By Merrick I. Ross (auth.), Raphael E Pollock M.D., Ph.D. (eds.)
Among the normal oncology modalities, surgical oncology is singular in that it lacks a separate board certification or maybe an extra qualification mecha nism. 'Card-carrying' surgical oncologists are qualified by means of the yankee Board of surgical procedure, as are all different normal surgeons. What distinguishes the surgical oncologist is a suite of cognitive abilities instead of a particular armamentarium of surgical thoughts. This diversified conceptual framework is derived from ex tensive extra education that ends up in an in-depth realizing of the common heritage and biologic habit of a few of the good tumor structures. outfitted with this attitude, the surgical oncologist is very good situated to combine many of the to be had healing modalities right into a coherent care application for the forged tumor sufferer. As a principal subject matter, the chapters of this booklet display that more and more refined diagnostic and staging techniques are supporting to maneuver chemo remedy and radiotherapy into the preoperative neoadjuvant atmosphere. This primary alteration relies at the wisdom that even early-stage reliable tumor ailment is often systemic on the time of presentation, not less than on a subclinical point. And even supposing the first tumor could be controllable through surgical procedure with radiotherapy, the out of control (and in the beginning clinically unappar ent) far away affliction eventually determines sufferer survival. the opposite perspec tive riding the neoadjuvant technique is an rising understanding that for many stable tumor platforms, neoadjuvant remedy responses can facilitate much less muti lating surgical procedure with similar degrees of neighborhood affliction control.
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Better predictors of outcomes may allow us to more selectively treat patients for optimal results. Better predictors of response to therapies may identify those who mayor may not require more intensive therapy than is considered standard. If more intensive therapies are clinically effective, they will result in improved oncologic results and a better quality of life for rectal cancer patients. A clinical example of this is 41 Table 4. Long-term effect of postoperative chemoradiation therapy on bowel function in rectal cancer patients % of patients Postoperative therapy Median bowel movement per day Clustering of bowel movements Fecal incontinence Occasional Frequent Urgency None Chemoradiation 2 7 3% 42% 7% 39% 0% 17% 19% 17% From Adam 11, Mohamdee MO, Martin IG, Scott N, Firan PJ, Johnston D, Dixon MF, Quirke P.
The next 10 years are going to be a very exciting time for surgeons interested in melanoma. Surgeons should be familiar with the subsets of patients eligible for adjuvant studies and mindful of the systemic therapies available. In addition, they should participate in the design of future adjuvant trials and make sure that the surgical approaches are appropriate for the stage of disease so that their patients can be best positioned to receive benefit from these systemic therapies. References 1. Morton DL, Wen DR, Wong lH, Economou lS, Cagel LA, Storm KS, Foshag U, Cochran Al.
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Surgical Oncology by Merrick I. Ross (auth.), Raphael E Pollock M.D., Ph.D. (eds.)