosis. The rate at which patients died differed substantially by site and by histological findings. The proportion of patients who died within the first 2 years following diagnosis was greatest for squamous cell carcinoma and carcinoma, NOS. In contrast, the survival rate for patients with adenocarcinoma was more constant across each of the intervals evaluated. These findings are consistent with reports 50 suggesting that, while 2- to 3-year follow-up is adequate to assess treatment efficacy for squamous cell carcinoma, much longer follow-up (ie, years) is required to assess outcome for adenocarcinomas. Squamous cell carcinoma is the predominant histological classification for cancers of the upper aerodigestive tract. The differences in survival for patients with squamous cell carcinoma follow a general pattern: the more posterior and inferior the site, the worse the prognosis. This progression holds for the lip, oral cavity, nasopharynx, oropharynx, and hypopharynx but not the larynx. Although these survival figures may partially reflect anatomical differences, it is likely that a greater impact on survival comes from differences in the type and extent of the squamous cell carcinomas at these locations. There are, however, anatomical differences between sites that are partially responsible in determining cure rates. For example, lymphatics in the larynx are not as abundant as they are in the hypopharynx. This difference in lymphatic drainage has been used to explain the higher metastatic rate and lower cure rate for hypopharyngeal cancer. 51 Anatomical differences may also compromise the ability to treat cancer adequately. The morbidity incurred from resecting a tumor confined to the anterior mobile tongue is much less than that from removing a similarly sized tumor in the base of tongue. It is more likely that speech and swallowing will be preserved with an aggressive resection of the more anteriorly located tongue lesion. To preserve these functions in the process of treating a tumor involving the base of tongue, some compromise may be accepted through less aggressive treatment, which may result in decreased chance of cure. 52,53 A more detailed analysis of the NCDB is required to identify relevant findings that help direct management of individual patients. Detailed assessments of these variables will be provided individually for specific histological types and anatomical subsites through a currently ongoing review of the NCDB. These analyses will be presented in a forthcoming series of reports. CONCLUSIONS This national survey of cancer of the head and neck using NCDB represents the largest to date. Demographics, patterns of care, and outcomes are broadly addressed in review of cancers affecting the upper aerodigestive tract and adjacent structures. More specific reports that analyze specific histological types and anatomical sites within the NCDB will follow in subsequent publications. Accepted for publication April 1, Supported in part by a Clinical Oncology Career Development Award (95-33) by the American Cancer Society. Reprints: Herman R. Menck, MBA, National Cancer Data Base, Commission on Cancer of the American College of Surgeons, 55 E Erie St, Chicago, IL ( REFERENCES 1. Mork J, Thoresen S, Hilde F-L, Langmark F, Glattre E. Head and neck cancer in Norway: a study of the quality of the cancer registry of Norway s data on head and neck cancer for the period APMIS. 1995;103: Bang G, Donath K, Thoresen S, Clausen OPF. DNA flow cytometry of reclassified subtypes of malignant salivary gland tumors. J Oral Pathol Med. 1994;23: Fraumeni JF, Devesa SS, Hoover RN, Kinlen LJ. Epidemiology of cancer. In: De- Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. 4th ed. Philadelphia, Pa: JB Lippincott Co; 1993: van der Sanden GAC, Coebergh JWW, Schouten LJ, Visser O, van Leeuwen FE. Cancer incidence in the Netherlands in 1989 and 1990: first results of the Nationwide Netherlands Cancer Registry. Eur J Cancer. 1995;31A: Hjalgrim J, Frisch M, Begtrup K, Melbye M. Recent increase in the incidence of non-hodgkin s lymphoma among young men and women in Denmark. Br J Cancer. 1996;73: Mattson B, Wallgren A. Completeness of the Swedish cancer register. Acta Radiol Oncol. 1984;23: Jessup JM, Menck HR, Winchester DP, Hundahl SA, Murphy GP. The National Cancer Data Base report on patterns of hospital reporting. Cancer. 1996;78: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP, eds. National Cancer Data Base Annual Review of Patient Care, Atlanta, Ga: American Cancer Society; Kosary CL, Ries LAG, Miller BA, Hankey BF, Harras A, Edwards BK, eds. SEER Cancer Statistics Review, : Tables and Graphs. Bethesda, Md: National Cancer Institute; NIH publication Reynolds T. National Statistics Source reaches 20th anniversary. J Natl Cancer Inst. 1993;85: Mettlin CJ, Menck HR, Winchester DP, Murphy GP. A comparison of breast, colorectal, lung, and prostate cancers reported to the National Cancer Data Base and the Surveillance, Epidemiology, and End Results Program. Cancer. 1997; 79: Hoffman HT, Karnell LH. Laryngeal cancer. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP, eds. National Cancer Data Base Annual Review of Patient Care Atlanta, Ga: American Cancer Society; 1995: Hundahl SA, Fleming ID, Shah JP. Thyroid cancer. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP, eds. National Cancer Data Base Annual Review of Patient Care Atlanta, Ga: American Cancer Society; 1995: Commission on Cancer. Data Acquisition Manual. Chicago, Ill: Commission on Cancer, American College of Surgeons; Commission on Cancer. Data Acquisition Manual, Revised Edition. Chicago, Ill: Data Standards Program of the Commission on Cancer, American College of Surgeons; American Joint Committee on Cancer. Manual for Staging of Cancer. Philadelphia, Pa: JB Lippincott; American Joint Committee on Cancer. Manual for Staging of Cancer. 2nd ed. Philadelphia, Pa: JB Lippincott; Beahrs O, Henson DE, Hutter RVP, Kennedy BJ, eds. American Joint Committee on Cancer: Manual for Staging of Cancer. 3rd ed. Philadelphia, Pa: JB Lippincott; Beahrs O, Henson DE, Hutter RVP, Kennedy BJ, eds. American Joint Committee on Cancer: Manual for Staging of Cancer. 4th ed. Philadelphia, Pa: JB Lippincott; Percy C, van Holten V, Muir C, eds. International Classification of Diseases for Oncology, Second Edition. Geneva, Switzerland: World Health Organization; CACI Marketing Systems Sourcebook of ZIP Code Demographics, Tape and File Documentation. Arlington, Va: CACI Inc; Carriaga MT, Henson DE. The histologic grading of cancer. Cancer. 1995;75: SPSS Inc. SPSS Users Guide: Release 7.5. Chicago, Ill: SPSS Inc; Boring CC, Squires TS, Tong T, Montgomery S. Cancer statistics. CA Cancer J Clin. 1994;44: Miller BA, Kolonel LN, Bernstein L, et al, eds. Racial/Ethnic Patterns of Cancer in the United States, Bethesda, Md: National Cancer Institute; NIH publication

12 26. Levi F, La Vecchia C, Lucchini F, Negri E. Worldwide trends in cancer mortality in the elderly, Eur J Cancer. 1996;32A: Jessup JM, Steele GD, Winchester DP. Introduction. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP, eds. National Cancer Data Base Annual Review of Patient Care Atlanta, Ga: American Cancer Society; 1995: Lee K, Strauss M. Head and neck cancer in blacks. J Natl Med Assoc. 1994;86: Spitz M. Epidemiology and risk factors for head and neck cancer. Semin Oncol. 1994;21: Walker B, Figgs LW, Zahm SH. Differences in cancer incidence, mortality, and survival between African Americans and whites. Environ Health Perspect. 1995; 103(suppl 8): Zheng T, Holford TR, Chen Y, et al. Time trend and age-period cohort effect on incidence of thyroid cancer in Connecticut: Int J Cancer. 1996;67: Ron E, Saftlas AF. Head and neck radiation carcinogenesis: epidemiologic evidence. Otolaryngol Head Neck Surg. 1996;115: Deandrea M, Gallone G, Veglio M, et al. Thyroid cancer histotype changes as observed in a major general hospital in a 21-year period. J Endocrinol Invest. 1997; 20: Tobias JS. Cancer of the head and neck. BMJ. 1994;308: Carrie S, Start RD, Goepel JR. The changing incidence of head and neck extranodal non-hodgkin s lymphoma: 25 years experience [abstract]. J Pathol. 1996; 178: Fleming ID, Phillips JL, Menck HR. The National Cancer Data Base report on completeness of American Joint Committee on Cancer Staging in the United States cancer facilities. Cancer. 1996;78: Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY. Malignant tumors of major salivary gland origin. Arch Otolaryngol Head Neck Surg. 1990; 116: Gaughan RK, Olsen KD, Lewis JE. Primary squamous cell carcinoma of the parotid gland. Arch Otolaryngol Head Neck Surg. 1992;118: Ellis GL, Auclair PL. Malignant epithelial tumors. In: Rosai J, Sobin LH, eds. Tumors of the Salivary Glands, Third Series Fascicle 17 of Atlas of Tumor Pathology. Bethesda, Md: Armed Forces Institute of Pathology; 1996: Freeman H. Cancer in the economically disadvantaged. Cancer. 1989;64(suppl): Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst. 1996;88: Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324: Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med. 1993;328: Robbins KT, Storniolo AM, Hryniuk WM, et al. Decadose effects of cisplatin on squamous cell carcinoma of the upper aerodigestive tract. Laryngoscope. 1996; 106: Harari PM. Why has induction chemotherapy for advanced head and neck cancer become a United States community standard of practice? J Clin Oncol. 1997; 15: Tomio L, Zorat PL, Paccagnella A, et al. A pilot study of concomitant radiation and chemotherapy in patients with locally advanced head and neck cancer. Am J Clin Oncol. 1993;16: Giri PG, LeBlanc M, Al Sarraf M, et al. Improved survival with chemotherapy and radiation therapy versus radiation therapy alone in advanced nasopharyngeal cancer: preliminary results of an intergroup randomized trial (Int 0099, SWOG 8892, RTOG 8817, ECOG 2388) [abstract]. Int J Radiat Oncol Biol Phys. 1996;36(suppl): Boysen M, Natvig K, Winterh O, Tausjo J. Value of routine follow-up in patients treated for squamous cell carcinoma of the head and neck. J Otolaryngol. 1985; 14: Snow G. Follow-up in patients treated for head and neck cancer: how frequent, how thorough and for how long. Eur J Cancer. 1992;28: Hoffman HT, Funk G, Endres D. Evaluation and surgical treatment of tumors of the salivary glands. In: Thawley S, Panje W, eds. Comprehensive Management of Head and Neck Tumors. 2nd ed. Philadelphia, Pa: WB Saunders Co. In press. 51. Hoffman HT, Karnell LH, Shah JP, et al. Hypopharyngeal cancer patient care evaluation. Laryngoscope. 1997;107: Jesse R, Sugarbaker E. Squamous cell carcinoma of the oropharynx: why we fail. Otolaryngol Head Neck Surg. 1976;132: Hoffman HT, Krause CJ, Eschwege F. Combined surgery and radiotherapy. In: Snow GB, Clark JR, eds. Multimodality Therapy for Head and Neck Cancer. New York, NY: Thieme Medical Publishers Inc; 1992:

The common feature of all melanomas is the cell of origin, the

The common feature of all melanomas is the cell of origin, the 1664 COMMUNICATION The American College of Surgeons Commission on Cancer and the American Cancer Society The National Cancer Data Base Report on Cutaneous and Noncutaneous Melanoma A Summary of 84,836

More information

C a nc e r C e nter. Annual Registry Report

C a nc e r C e nter. Annual Registry Report C a nc e r C e nter Annual Registry Report 214 214 Cancer Registry Report Larraine A. Tooker, CTR Please note that the 214 Cancer Registry Annual Report is created in 214, but it reflects data on cases

More information

Chapter I Overview Chapter Contents

Chapter I Overview Chapter Contents Chapter I Overview Chapter Contents Table Number Contents I-1 Estimated New Cancer Cases and Deaths for 2005 I-2 53-Year Trends in US Cancer Death Rates I-3 Summary of Changes in Cancer Incidence and Mortality

More information

Pediatric Oncology for Otolaryngologists

Pediatric Oncology for Otolaryngologists Pediatric Oncology for Otolaryngologists Frederick S. Huang, M.D. Division of Hematology/Oncology Department of Pediatrics The University of Texas Medical Branch Grand Rounds Presentation to Department

More information

Diagnosis and Treatment of Common Oral Lesions Causing Pain

Diagnosis and Treatment of Common Oral Lesions Causing Pain Diagnosis and Treatment of Common Oral Lesions Causing Pain John D. McDowell, DDS, MS University of Colorado School of Dentistry Chair, Oral Diagnosis, Medicine and Radiology Director, Oral Medicine and

More information

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,

More information

2012 CANCER PROGRAM ANNUAL REPORT

2012 CANCER PROGRAM ANNUAL REPORT MERCY REGIONAL CANCER CENTER 2012 CANCER PROGRAM ANNUAL REPORT Using 2011 Data Mercy Regional Cancer Center When you have cancer, you might think first of treatments chemotherapy and radiation. You want

More information

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 General Data Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 The vast majority of the patients in this study were diagnosed

More information

The Ontario Cancer Registry moves to the 21 st Century

The Ontario Cancer Registry moves to the 21 st Century The Ontario Cancer Registry moves to the 21 st Century Rebuilding the OCR Public Health Ontario Grand Rounds Oct. 14, 2014 Diane Nishri, MSc Mary Jane King, MPH, CTR Outline 1. What is the Ontario Cancer

More information

Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation

Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation Yan Xing, MD, PhD, Ryaz B. Chagpar, MD, MS, Y Nancy You MD, MHSc, Yi Ju Chiang, MSPH, Barry W. Feig, MD, George

More information

General Rules SEER Summary Stage 2000. Objectives. What is Staging? 5/8/2014

General Rules SEER Summary Stage 2000. Objectives. What is Staging? 5/8/2014 General Rules SEER Summary Stage 2000 Linda Mulvihill Public Health Advisor NCRA Annual Meeting May 2014 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention

More information

Number. Source: Vital Records, M CDPH

Number. Source: Vital Records, M CDPH Epidemiology of Cancer in Department of Public Health Revised April 212 Introduction The general public is very concerned about cancer in the community. Many residents believe that cancer rates are high

More information

DELRAY MEDICAL CENTER. Cancer Program Annual Report

DELRAY MEDICAL CENTER. Cancer Program Annual Report DELRAY MEDICAL CENTER Cancer Program Annual Report Cancer Statistical Data From 2010 TABLE OF CONTENTS Chairman s Report....3 Tumor Registry Statistical Report Summary...4-11 Lung Study.12-17 Definitions

More information

Cancer in Ireland 2013: Annual report of the National Cancer Registry

Cancer in Ireland 2013: Annual report of the National Cancer Registry Cancer in 2013: Annual report of the National Cancer Registry ABBREVIATIONS Acronyms 95% CI 95% confidence interval APC Annual percentage change ASR Age standardised rate (European standard population)

More information

Chapter 14 Cancer of the Cervix Uteri

Chapter 14 Cancer of the Cervix Uteri Carol L. Kosary Introduction Despite the existence of effective screening through the use of Pap smears since the 195 s, there were 9,71 estimated cases of invasive cervical cancer and 3,7 deaths in 26

More information

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc. Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs

More information

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data The 2014 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2013 More than 70 percent of all newly diagnosed cancer patients are treated in the more than 1,500

More information

Singapore Cancer Registry Annual Registry Report Trends in Cancer Incidence in Singapore 2009 2013. National Registry of Diseases Office (NRDO)

Singapore Cancer Registry Annual Registry Report Trends in Cancer Incidence in Singapore 2009 2013. National Registry of Diseases Office (NRDO) Singapore Cancer Registry Annual Registry Report Trends in Cancer Incidence in Singapore 2009 2013 National Registry of Diseases Office (NRDO) Released November 3, 2014 Acknowledgement This report was

More information

Report series: General cancer information

Report series: General cancer information Fighting cancer with information Report series: General cancer information Eastern Cancer Registration and Information Centre ECRIC report series: General cancer information Cancer is a general term for

More information

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Acknowledgements and Disclaimer The collection of cancer incidence data used in this

More information

PROTOCOL OF THE RITA DATA QUALITY STUDY

PROTOCOL OF THE RITA DATA QUALITY STUDY PROTOCOL OF THE RITA DATA QUALITY STUDY INTRODUCTION The RITA project is aimed at estimating the burden of rare malignant tumours in Italy using the population based cancer registries (CRs) data. One of

More information

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD Public Outcomes Report Lung Cancer Submitted by Omar A. Majid, MD Lung cancer is the most common cancer-related cause of death among men and women. It has been estimated that there will be 226,1 new cases

More information

Cancer Staging. Introduction. Overview

Cancer Staging. Introduction. Overview Many Hearts Many Minds One Goal Volume 2 Number 3 May 2005 Cancer Staging bt Maureen MacIntyre, Director, Surveillance and Epidemiology Unit, Cancer Care Nova Scotia and Dr. Eva Grunfeld, Clinician Scientist

More information

THYROID CANCER. I. Introduction

THYROID CANCER. I. Introduction THYROID CANCER I. Introduction There are over 11,000 new cases of thyroid cancer each year in the US. Females are more likely to have thyroid cancer than men by a ratio of 3:1, and it is more common in

More information

SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD

SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD Case Presentation 35 year old male referred from PMD with an asymptomatic palpable right neck mass PMH/PSH:

More information

Analysis of Population Cancer Risk Factors in National Information System SVOD

Analysis of Population Cancer Risk Factors in National Information System SVOD Analysis of Population Cancer Risk Factors in National Information System SVOD Mužík J. 1, Dušek L. 1,2, Pavliš P. 1, Koptíková J. 1, Žaloudík J. 3, Vyzula R. 3 Abstract Human risk assessment requires

More information

R E X C A N C E R C E N T E R. Annual Report 2012. Rex Cancer Care Committee 2012 On behalf of the Rex Cancer Center & Rex Health Care

R E X C A N C E R C E N T E R. Annual Report 2012. Rex Cancer Care Committee 2012 On behalf of the Rex Cancer Center & Rex Health Care R E X C A N C E R C E N T E R Annual Report 2012 Rex Cancer Care Committee 2012 On behalf of the Rex Cancer Center & Rex Health Care An American College of Surgeons Commission on Cancer Accredited Comprehensive

More information

Optimizing Treatment in Head and Neck Cancer with Limited Resources

Optimizing Treatment in Head and Neck Cancer with Limited Resources Optimizing Treatment in Head and Neck Cancer with Limited Resources Friday, February 19, 2016, 7:00 am MT Moderator: Randall Kimple, MD, University of Wisconsin Induction Chemotherapy Predicts Cumulative

More information

Dictionary of SEER*Stat Variables November 2011 Submission (released April 2012) http://seer.cancer.gov/data/seerstat/nov2011/ 1 of 18

Dictionary of SEER*Stat Variables November 2011 Submission (released April 2012) http://seer.cancer.gov/data/seerstat/nov2011/ 1 of 18 November 2011 Data Submission Item # refers to the item - see http://www.naaccr.org/standardsandregistryoperations/volumeii.aspx CS= Collaborative Staging SSF = Site-specific Factor Field Item # Description

More information

Table 16a Multiple Myeloma Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for 2002-2006

Table 16a Multiple Myeloma Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for 2002-2006 Multiple Myeloma Figure 16 Definition: Multiple myeloma forms in plasma cells that are normally found in the bone marrow. 1 The plasma cells grow out of control and form tumors (plasmacytoma) or crowd

More information

Male. Female. Death rates from lung cancer in USA

Male. Female. Death rates from lung cancer in USA Male Female Death rates from lung cancer in USA Smoking represents an interesting combination of an entrenched industry and a clearly drug-induced cancer Tobacco Use in the US, 1900-2000 5000 100 Per Capita

More information

TNM Staging of Head and Neck Cancer and Neck Dissection Classification

TNM Staging of Head and Neck Cancer and Neck Dissection Classification QUICK REFERENCE GUIDE TO TNM Staging of Head and Neck Cancer and Neck Dissection Classification Fourth Edition 2014 All materials in this ebook are copyrighted by the American Academy of Otolaryngology

More information

Measures of Prognosis. Sukon Kanchanaraksa, PhD Johns Hopkins University

Measures of Prognosis. Sukon Kanchanaraksa, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Surgical Margins and follow up of Squamous Cell Carcinoma. Steve Keohane

Surgical Margins and follow up of Squamous Cell Carcinoma. Steve Keohane Surgical Margins and follow up of Squamous Cell Carcinoma Steve Keohane Poor registration Well established projected increase in incidence for next 2 decades Significant morbidity but relatively low mortality

More information

Estimated New Cases of Leukemia, Lymphoma, Myeloma 2014

Estimated New Cases of Leukemia, Lymphoma, Myeloma 2014 ABOUT BLOOD CANCERS Leukemia, Hodgkin lymphoma (HL), non-hodgkin lymphoma (NHL), myeloma, myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPNs) are types of cancer that can affect the

More information

THE CANCER CENTER 2013 ANNUAL REPORT CONTAINING 2012 STATISTICS

THE CANCER CENTER 2013 ANNUAL REPORT CONTAINING 2012 STATISTICS THE CANCER CENTER 2013 ANNUAL REPORT CONTAINING 2012 STATISTICS Northside Medical Center Cancer Committee Mission Statement It is the mission of the Cancer Committee to evaluate and monitor the care of

More information

Lung Cancer: More than meets the eye

Lung Cancer: More than meets the eye Lung Cancer Education Program November 23, 2013 Lung Cancer: More than meets the eye Shantanu Banerji MD, FRCPC Presenter Disclosure Faculty: Shantanu Banerji Relationships with commercial interests: Grants/Research

More information

Differences in type of comorbidity and complications in young and elderly

Differences in type of comorbidity and complications in young and elderly Differences in type of comorbidity and complications in young and elderly 5.1 Relation between age, comorbidity, and complications in patients undergoing major surgery for head and neck cancer Peters TTA

More information

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH 9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing

More information

Report with statistical data from 2007

Report with statistical data from 2007 2008 Cancer Program Annual Report with statistical data from 2007 Lake Cumberland Regional Hospital 305 Langdon Streett Somerset, KY 42503 Telephone: 606-679-7441 Fax: 606-678-9919 Cancer Committee Mullai,

More information

SCD Case Study. Most malignant lesions of the tonsil are either lymphosarcoma or carcinoma.

SCD Case Study. Most malignant lesions of the tonsil are either lymphosarcoma or carcinoma. SCD Case Study Dry Mouth This case study details a patient who has experienced xerostomia as a result of treatment for squamous cell carcinoma of the left tonsil involving surgery followed by deep x-ray

More information

Secondary Cancer Rates Following Breast Cancer Diagnosis

Secondary Cancer Rates Following Breast Cancer Diagnosis Copyright E 2007 Journal of Insurance Medicine J Insur Med 2007;39:98 106 ORIGINAL RESEARCH Secondary Cancer Rates Following Breast Cancer Diagnosis David Wesley, MD Life table analysis and other mortality

More information

Multiple Primary and Histology Coding Rules

Multiple Primary and Histology Coding Rules Multiple Primary and Histology Coding Rules January 10, 2008 National Cancer Institute Surveillance Epidemiology and End Results Program Bethesda, MD PLEASE NOTE This PDF of the 2007 Multiple Primaries

More information

The TV Series. www.healthybodyhealthymind.com INFORMATION TELEVISION NETWORK

The TV Series. www.healthybodyhealthymind.com INFORMATION TELEVISION NETWORK The TV Series www.healthybodyhealthymind.com Produced By: INFORMATION TELEVISION NETWORK ONE PARK PLACE 621 NW 53RD ST BOCA RATON, FL 33428 1-800-INFO-ITV www.itvisus.com 2005 Information Television Network.

More information

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal

More information

October is Breast Cancer Awareness Month!

October is Breast Cancer Awareness Month! October is Breast Cancer Awareness Month! A STUDY OF CHARACTERISTICS AND MANAGEMENT OF BREAST CANCER IN TAIWAN Eric Kam-Chuan Lau, OMS II a, Jim Yu, OMSII a, Christabel Moy, OMSII a, Jian Ming Chen, MD

More information

Paranasal sinus anatomy

Paranasal sinus anatomy Paranasal sinus anatomy Sphenoid Nasopharynx Respiratory mucosa Pseudostratified, goblet & ciliated cells Seromucinous glands Nasopharyngeal mucosa/carcinoma Squamous metaplasia (?) with CIS Normal respiratory

More information

The Burden of Cancer in Asia

The Burden of Cancer in Asia P F I Z E R F A C T S The Burden of Cancer in Asia Medical Division PG283663 2008 Pfizer Inc. All rights reserved. Printed in USA/December 2008 In 2002, 4.2 million new cancer cases 39% of new cases worldwide

More information

IV. DEFINITION OF LYMPH NODE GROUPS (FIGURE 1) Level IA: Submental Group

IV. DEFINITION OF LYMPH NODE GROUPS (FIGURE 1) Level IA: Submental Group IV. DEFINITION OF LYMPH NODE GROUPS (FIGURE 1) Fig. 1 The level system is used for describing the location of lymph nodes in the neck: Level I, submental and submandibular group; Level II, upper jugular

More information

Post-PET Restaging Cancer Form National Oncologic PET Registry

Post-PET Restaging Cancer Form National Oncologic PET Registry Post-PET Restaging Cancer Form National Oncologic PET Registry Facility ID #: Registry Case Number: Patient Name: Your patient had a PET scan on: mm/dd/yyyy. The PET scan was done for restaging of (cancer

More information

Update on Mesothelioma

Update on Mesothelioma November 8, 2012 Update on Mesothelioma Intro incidence and nomenclature Update on Classification Diagnostic specimens Morphologic features Epithelioid Histology Biphasic Histology Immunohistochemical

More information

Cancer Survival Among Adults: U.S. SEER Program, 1988-2001

Cancer Survival Among Adults: U.S. SEER Program, 1988-2001 SEER Monograph Cancer Among Adults: U.S. SEER Program, 1988-2001 Patient and Tumor Characteristics Edited by: Lynn A. Gloeckler Ries John L. Young, Jr. Gretchen E. Keel Milton P. Eisner Yi Dan Lin Marie-Josephe

More information

Small Cell Lung Cancer

Small Cell Lung Cancer Small Cell Lung Cancer Types of Lung Cancer Non-small cell carcinoma (NSCC) (87%) Adenocarcinoma (38%) Squamous cell (20%) Large cell (5%) Small cell carcinoma (13%) Small cell lung cancer is virtually

More information

AJCC Cancer Staging System, 8 th Edition: UPDATE

AJCC Cancer Staging System, 8 th Edition: UPDATE AJCC Cancer Staging System, 8 th Edition: UPDATE Creating the Bridge from a Population Based to a More Personalized Approach Mahul B. Amin, MD, FCAP Editor-in-Chief, AJCC Cancer Staging System Validating

More information

An Introduction to the. cancer registry. instructor s guide

An Introduction to the. cancer registry. instructor s guide An Introduction to the cancer registry instructor s guide National Cancer Registrars Association Education Foundation 1340 Braddock Place, Suite 203 Alexandria, Virginia 22314 (703) 299-6640 www.ncraeducationfoundation.org

More information

Hospital-Based Tumor Registry. Srinagarind Hospital, Khon Kaen University

Hospital-Based Tumor Registry. Srinagarind Hospital, Khon Kaen University Hospital-Based Tumor Registry Srinagarind Hospital, Khon Kaen University Statistical Report 2012 Cancer Unit, Faculty of Medicine Khon Kaen University Khon Kaen, Thailand Tel & Fax:+66(43)-202485 E-mail:

More information

Rare Thoracic Tumours

Rare Thoracic Tumours Rare Thoracic Tumours 1. Epithelial Tumour of Trachea 1 1.1 General Results Table 1. Epithelial Tumours of Trachea: Incidence, Trends, Survival Flemish Region 2001-2010 Both Sexes Incidence Trend EAPC

More information

Chapter 13. The hospital-based cancer registry

Chapter 13. The hospital-based cancer registry Chapter 13. The hospital-based cancer registry J.L. Young California Tumor Registry, 1812 14th Street, Suite 200, Sacramento, CA 95814, USA Introduction The purposes of a hospital-based cancer registry

More information

ORIGINAL ARTICLE SQUAMOUS CELL CARCINOMA OF THE PAROTID GLAND

ORIGINAL ARTICLE SQUAMOUS CELL CARCINOMA OF THE PAROTID GLAND ORIGINAL ARTICLE SQUAMOUS CELL CARCINOMA OF THE PAROTID GLAND Yu-Lan Mary Ying, MD, Jonas T. Johnson, MD, Eugene N. Myers, MD Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh,

More information

Cancer is the leading cause of death for Canadians aged 35 to 64 and is also the leading cause of critical illness claims in Canada.

Cancer is the leading cause of death for Canadians aged 35 to 64 and is also the leading cause of critical illness claims in Canada. Underwriting cancer In this issue of the Decision, we provide an overview of Canadian cancer statistics and the information we use to make an underwriting decision. The next few issues will deal with specific

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

David Feltl, M.D., Ph.D., MBA. Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes.

David Feltl, M.D., Ph.D., MBA. Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes. David Feltl, M.D., Ph.D., MBA Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes. Contents Cancer epidemiology in the Czech Republic National oncology program

More information

Table 2.2. Cohort studies of consumption of alcoholic beverages and cancer in special populations

Table 2.2. Cohort studies of consumption of alcoholic beverages and cancer in special populations North America Canada Canadian 1951 Schmidt & Popham (1981) 1951 70 9 889 alcoholic men, aged 15 years, admitted to the clinical service of the Addiction Research Foundation of Ontario between Death records

More information

Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008

Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008 Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008 David R. Risser, M.P.H., Ph.D. David.Risser@dshs.state.tx.us Epidemiologist Cancer Epidemiology and Surveillance Branch

More information

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer Copyright E 2007 Journal of Insurance Medicine J Insur Med 2007;39:242 250 MORTALITY Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer David Wesley, MD; Hugh

More information

Cervical Nodes: When to Worry and What to do.

Cervical Nodes: When to Worry and What to do. Cervical Nodes: When to Worry and What to do. Donna Sutherland MD, FRCSC CancerCare Manitoba, Head and Neck Surgery University of Manitoba, Department of Otolaryngology Objectives Be familiar with various

More information

Inpatient Oncology Length of Stay and Hospital Costs: Implications for Rising Inpatient Expenditures

Inpatient Oncology Length of Stay and Hospital Costs: Implications for Rising Inpatient Expenditures Inpatient Oncology Length of Stay and Hospital Costs: Implications for Rising Inpatient Expenditures Katie J. Suda, PharmD* Susannah E. Motl, PharmD John C. Kuth, PharmD * University of Tennessee, College

More information

NECK MASSES. Rory Attwood. MBChB,FRCS Division of Otorhinolaryngology Faculty of Health Sciences Tygerberg Campus, University of Stellenbosch

NECK MASSES. Rory Attwood. MBChB,FRCS Division of Otorhinolaryngology Faculty of Health Sciences Tygerberg Campus, University of Stellenbosch NECK MASSES Rory Attwood MBChB,FRCS Division of Otorhinolaryngology Faculty of Health Sciences Tygerberg Campus, University of Stellenbosch Neck masses - Introduction Common in children Lymphadenopathy

More information

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA)

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) Merat Esfahani, MD Medical Oncologist, Hematologist Cancer Liaison Physician SwedishAmerican Regional Cancer Center

More information

Staging Head and Neck Cancers Transitioning to the Seventh Edition of The AJCC Cancer Staging Manual

Staging Head and Neck Cancers Transitioning to the Seventh Edition of The AJCC Cancer Staging Manual Staging Head and Neck Cancers Transitioning to the Seventh Edition of The AJCC Cancer Staging Manual Jatin P. Shah, MD, PhD (Hon) Memorial Sloan-Kettering Cancer Center New York, New York The American

More information

Section 8» Incidence, Mortality, Survival and Prevalence

Section 8» Incidence, Mortality, Survival and Prevalence Section 8» Incidence, Mortality, Survival and Prevalence 8.1. Description of Statistics Reported This section focuses on the regional distribution of cancer with data derived from the BC Cancer Registry

More information

Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines

Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines April 2008 (presented at 6/12/08 cancer committee meeting) By Shelly Smits, RHIT, CCS, CTR Conclusions by Dr. Ian Thompson, MD Dr. James

More information

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML)

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) George Yaghmour, MD Hematology Oncology Fellow PGY5 UTHSC/West cancer Center, Memphis, TN May,1st,2015 Off-Label Use Disclosure(s) I do not intend

More information

Big Data and Oncology Care Quality Improvement in the United States

Big Data and Oncology Care Quality Improvement in the United States Big Data and Oncology Care Quality Improvement in the United States Peter P. Yu, MD, FACP, FASCO President, American Society of Clinical Oncology Director of Cancer Research, Palo Alto Medical Foundation

More information

2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER

2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER 2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER Humboldt County is located on the Redwood Coast of Northern California. U.S census data for 2010 reports county population at 134,623, an increase of

More information

National Cancer Institute

National Cancer Institute National Cancer Institute Information Systems, Technology, and Dissemination in the SEER Program U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Information Systems, Technology,

More information

Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment

Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment Reference: NHS England xxx/x/x 1 Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy)

More information

The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality. Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006

The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality. Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006 The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006 Overview Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy

More information

Cervical lymphadenopathy

Cervical lymphadenopathy Cervical lymphadenopathy Introduction There are various classifications of lymphadenopathy, but a simple and clinically useful system is to classify lymphadenopathy as "generalized" if lymph nodes are

More information

ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival

ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival It is logical that the Cancer Program Committee choose to review the Lung Site, as Lung is the second

More information

2003 2007 STUDIES OF QUALITY OUTCOMES /BRAIN TUMORS ASTROCYTOMA. Introduction

2003 2007 STUDIES OF QUALITY OUTCOMES /BRAIN TUMORS ASTROCYTOMA. Introduction 2003 2007 STUDIES OF QUALITY OUTCOMES /BRAIN TUMORS ASTROCYTOMA Introduction Astrocytoma represents an important subtype of glial tumors. Its name derives from the fact that the involved cells have the

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck

More information

Metastatic Cancer: Questions and Answers. Key Points

Metastatic Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Metastatic Cancer: Questions

More information

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology Oncology Annual Report: Prostate Cancer 25 Update By: John Konefal, MD, Radiation Oncology Prostate cancer is the most common cancer in men, with 232,9 new cases projected to be diagnosed in the U.S. in

More information

Stage IV Renal Cell Carcinoma. Changing Management in A Comprehensive Community Cancer Center. Susquehanna Health Cancer Center

Stage IV Renal Cell Carcinoma. Changing Management in A Comprehensive Community Cancer Center. Susquehanna Health Cancer Center Stage IV Renal Cell Carcinoma Changing Management in A Comprehensive Community Cancer Center Susquehanna Health Cancer Center 2000 2009 Warren L. Robinson, MD, FACP January 27, 2014 Introduction 65,150

More information

Case Number: RT2009-124(M) Potential Audiences: Intent Doctor, Oncology Special Nurse, Resident Doctor

Case Number: RT2009-124(M) Potential Audiences: Intent Doctor, Oncology Special Nurse, Resident Doctor Renal Cell Carcinoma of the Left Kidney Post Radical Surgery with pt4 Classification with Multiple Lung and Single Brain Metastases: the Role and Treatment Consideration of Radiotherapy Case Number: RT2009-124(M)

More information

Cancer Conferences 2008

Cancer Conferences 2008 2009 Annual Report Cancer Registry Report The Cancer Registry collects data on all cancer patients who were diagnosed and/or treated at East Alabama Medical Center. Diagnostic, therapeutic and outcome

More information

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj.

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj. PSA Testing 101 Stanley H. Weiss, MD Professor, UMDNJ-New Jersey Medical School Director & PI, Essex County Cancer Coalition weiss@umdnj.edu September 23, 2010 Screening: 3 tests for PCa A good screening

More information

The Need for Accurate Lung Cancer Staging

The Need for Accurate Lung Cancer Staging The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives

More information

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials)

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) 3 Integrated Trials Testing Targeted Therapy in Early Stage Lung Cancer Part of NCI s Precision Medicine Effort in

More information

Squamous Cell Carcinoma of Anal Canal Treatment Guidelines

Squamous Cell Carcinoma of Anal Canal Treatment Guidelines May 2009 Squamous Cell Carcinoma of Anal Canal Treatment Guidelines Presented at Cancer Committee: August 6, 2009 By Shelly Smits, RHIT, CCS, CTR Conclusions by Ian Thompson, MD Data Source: Cancer registry

More information

Epidemiology, Staging and Treatment of Lung Cancer. Mark A. Socinski, MD

Epidemiology, Staging and Treatment of Lung Cancer. Mark A. Socinski, MD Epidemiology, Staging and Treatment of Lung Cancer Mark A. Socinski, MD Associate Professor of Medicine Multidisciplinary Thoracic Oncology Program Lineberger Comprehensive Cancer Center University of

More information

RESEARCH EDUCATE ADVOCATE. Just Diagnosed with Melanoma Now What?

RESEARCH EDUCATE ADVOCATE. Just Diagnosed with Melanoma Now What? RESEARCH EDUCATE ADVOCATE Just Diagnosed with Melanoma Now What? INTRODUCTION If you are reading this, you have undergone a biopsy (either of a skin lesion or a lymph node) or have had other tests in which

More information

Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics

Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics In Situ Breast Cancer in Wisconsin INTRODUCTION This bulletin provides information

More information

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis LYMPHOMA IN DOGS Lymphoma is a relatively common cancer in dogs. It is a cancer of lymphocytes (a type of white blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in the

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT

More information

Cancer research in the Midland Region the prostate and bowel cancer projects

Cancer research in the Midland Region the prostate and bowel cancer projects Cancer research in the Midland Region the prostate and bowel cancer projects Ross Lawrenson Waikato Clinical School University of Auckland MoH/HRC Cancer Research agenda Lung cancer Palliative care Prostate

More information

BREAST CANCER IN THE 21 st CENTURY. The Carolinas Medical Center NorthEast Experience. Garry Schwartz, MD

BREAST CANCER IN THE 21 st CENTURY. The Carolinas Medical Center NorthEast Experience. Garry Schwartz, MD BREAST CANCER IN THE 21 st CENTURY The Carolinas Medical Center NorthEast Experience Garry Schwartz, MD The American Cancer Society's most recent estimates for breast cancer in the United States for 2009

More information

Likelihood of Cancer

Likelihood of Cancer Suggested Grade Levels: 9 and up Likelihood of Cancer Possible Subject Area(s): Social Studies, Health, and Science Math Skills: reading and interpreting pie charts; calculating and understanding percentages

More information

CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal

CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal 1. STUDY TITLE: Longitudinal Assessment of Chronic Health Conditions: The Aging of Childhood Cancer Survivors 2. WORKING GROUP AND INVESTIGATORS:

More information