What's New

A Standardized Clinical Pathway Approach to Esophageal Cancer

    • Clinical pathways for esophagectomy have been recently introduced in different esophageal centers worldwide.
    • The reported esophagectomy pathway has been refined over a 20-year period and covers pre-, peri-, and postoperative care.
    • Optimized pain control, enteral feedings, catheter removal, and postoperative mobilization represent central pathway components.
    • A decrease in hospital stay, costs, and morbidity has been associated with standardized clinical pathways.

Principles of Cancer Diagnosis

    • Updated information regarding histologic and cytologic evaluation and new areas of research throughout the paper.
    • New section added addressing metastatic disease and theories supporting the way in which these tumor cells spread. New scientific studies demonstrating how metastatic tumors may harbor resistive subtypes.
    • New information added regarding liquid biopsy and its potential role in diagnosing cancer.

Principles of Cancer Diagnosis

    • Updated information regarding histologic and cytologic evaluation and new areas of research throughout the paper.
    • New section added addressing metastatic disease and theories supporting the way in which these tumor cells spread. New scientific studies demonstrating how metastatic tumors may harbor resistive subtypes.
    • New information added regarding liquid biopsy and its potential role in diagnosing cancer.

Principles of Cancer Treatment

    • Updated chemotherapy regimens and new areas of research throughout the paper.
    • New section on stereotactic body radiation therapy and proton therapy and the role these therapies play in treating cancer.
    • Updated information regarding how cancer cells mutate and develop resistance to treatment.
    • New section on directed chemotherapy including selected hepatic artery infusion and isolated limb perfusion and infusion.
    • Updated section on immunotherapy including references to recent scientific studies.

Principles of Cancer Treatment

    • Updated chemotherapy regimens and new areas of research throughout the paper.
    • New section on stereotactic body radiation therapy and proton therapy and the role these therapies play in treating cancer.
    • Updated information regarding how cancer cells mutate and develop resistance to treatment.
    • New section on directed chemotherapy including selected hepatic artery infusion and isolated limb perfusion and infusion.
    • Updated section on immunotherapy including references to recent scientific studies.

Imaging and Staging of Esophageal Malignancy

    • Multimodal approach to therapy demonstrates survival benefits, employing neoadjuvant chemotherapy, radiation therapy, or both, followed by surgical resection.
    • EUSG vs. PET/MRI - PET/MRI demonstrates slightly superior accuracy for staging of lymph nodes, and may provide an important role in preoperative esophageal cancer in the future.
    • Evidence that 18F-FDG PET/CT is the best systemic staging modality in esophageal cancer. Although expensive, and thus not the initial approach for diagnosis, PET/CT allows for optimization of relationship of anatomic abnormalities and hypermetabolic areas. The degree of hypermetabolism has also shown utility in prognosis. Furthermore, some argue that repeat PET/CT after neoadjuvant therapy should be performed to detect metastatic disease previously not appreciated.

Imaging and Staging of Esophageal Malignancy

    • Multimodal approach to therapy demonstrates survival benefits, employing neoadjuvant chemotherapy, radiation therapy, or both, followed by surgical resection.
    • EUSG vs. PET/MRI - PET/MRI demonstrates slightly superior accuracy for staging of lymph nodes, and may provide an important role in preoperative esophageal cancer in the future.
    • Evidence that 18F-FDG PET/CT is the best systemic staging modality in esophageal cancer. Although expensive, and thus not the initial approach for diagnosis, PET/CT allows for optimization of relationship of anatomic abnormalities and hypermetabolic areas. The degree of hypermetabolism has also shown utility in prognosis. Furthermore, some argue that repeat PET/CT after neoadjuvant therapy should be performed to detect metastatic disease previously not appreciated.

Cutaneous Scarring

    • Over the past 10 years, our understanding of the pathogenesis of keloids and hypertrophic scars has improved markedly. As a result, these previously intractable scars are now regarded as being treatable.
    • Keloids and hypertrophic scars are inflammatory disorders of the reticular dermis.
    • Mechanical forces play an important role in the pathophysiology of keloids and hypertrophic scars.
    • Hypertension is associated with the development of severe keloids and hypertrophic scars.
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