1. Cancer – Reflections from the Past 1Praful Desai

Radiotherapy 3Chemotherapy 4Biological (targeted) therapy 5The Indian scenario 5The future 6

2. Surgical Oncology: An Overview 7Praful Desai

3. Geographic Variations in Frequency and Incidence: A Global Perspective 9Ganesh Balasubramaniam

Geographic variations in incidence 10Incidence rates based on economic development 10

4. Primary and Secondary Prevention of Common Cancers 15Surendra Shastri, Aditi Shastri

Cervical cancer screening and prevention 15Breast cancer screening 18Oral cancer prevention and screening 20

5. The Changing Face of Surgical Pathology 24Anita Borges

6. Current and Future Imaging Techniques: Therapeutic Impact on Treatment Planning 35Bhavin Jankharia

Plain radiographs 35Mammography 35Ultrasound 36Computed tomography scan 36Magnetic resonance imaging 37Positron emission tomography/computed tomography 37Positron emission tomography/magnetic resonance imaging 39Interventional radiology 40

7. Role of Nuclear Medicine in Oncology 42BA Krishna

Principle of nuclear imaging 43Diagnostic role 43Types of nuclear scans in oncology 43Clinical applications 44Breast cancer 46Lung cancer 48Gastrointestinal cancers 50Genitourinary cancers 52Head and neck cancer 53Bone and soft tissue tumors 53Positron emission tomography-computed tomography in radiotherapy 53Infections in oncology 54

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Evolving applications of positron emission tomography scan with new tracers 54Therapeutic nuclear oncology 55

8. Tumor Markers in Cancer: Therapeutic Impact 59Praful Desai

Therapeutic impact of tumor markers in cancer 59

9. Cancer Chemotherapy: Future Perspectives 61SH Advani

Supportive care 62Introduction of hormone therapy 63Biological therapeutics 63Growth signal inhibitors 63

10. Radiotherapy: Prospects and Retrospects 65Nagraj G Huilgol, Mukul Roy

Biological basics of radiation therapy 67Rationale for combination chemoradiotherapy 68Brachytherapy 70Development of new radionuclides and radiation physics 70Brachytherapy types based on dose rate 71Types of brachytherapy based on sources placed 71Intensity-modulated radiotherapy 71Future of radiation oncology 72

11. Hormonal Dependence of Malignant Cells 74Rajendra Badwe, Sudeep Gupta, Gautam Goyal

History 74Pathophysiology 74Molecular effects of hormonal therapies 75Breast cancer 76Hormones in prostate cancer 79Hormonal use in other tumors 81Newer perspectives 82

12. Genetics and Cancer 84Rajiv Sarin

Genetics of sporadic and hereditary cancers 84Burden of hereditary cancers 84Genetic mechanism of cancer development: multistep carcinogenesis and genomic instability 85Tumor suppressor genes and oncogenes 86The two-hit model of Knudson and hereditary retinoblastoma 86Epigenetics and cancer 87Clinical presentation and evaluation of hereditary cancers 87Ascertaining family history 88Genetic testing, its indications and interpretation 91Cancer screening and prevention in high-risk individuals/mutation carriers 92Molecular taxonomy of cancers and its clinical relevance 93Molecular diagnostic techniques in cancer 94

13. Nanotechnology in Cancer Diagnosis and Treatment: A New Frontier 98Neil Desai

Nanotechnology application in cancer diagnosis 100Nanotechnology application in cancer therapy 102

14. Translational Research in Oncology 112CS Pramesh, Rajendra Badwe

Research in cancer 112A brief history of cancer research 112Translational research 113

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15. The Impact of Minimally Invasive Surgery in Oncology 120Shailesh Puntambekar, Geetanjali Agarwal-Joshi, Saurabh Joshi, Akhil Lawande

Laparoscopy in oncology 121Esophagus 122Colon and rectal cancer 125Hysterectomy 130

16. Toward the Future of Minimal Access Surgery: A Personal Perspective 135Tehemton E Udwadia

Training 135Simulator training 136Technology 137Pragmatic evaluation 138The future 138Socioeconomic reality 139

17. Oral Premalignant Lesions 142Vijay Haribhakti

Definitions and terms 142Leukoplakia 142Erythroplakia 143Submucous fibrosis (SMF) 143Oral lichen planus (OLP) 144Approach to a patient 144Biopsy interpretation 145Management 146

18. Oral Cancers 147Vijay Haribhakti

Anatomical boundaries and subsites 147General features 147Approach to treatment 149Surgical approaches 149The lips 153Cheek and gum 153The mandible 154Retromolar trigone 157Floor of mouth/tongue 157Radiotherapy 159Chemotherapy 159

19. Cancer of the Larynx 160Vijay Haribhakti

Diagnosis 161Staging of cancer of the larynx 162Management of laryngeal cancer 162

20. Cancer of the Pharynx 168Vijay Haribhakti

Surgical anatomy 168General features 168The nasopharynx 169The oropharynx 171The hypopharynx and cervical esophagus 174

21. Salivary Gland Tumors 180Vijay Haribhakti

Surgical anatomy 180Clinical features and diagnosis 181

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Classification of salivary tumors 183Mucoepidermoid carcinoma 183Adenoid cystic carcinoma 183Adenocarcinoma 183Others 183Treatment goals and alternatives 184Superficial parotidectomy—technique 184Management of the neck 184Issues in salivary gland surgery 185

22. Carcinoma of the Thyroid 186Praful Desai, Sarabjeet Kaur Arneja

Etiology 186Pathology 186Staging 188Clinical features and investigations 188Fine needle aspiration cytology 188Treatment 188Management of neck nodes 190Adjuvant radioactive iodine 191Lobectomy versus total thyroidectomy in thyroid cancers 191Solitary thyroid nodule—management algorithm 191

23. Parathyroid Tumors 194Praful Desai

24. The Metastatic Neck 197Vijay Haribhakti

Anatomy of the fascia and spaces of the neck 197Triangles of the neck 197Neck levels 198Determinants of nodal metastasis 199Clinical features 199Staging 199Management of the metastatic neck 200Nomenclature of neck dissections 200The surgical pathology report 201

25. The Role of Diagnostic and Therapeutic Endoscopy in Digestive Tract Malignancies 202Samir Parikh

Premalignant/dysplastic lesions of digestive tract 203Diagnosis and staging of digestive cancers 206Endoscopic treatment 210Endoscopic resection 211Laparoscopic surgery 213Natural orifice transluminal endoscopic surgery 213Endoscopic palliative treatment 214Endoscopic treatment of postoperative/postradiotherapy complications 216

26. Cancer of the Esophagus 222Praful Desai, Ganesh Balasubramaniam

Associated factors 223Pretherapy work-up and investigation 223Surgical approach 224Localized (locoregional) esophageal cancer 224Nodal dissection (two-field/three-field) 226Type of anastomotic disruptions 228Chemoradiotherapy as definitive treatment 229Palliation 229

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Chemotherapy 229Tracheoesophageal fistula 231

27. Carcinoma Stomach 233Praful Desai, Bhavna Parikh, Nagraj G Huilgol, Ganesh Balasubramaniam

Epidemiology 233Diet 234Tobacco 234Alcohol 234Obesity 234Ethnicity 235Genetics 235Pathology 235

28. Tumors of the Small Bowel 245Ratna Parikh, Praful Desai

Etiology 245Clinical presentation 245Diagnostic work-up 245Carcinoid tumors 245Treatment 246

29. Cancer of Colon, Rectum and Anal Canal 250Praful Desai, Sarabjeet Kaur Arneja, Bhavna Parikh

Carcinoma of the Colon 250Pathology 250Diagnosis/investigations 252Staging 253Treatment planning 254Complications of colonic surgery 255Neoadjuvant chemotherapy in colonic cancers 255

Carcinoma of the Rectum 255Etiology 255Clinical presentation and investigations 256Fundamental principles of therapy 256

Cancers of the Anal Canal 264Introduction and etiology 264Diagnosis and pretherapy workup 264Pathology 265Treatment 265

30. Pseudomyxoma Peritonei 269Ratna Parikh, Praful Desai, Sarabjeet Kaur Arneja

Pathology 269Diagnosis 269Treatment 269Chemotherapy 271

31. Gastrointestinal Stromal Tumors 273Praful Desai, Keyuri Patel

Pathology 273Clinical 274Investigations 275Management 275

32. Hepatic Malignancies 277Deepak Chhabra, Palepu Jagannath

Hepatocellular carcinoma 277

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Surgical treatment of hepatocellular carcinoma 281Liver transplantation 285Locoregional therapy 285Targeted therapy 287Prevention and surveillance 287Other primary malignant liver tumors 287Rare primary liver tumors 288

33. Biliary Malignancies 291Deepak Chhabra, Palepu Jagannath

Gallbladder Carcinoma 291Epidemiology and risk factors for gallbladder carcinoma 291Clinical presentation 292Pathology and patterns of spread 292Staging 293Investigations 293Management 295Extent of liver resection for gallbladder cancers 296Extent of lymphadenectomy 299Bile duct resection 299Neoadjuvant and adjuvant treatments for GBC 299Palliative care 299

Hilar 299

Cholangiocarcinoma 299Epidemiology and risk factors for cholangiocarcioma 300Pathology and patterns of spread 300Staging 301Preoperative evaluation 303Management 304Principles of surgical resection in hilar cholangiocarcinoma 304Palliation 306Systemic and other treatments 306

34. Pancreatic Malignancies 310Shailesh V Shrikhande, Palepu Jagannath

Risk factors and molecular biology 310Clinical features 310Pretherapy investigations 311Confirmation of diagnosis 312Obstructive jaundice in resectable pancreatic head and periampullary cancer: management approach 312Treatment 312Adjuvant therapy in pancreatic cancer 319Neoadjuvant approaches in pancreatic cancer 319Palliation in pancreatic cancer 319Uncommon pancreatic tumors 319

35. Breast Cancer 325Ratna Parikh, Praful Desai, Anita Borges, Sarabjeet Kaur Arneja, Nagraj G Huilgol, Bhavin Jankharia, Bhavna Parikh, Ganesh Balasubramaniam

Epidemiology 325Pathology 326Grading of breast carcinoma 328Hormone receptor 329HER2 neu 329Molecular classification 329Screening 330Prevention 330

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Diagnosis 330Noninvasive breast cancer 336Invasive breast cancer 339Sentinel lymph node retrieval in breast cancer 343Locally advanced breast cancer 344Inflammatory breast cancer 345Bilateral breast cancer 346Mucinous breast cancer (colloid or granulomatous carcinoma) 346Tubular carcinoma 346Papillary carcinoma 346Medullary carcinoma 346Male breast cancer 347Phyllodes tumor (cystosarcoma phyllodes) 347Paget’s disease 347Breast cancer and pregnancy 349Recurrent disease 350Metastatic breast cancer 350Systemic therapy of breast cancer 352Radiation therapy 355

36. Ovarian Cancer 363Ratna Parikh, Praful Desai, Ganesh Balasubramaniam, Bhavna Parikh, Sarabjeet Kaur Arneja

Epidemiology 363Associated factors 363Surveillance 365Chemoprevention 365Prophylactic surgery 365Pathology 365Clinical features 368Investigations 368Mode of spread 369Surgery 370Systemic therapy of epithelial ovarian cancer 371Management of recurrent disease 372Common protocols 373

37. Carcinoma of the Cervix 379Praful Desai, Keyuri Patel, Bhavna Parikh, Nagraj G Huilgol, Ganesh Balasubramaniam

Epidemiology 379Human papilloma virus infection 379Pathology 381Screening for cervical cancer 383Papanicolaou smears 383Problems and challenges 384Clinical features and pre-therapy work-up 385Invasive carcinoma of the cervix: surgical management 385

Chemotherapy 389Neoadjuvant chemotherapy 389Adjuvant chemotherapy 390Salvage chemotherapy for metastatic and recurrent disease 390Standard protocols 390

Radiotherapy 391Stage IA–C FIGO 391Stage IA 2 391FIGO–stage IBI, and IIA A 391Adjuvant postoperative radiation therapy 391Acute side-effects 392Late side-effects 392

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38. Endometrial Cancer 394Praful Desai, Keyuri Patel, Bhavna Parikh, Nagraj G Huilgol, Ganesh Balasubramaniam

Epidemiology 394Pathology 396Clinical features 397Treatment 398Radiotherapy (RT) 399

39. Management of Lung Cancer 403Ramakant Deshpande, Tanveer Abdul Majeed

Epidemiology 403Etiology 404Pathology 405Modes of dissemination 405Clinical features 407Diagnosis of lung cancer 407Treatment of lung cancer 409

40. Mediastinal Tumors 424Ramakant Deshpande, Tanveer Abdul Majeed

Surgical anatomy of mediastinum 424Incidence and pathology 424Diagnosis 424Symptoms and signs 425Paraneoplastic syndrome 425Thymus 426Thymoma 426Germ cell tumors 428

41. Tumors of the Chest Wall 436Ramakant Deshpande, Tanveer Abdul Majeed

Histological types 436Clinical features 439Diagnosis 440Chest wall resections and reconstructions 440

42. Tumors of the Adrenal Gland 444Varun Gunavanthe, Jagdeesh Kulkarni

Clinical presentation 444Etiopathology of adrenal mass 445Surgical indications for adrenalectomy 446Differential diagnosis of adrenal tumors 446Illustrative case reports 451

43. Renal Cell Carcinoma 454Hemant B Tongaonkar, Ganesh K Bakshi, Santosh Menon, Kumar Prabhash, Amit Joshi

Epidemiology 454Etiology 454Pathology 455Pathogenesis 456Diagnosis and staging 456Treatment of localized renal cell carcinoma 462Management of tumor extension to renal vein or inferior vena cava 464Metastatic renal cell carcinoma 466

44. Prostate Cancer 474Jagdeesh Kulkarni, Varun Gunavanthe, Nasreen Gite, Abhijit Dhale, Devendra Choudhary

Epidemiology 475Primary chemoprevention 476

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Pathology 476Diagnosis 477Staging and risk stratification 480Treatment options and optimum management 480Castration resistant prostate cancer 484

45. Bladder Cancer 488Jagdeesh Kulkarni, Varun Gunavanthe, Nasreen Gite, Abhijit Dhale, Devendra Choudhary

Etiology and risk factors 488Clinical features 488Pathology 488Staging 489Investigations and staging techniques 490Contemporary management of bladder cancer 492Metastatic and recurrent tumors 498Minimally invasive surgery for bladder cancer 498

46. Testicular Tumors 500Jagdeesh Kulkarni, Abhijit Dhale, Devendra Choudhary, Nasreen Gite, Varun Gunavanthe

Epidemiology and risk factors 500Classification 500Germ cell tumors 500Classification of germ cell tumors of testis 501Clinical features 502Investigations 502Treatment of primary tumor—orchiectomy 503Testes sparing surgery 504Staging, stage grouping and risk stratification 504Management of germ cell tumors of the testis 504Growing teratoma syndrome 508Salvage therapy 509Fertility in testicular tumors 509Tumors in undescended testis 509

47. Stoma Care 512Harikesh Buch, Carlo Pezcoller, Louise Forest Lalande

Development of stoma appliance and stoma care 512Incidence of stomas 512Marking the stoma site and creation of ideal stoma 512Indication for intestinal stoma surgery 515Preoperative preparations 515Technique of creation of stoma 516Preoperative and postoperative counseling 520Common stoma complications and its management 520Complications related to urostomy 522Psychosocial issues of ostomates 524Other common problems that patient will have 525Management of different types of stoma 526Stoma support groups 527

48. Neuroendocrine Tumors (Carcinoids) 529Praful Desai, Keyuri Patel

Pathology 529Investigations 532Gastrointestinal carcinoids (NETs) 533Molecular based therapy 535

49. Bone Tumors and Soft Tissue Sarcomas 536Ajay Puri, Nirmala Jambhekar

Primary bone tumors 536

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Osteosarcoma 538Ewing sarcoma 541Chondrosarcoma 542Principles of surgical treatment and reconstruction after wide excision in bone tumors 543Soft tissue sarcomas 545Management of metastatic disease from bone and soft tissue sarcomas 547

50. Retroperitoneal Sarcomas 550Praful Desai

Etiology 550Pathology 550Clinical features 550Investigations 550Treatment 550

51. Management of Skeletal Metastases 553Jai Prakash Agarwal, Nikhil Kalyani

Clinical presentation and diagnosis 553Treatment 555

52. Management of Primary Brain Tumors 560Rakesh Jalali, Uday Krishna

Epidemiology 560Imaging of primary brain tumors 561Histology of CNS tumors 561Management of common symptoms and complications of CNS tumors 564Management of individual tumors 565Management of pediatric CNS tumors 568Management of benign tumors and intracranial extra-axial tumors 570Palliative and supportive care 572Hospice/end of life care 572Quality of life 573

53. Management of Brain Metastasis 577Rakesh Jalali, Uday Krishna

Epidemiology 577Clinical presentation 577Diagnosis and evaluation 577Pathogenesis and spread of metastases to the brain 578Prognostic factors and staging 578Medical management of brain metastasis 579Radiotherapy 580

54. Cancers from an Unknown Primary Site 585Praful Desai

Clinical presentation 585Clinical approach and investigations including histologic studies of the metastatic lesion 585Treatment 586

55. Paraneoplastic Syndromes in Cancer 588Praful Desai

56. Reconstructive Surgery in Oncology 590Dhairyasheel Savant, Mridula Kuchekar

Reconstruction techniques in head and neck cancers 591Reconstructive options for various sites in the head and neck region 593Mandibular reconstructions 595Chest wall reconstruction 598Abdominal wall reconstruction 601Breast reconstruction 603

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57. Emergencies in Oncology 609Vijaya Patil, Kailash Sharma

Neutropenic sepsis 609Tumor lysis syndrome 609Hypercalcemia 610Anaphylactic reactions due to chemotherapeutic agents 610Pheochromocytoma 611Tumor-induced hypoglycemia 611Superior vena cava syndrome 611Airway obstruction 611Cardiac tamponade 612Cardiac failure 612Spinal cord compression 612Hyperviscosity syndrome 612Hyponatremia 613

58. Pediatric Oncology: A Journey from Nihilism to Cautious Optimism 614Purna Kurkure

Burden of childhood cancers 614Neuroblastoma 617Wilm’s tumor 619Retinoblastoma 620Barriers to optimal treatment of childhood cancers in India 621

59. Lymphomas in Children 624Brijesh Arora, Vishal Sodhi

Lymphomas in children 624

60. Adult Lymphomas 644Manju Sengar

Non-Hodgkin lymphoma 644

61. Evidence-based Medicine in Oncology: Problems, Challenges and Opportunities 653Praful Desai

Problems and challenges 653

62. General Principles in Oncologic Anesthesia 657Sateesh Gupte

Gastrointestinal 657Fever 658Hematological abnormalities 658Hypoglycemia 658Hypercalcemia 658Renal dysfunction 659Endocrinologic 659Neurologic 659Lactic acidosis 659Anesthetic problems in specific operations 660Tumors of endocrine gland 661Adrenal 661Cancer chemotherapy 662

63. Cancer Pain Management 666KS Sharma, PN Jain

Epidemiology 666Definition and types of pain 667Practical approach to a patient with cancer pain 668Pharmacological management of cancer pain 668Interventions in pain management 672

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64. Palliative Care and Quality of Life in Advanced Cancer 674Mary Ann Muckaden, Jayita Deodhar, Shrikant Atreya

Incidence of advanced cancers 674Definition of palliative care 675Goals of care 675Physical symptoms and their control 675Gastrointestinal symptoms 675Psychological care 679Place of care 680Spiritual care 680Ethics and palliative care 681End-of-life care 681Ethics in end-of-life care 681Bereavement support 682Research and palliative care 682Pediatric palliative care 682Community-based palliative care 682Epilogue 683

65. Microbial Pathogens and Infection Control in Immunocompromised Cancer Patients 685Rohini Kelkar

Etiology 685Epidemiology 687Laboratory diagnosis 687Viral infections 688Fungal infections 689Mycobacterial infections 693Cytomegalovirus infections 693Infections in surgical oncology: surgical site infections 694Multidrug-resistant organisms: current scenario 694Principles of antimicrobial prophylaxis in surgical oncology 696Infections in hematopoietic cell transplant recipients 697Management principles 698Guidelines for antimicrobial therapy 698Prevention and control of infectious complications 699Prevention of surgical site infections 700

66. Cancer Control in Developing Countries 706Praful Desai, Bhagwan Nene, Manoj Chauhan

Methodology—low cost/low technology effort—a replicable module 706Comprehensive cancer centers 707Community cancer centers 707

67. The Future: Cure, Control or Peaceful Coexistence? 711Praful Desai

68. The Conquest of Mortality: Science, Medicine and Technology’s Final Destination? 714Praful Desai

Index 719