Partners in Practice Articles

Gastric adenocarcinoma commonly spreads through carcinomatosis or peritoneal metastases (PM). This was often discovered at the time of attempted curative gastric resection, given the poor ability of preoperative staging CT scans to detect the presence and extent of PM. In patients where visible PMs are absent, diagnostic laparoscopy with peritoneal lavage and cytology has been shown to be an effective method of noting free intraperitoneal tumor cells. This is also defined as M1 disease and is generally associated with T3 or T4 primary gastric cancers.

There has been significant debate over the use of minimally invasive resection for the management of advanced gastric cancer. Laparoscopic surgery appears as a favorable approach, given the previously reported decrease in postoperative pain, pulmonary complications, and hospital lengths of stay. The reluctance to widely adopt this technique centers on concerns about its oncologic completeness and the complexity of the procedure.

by Renuka Iyer, MD

To prepare for the second annual Roswell Park Cancer Institute (RPCI) patient seminar on neuroendocrine cancer on October 18, 2014, I sat down to think about the progress made in this field.

by Smit Singla, MD, MRCSEd, MSc, and Boris Kuvshinoff, MD, MBA

Neuroendocrine tumors (NET) are a group of relatively slow-growing tumors that arise mostly in the pulmonary and gastrointestinal system. Considered rare, their incidence has increased 6.3% in the last 25 years, with a prevalence of 35 per 100,000 patients. Because patients with these tumors generally present with vague symptoms, the diagnosis is often delayed by five to seven years.

by Steven Hochwald, MD

There are several ways to remove the adrenal gland. For many years the minimally invasive transperitoneal approach has been the preferred technique and is now used more than any other. Yet it has limitations, including painful and unsightly incisions on the anterior abdominal wall.

by Moshim Kukar, MD

Primary hyperparathyroidism is a common disorder in which one or more parathyroid glands are abnormally enlarged. Surgical removal of the enlarged glands is the definitive treatment. The traditional surgical approach of four-gland exploration has been largely replaced with minimally invasive parathyroidectomy (MIP), which reduces the incidence of such associated complications as permanent hypocalcemia and recurrent laryngeal nerve injury.

OmniSeq Target™ is a multi-analyte test platform developed by the Center for Personalized Medicine at Roswell Park Cancer Institute (RPCI) to determine the presence or absence of relevant tumor genomic alterations that impact therapeutic decisions.

Most cancer patients with refractory disease have limited choices on the menu of standard treatments, but phase I clinical trials can expand those options and offer hope.

The relatively new and growing field of interventional pulmonology is an area of pulmonary medicine that focuses on using minimally invasive endoscopic techniques to diagnose and treat lung, thoracic, tracheal and mediastinal conditions.

by Andrew Bain, MD

Endoscopy plays a paramount role in the diagnosis, staging, treatment, and palliation of esophageal cancer.

by Usha Malhotra, MD

Esophageal cancer is a highly aggressive cancer with limited treatment options. In the United States, cancers of the lower esophagus and gastroesophageal junction are some of the fastest-growing malignancies. Treatment is tailored to the stage of the cancer and involves various modalities, including radiation, surgical resection and chemotherapy. Integration of targeted therapies into the therapeutic algorithms for esophageal adenocarcinoma is an area of active investigation.

by Charles M. LeVea, MD, PhD

Esophageal cancer is best treated by a multidisciplinary team. The surgical pathologist contributes by making the pathological diagnosis and presenting the pathological findings at the multidisciplinary esophageal tumor board. This face-to-face communication is essential for ensuring clear communication among team members and identifying individualized treatment options for our patients.