Ebook Oncology in primary care: Part 1

Oncology in
Primary Care

(c) 2015 Wolters Kluwer. All Rights Reserved.



Oncology in
Primary Care

Senior Editors
Michal G. Rose, MD

Associate Editors
Kevin C. Oeffinger, MD

Associate Professor of Medicine (Medical Oncology)
Yale University School of Medicine
Director, Veterans Affairs CT Comprehensive
Cancer Center
West Haven, CT

Member and Attending Physician
Director, Memorial Sloan-Kettering Cancer Center
Adult Long-Term Follow-Up Program
Departments of Medicine and Pediatrics
Memorial Sloan-Kettering Cancer Center
New York, NY

Vincent T. DeVita Jr, MD

Amy and Joseph Perella Professor of Medicine
Yale Cancer Center and Smilow Cancer Hospital at
Yale-New Haven
Yale University School of Medicine;
Professor of Epidemiology and Public Health
Yale University School of Public Health
New Haven, CT

Theodore S. Lawrence, MD, PhD
Isadore Lampe Professor and Chair
Department of Radiation Oncology
University of Michigan
Ann Arbor, MI

Thomas L. Schwenk, MD
Dean, School of Medicine
Vice President for Health Sciences
University of Nevada
Reno, NV

Richard C. Wender, MD
Alumni Professor & Chair
Department of Family & Community Medicine
Thomas Jefferson University
President, JeffCare (Jefferson’s Physician-Hospital
Organization)
Thomas Jefferson University Hospitals, Inc.
Philadelphia, PA

Steven A. Rosenberg, MD, PhD

Chief of Surgery, National Cancer Institute,
National Institutes of Health;
Professor of Surgery, Uniformed Services University
of the Health Sciences School of Medicine
Bethesda, MD;
Professor of Surgery, George Washington University
School of Medicine and Health Sciences
Washington, DC

(c) 2015 Wolters Kluwer. All Rights Reserved.


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Printed in China

Library of Congress Cataloging-in-Publication Data
Oncology in primary care / senior editors, Michal G. Rose ... [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-1149-1 — ISBN 1-4511-7599-X
I. Rose, Michal G.
[DNLM: 1. Neoplasms—diagnosis. 2. Neoplasms—therapy. 3. Primary Health Care—methods. 4. Risk Assessment. QZ 241]
RC261.A1
616.99'4—dc23
2013003256

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the
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(c) 2015 Wolters Kluwer. All Rights Reserved.

To the memory of my parents,
Mrs. Sheila Ben-Tuvia and Professor Adam Ben-Tuvia
Michal G. Rose, MD

To Dr. Richard Kaufman
Vincent T. DeVita Jr, MD

To my wife Wendy
Theodore S. Lawrence, MD, PhD

To Alice
Steven A. Rosenberg, MD, PhD

(c) 2015 Wolters Kluwer. All Rights Reserved.



Contributors

Donald I. Abrams, MD
San Francisco General Hospital
San Francisco, California

Shrujal S. Baxi, MD, MPH
Assistant Attending Physician
Head and Neck Oncology Service
Memorial Sloan-Kettering Cancer Center
Instructor of Medicine

Weill Cornell Medical College
New York, New York

Carlos Acevedo-Gadea, MD
Clinical Fellow
Yale Cancer Center
Yale School of Medicine
New Haven, Connecticut

Ann M. Berger, MSN, MD
Bethesda, MD

Tim Ahles, PhD
Director of the Neurocognitive Research Laboratory
Memorial Sloan-Kettering Cancer Center
New York, New York
Manmeet S. Ahluwalia, MD
Section Head, Neuro-Oncology Outcomes
The Rose Ella Burkhardt Brain Tumor and
Neuro-Oncology Center
Neurological Institute, Cleveland Clinic
Assistant Professor, Department of Medicine
Cleveland Clinic Lerner College of Medicine of Case Western
Reserve University
Cleveland, Ohio
Richard B. Alexander, MD
Professor
Department of Surgery/Urology
University of Maryland School of Medicine
Chief, Urology

Veterans Affairs Maryland Health Care System
Baltimore, Maryland
Richard J. Barth Jr, MD
Associate Professor
Department of Surgery
The Geisel School of Medicine at Dartmouth
Chief of Surgical Oncology
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire
Chiara Battelli, MD, PhD
Clinical and Research Fellow
Division of Hematology-Oncology
Department of Medicine
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Smita Bhatia, MD, MPH
Chair and Professor, Population Sciences
City of Hope National Medical Center
Duarte, California
Daniel J. Boffa, MD
Assistant Professor
Department of Thoracic Surgery
Yale University School of Medicine
Attending
Yale-New Haven Hospital
New Haven, Connecticut
Danielle C. Bonadies, MS, CGC
Assistant Director, Cancer Genetic Counseling

Yale Cancer Center
New Haven, Connecticut
Michael Boyiadzis, MD, MHSc
Assistant Professor of Medicine
University of Pittsburgh School of Medicine
University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania
Eduardo Bruera, MD
Professor and Chair
Department of Palliative Care and Rehabilitation Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Christina Brzezniak, DO
Clinical Fellow
Hematology and Oncology
Walter Reed National Military Medical Center
Bethesda, Maryland
Tim Byers, MD, MPH
Associate Dean for Public Health Practice
Colorado School of Public Health
Aurora, Colorado

vii

(c) 2015 Wolters Kluwer. All Rights Reserved.


viii

Oncology in Primar y Care

Gayle L. Byker, MD, MBA
Hospice Medical Director
Capital Caring
Falls Church, Virginia

Allen J. Dietrich, MD
Professor
Department of Community and Family Medicine
Norris Cotton Cancer Center
Geisel School of Medicine at Dartmouth
Hanover, New Hampshire

Bryan W. Chang, MD
Assistant Professor
Radiation Oncology
Yale University School of Medicine
Physician
Yale-New Haven Hospital
New Haven, Connecticut

Barbara K. Dunn, MD, PhD
Medical Officer
Division of Cancer Prevention
National Cancer Institute
Bethesda, Maryland

Herta H. Chao, MD, PhD
Associate Professor of Medicine
Yale School of Medicine

Veterans Affairs Cancer Center
West Haven, Connecticut

Laura J. Esserman, MD, MBA
Professor of Surgery and Radiology
University of California, San Francisco
Director, Carol Franc Buck Breast Care Center
Helen Diller Family Comprehensive Cancer Center
University of California, San Francisco
San Francisco, California

Wichai Chinratanalab, MD
Assistant Professor of Medicine
Division of Hematology/Oncology
Vanderbilt University School of Medicine
Nashville, Tennessee

Daniel G. Federman, MD, FACP
Professor of Medicine
Yale University School of Medicine
Chief in Primary Care
Veterans Affairs Connecticut Healthcare System
West Haven, Connecticut

Gina G. Chung, MD
Assistant Professor
Yale Cancer Center
Yale University School of Medicine
Attending Physician
Internal Medicine

Yale New Haven Hospital
New Haven, Connecticut

Michael Feuerstein, PhD
Professor of Medical and Clinical Psychology and Preventive
Medicine and Biometrics
Uniformed Services University of the Health Sciences
Bethesda, Maryland

Lauren G. Collins, MD
Assistant Professor
Department of Family and Community Medicine
Jefferson Medical College/Thomas Jefferson University
Philadelphia, Pennsylvania
Alicia J. Cool, MD
Procedural Dermatology Fellow
Yale Department of Dermatology
Section of Dermatologic Surgery and Cutaneous Oncology
Yale University School of Medicine
Yale New Haven Hospital
New Haven, Connecticut
Shalini Dalal, MD
Assistant Professor
Department of Palliative Care and Rehabilitation Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Barbara A. Degar, MD
Assistant Professor in Pediatrics
Harvard Medical School
Senior Physician in Pediatric Oncology

Dana-Farber Cancer Institute/Boston Children’s Hospital
Cancer Center
Boston, Massachusetts
Aarati D. Didwania, MD
Associate Professor
General Internal Medicine and Geriatrics
Feinberg School of Medicine, Northwestern University
Chicago, Illinois

Aaron W. Flanders, MD
Hematology and Oncology Fellow
Walter Reed National Military Medical Center
Bethesda, Maryland
Christopher Ian Flowers, MD, FRCR
Associate Professor
Department of Oncological Sciences
University of South Florida
Director of Breast Imaging
Moffitt Cancer Center
Tampa, Florida
Kenneth A. Foon, MD
Vice President, Medical Affairs
Celgene Corporation
Summit, New Jersey
Danielle N. Friedman, MD
Instructor, Department of Pediatrics
Long-Term Follow-Up Program
Memorial Sloan-Kettering Cancer Center
New York, New York
Scott Nicholas Gettinger, MD

Associate Professor of Medicine
Yale University School of Medicine
Yale Cancer Center
New Haven, Connecticut

(c) 2015 Wolters Kluwer. All Rights Reserved.


CONTRIBUTORS

Shari Goldfarb, MD
Assistant Attending Physician
Departments of Medicine and Epidemiology and Biostatistics,
Memorial Sloan-Kettering Cancer Center
Department of Medicine, Weill Cornell Medical College
New York, New York
Stacey A. Goodman, MD
Professor of Medicine
Division of Hematology/Oncology
Department of Medicine, Vanderbilt University
Nashville, Tennessee
Elon J. Granader, MD, MSc
Department of Radiology
University of Michigan Health System
Ann Arbor, Michigan

Susan Hong, MD, MPH
Associate Professor of Medicine
Department of Medicine
University of Chicago

Chicago, Illinois
Bonnie Indeck, MSW, LCSW
Manager, Oncology Social Work
Smilow Cancer Hospital at Yale-New Haven
New Haven, Connecticut
Iris Isufi, MD
Assistant Professor of Medicine, Hematology
Yale University School of Medicine
New Haven, Connecticut
Ahmedin Jemal, DVM, PhD
Vice President, Surveillance and Health Services Research
National Home Office
American Cancer Society, Inc
Atlanta, Georgia

F. Anthony Greco, MD
Director, Sarah Cannon Cancer Center
Centennial Medical Center
Nashville, Tennessee

Nirav S. Kapadia, MD
Department of Radiation Oncology
University of Michigan Health System
Ann Arbor, Michigan

Peter Greenwald, MD, DrPH
Associate Director for Prevention
National Cancer Institute
Bethesda, Maryland

Kristen Kellar-Graney, MS
Tumor Biologist and Clinical Researcher
Washington Musculoskeletal Tumor Center
Bethesda, Maryland

John D. Hainsworth, MD
Chief Scientific Officer
Sarah Cannon Research Institute
Nashville, Tennessee
Diane M. Harper, MD, MPH, MS
Professor and Vice Chair
Department of Obstetrics and Gynecology
Community and Family Medicine
University of Missouri-Kansas City School of Medicine
Chief of Women’s Health
Truman Medical Center Lakewood
Kansas City, Missouri
Alton Hart Jr, MD, MPH
Associate Scientific Director
Virginia Commonwealth University
Richmond, Virginia
Tara O. Henderson, MD, MPH
Assistant Professor
Department of Pediatrics, Section of Hematology, Oncology and
Stem Cell Transplantation
University of Chicago
Chicago, Illinois
Howard S. Hochster, MD
Professor of Medicine, Medical Oncology
Associate Director for Clinical Research, Yale Cancer Center

Clinical Program Leader, Gastrointestinal Cancers Program,
Smilow Cancer Hospital at Yale-New Haven
Clinical Research Program Leader, Gastrointestinal Cancers
Program, Yale Cancer Center
Yale University School of Medicine
New Haven, Connecticut

Joanne Frankel Kelvin, RN, MSN
Clinical Nurse Specialist
Survivorship
Memorial Sloan-Kettering Cancer Center
New York, New York
Amsale Ketema, MD
Assistant Clinical Member at Memorial Sloan-Kettering
Cancer Center
Assistant Professor of Clinical Medicine at Weill Cornell
Medical College
New York, New York
Robert S. Kirsner, MD, PhD
Professor and Vice Chairman
Department of Dermatology and Cutaneous Surgery
University of Miami Miller School of Medicine
Chief of Dermatology
University of Miami Hospital
Miami, Florida
Manish Kohli, MD
Associate Professor of Oncology
Chair, Genito-Urinary Medical Oncology
Mayo Clinic
Rochester, Minnesota

Marisa A. Kollmeier, MD
Assistant Professor, Attending Physician
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York

(c) 2015 Wolters Kluwer. All Rights Reserved.

ix


x

Oncology in Primar y Care

Jack S. Mandel, PhD, MPH
Chief Science Officer
Exponent, Inc
Menlo Park, California

Panagiotis A. Konstantinopoulos, MD, PhD
Assistant Professor of Medicine
Medicine-Division of Hematology/Oncology
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Amrita Y. Krishnan, MD, FACP
Associate Director, Medical Education and Training
Director, Multiple Myeloma Program
Department of Hematology and Hematopoietic

Cell Transplantation
City of Hope Medical Center
Duarte, California
Elizabeth A. Kvale, MD
Associate Professor
Department of Medicine, Director Supportive Care
University of Alabama at Birmingham
Staff Physician
Palliative Medicine
Birmingham Veterans Affairs Medical Center
Birmingham, Alabama
Jill Lacy, MD
Associate Professor
Director, Hematology-Oncology Fellowship
Program, Section of Medical Oncology
Yale University School of Medicine
Yale-New Haven Hospital
New Haven, Connecticut
Theodore S. Lawrence, MD, PhD, FASTRO
Isadore Lampe Professor and Chair
Department of Radiation Oncology
University of Michigan
Ann Arbor, MI
David J. Leffell, MD
David Paige Smith Professor of Dermatology and Surgery
Yale School of Medicine
New Haven, Connecticut
Jia Li, MD, PhD
Assistant Professor of Medicine
Yale School of Medicine

New Haven, Connecticut

Anna Rita Marcelli, MD
Assistant Professor of Clinical Medicine
Assistant Attending Physician
Memorial Sloan-Kettering Cancer Center
New York, New York
Steven C. Martin, MD
Member
Department of Medicine
Memorial Sloan-Kettering Cancer Center
Chief, General Internal Medicine
Memorial Hospital for Cancer and Allied Diseases
New York, New York
Ellen T. Matloff, MS, CGC
Research Scientist, Department of Genetics
Yale School of Medicine
Director, Cancer Genetic Counseling
Yale Cancer Center
New Haven, Connecticut
Laura C. McCullough, MD
General Pediatrician, Milton Pediatrics
Children’s Hospital Boston
Massachusetts General Hospital
Brigham and Women’s Hospital
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Aleagia Mercer-Falkoff, MD
Mercy Medical Center
Baltimore, Maryland

Lindsay M. Morton, PhD
Investigator, Radiation Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute
Rockville, Maryland
Anil B. Nagar, MD
Associate Professor
Internal Medicine, Digestive Diseases
Yale University
New Haven, Connecticut
Endoscopy Director
West Haven Veterans Affairs Medical Center
West Haven, Connecticut

Jennifer E. Liu, MD, FACC
Director of Cardiovascular Laboratories
Memorial Sloan-Kettering Cancer Center
New York, New York
Konstantinos I. Makris, MD
Endocrine Surgery Fellow
Department of Surgery
The Johns Hopkins University School of Medicine
Baltimore, Maryland
Martin M. Malawer, MD, FACS
Director of Orthopedic Oncology
Professor of Orthopedic Surgery, George Washington University
Professor (Clinical Scholar) in Orthopedics, Georgetown
University School of Medicine
Washington, District of Columbia

Nitya Nathwani, MD
Assistant Professor
Department of Hematology and Hematopoietic
Cell Transplantation
City of Hope Medical Center
Duarte, California
Larissa Nekhlyudov, MD, MPH
Associate Professor
Department of Population Medicine
Harvard Medical School
Primary Care Physician
Department of Medicine
Harvard Vanguard Medical Associates
Boston, Massachusetts

(c) 2015 Wolters Kluwer. All Rights Reserved.


CONTRIBUTORS

Leslie Nowell, DO
Showa Associates’ Wellness Center
Sunbury, Ohio

Michelle B. Riba, MD, MS
Clinical Professor and Associate Chair
Department of Psychiatry
University of Michigan
Ann Arbor, Michigan

Sasha Nunes
Dietetic Intern
Sodexo Mid-Atlantic Dietetic Internship
Washington, District of Columbia
Kevin C. Oeffinger, MD
Member and Attending Physician
Director, Memorial Sloan-Kettering Cancer Center
Adult Long-Term Follow-Up Program
Departments of Medicine and Pediatrics
Memorial Sloan-Kettering Cancer Center
New York, New York

Nora Rightmer, LCSW
Clinical Oncology Social Worker
Smilow Cancer Hospital at Yale-New Haven
New Haven, Connecticut
Michal G. Rose, MD
Associate Professor of Medicine (Medical Oncology)
Yale University School of Medicine
Director, Veterans Affairs CT Comprehensive Cancer Center
West Haven, Connecticut

Susan M. Parks, MD
Associate Professor
Department of Family and Community Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania

Robert E. Roses, MD
Assistant Professor of Surgery

Hospital of the University of Pennsylvania
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania

Kimberly S. Peairs, MD
Assistant Professor
Department of Medicine and The Sidney Kimmel
Comprehensive Cancer Center
Johns Hopkins University School of Medicine
Lutherville, Maryland
Assistant Professor of Medicine
Johns Hopkins Hospital
Baltimore, Maryland

Richard E. Royal, MD
Associate Professor
Department of Surgical Oncology
University of Texas
Gastrointestinal and Melanoma Centers
M.D. Anderson Cancer Center
Houston, Texas

David G. Pfister, MD
Professor
Department of Medicine
Weill Cornell Medical College
Member, Attending Physician
Chief, Head and Neck Oncology Service
Memorial Sloan-Kettering Cancer Center
New York, New York

Mack T. Ruffin, IV, MD
Dr. Max and Buena Lichter Research Professor
Associate Chair for Research Programs
Department of Family Medicine
University of Michigan
Ann Arbor, Michigan

Mark P. Purdue, PhD
Investigator
Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, Maryland
Mohammad Ali Raza, MD
Clinical Fellow
Medical Oncology/Hematology
Yale University
Yale Cancer Center
New Haven, Connecticut
Alvin L. Reaves III, MD
Clinical Instructor of Medicine
Emory Palliative Care Center
Emory University
Atlanta, Georgia
Nishitha M. Reddy, MD
Assistant Professor of Medicine
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee

Marina Rozenberg, MD

Assistant Clinical Member
Memorial Sloan-Kettering Cancer Center
New York, New York

Shannon Ryan-Cebula, MD
Bethesda, Maryland
Hamid Saadati, MD
Hematology Oncology Fellow
Smilow Cancer Hospital at Yale-New Haven
New Haven, Connecticut
Bipin N. Savani, MD
Associate Professor of Medicine
Director, Long-Term Transplant Clinic
Hematology and Stem Cell Transplantation Section
Vanderbilt University School of Medicine
Nashville, Tennessee
Glenn L. Schattman, MD
Associate Professor of Clinical Reproductive Medicine
Associate Professor of Clinical Obstetrics and Gynecology
Weill Cornell Medical College
Associate Attending Physician, Reproductive Medicine
Associate Attending Obstetrician and Gynecologist
New York-Presbyterian Hospital/Weill Cornell Medical Center
New York, New York

(c) 2015 Wolters Kluwer. All Rights Reserved.

xi

xii

Oncology in Primar y Care

Thomas L. Schwenk, MD
Dean, School of Medicine
Vice President for Health Sciences
University of Nevada
Reno, Nevada

Kristine Swartz, MD
Instructor
Family and Community Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania

Stuart E. Seropian, MD
Associate Professor of Medicine
Department of Internal Medicine, Yale Cancer Center
Yale University
Attending Physician
Internal Medicine and Hematology
Yale-New Haven Hospital
New Haven, Connecticut

Tamar Hamosh Taddei, MD
Assistant Professor
Department of Medicine, Section of Digestive Diseases
Yale University School of Medicine
New Haven, Connecticut

Director, HCC Initiative
Veterans Affairs Connecticut Healthcare System
West Haven, Connecticut

Charles A. Sklar, MD
Director, Long-Term Follow-Up Program
Memorial Sloan-Kettering Cancer Center
Professor of Pediatrics
Weill Cornell Medical College
New York, New York

Briana L. Todd, MS
Doctoral Candidate
Department of Medical and Clinical Psychology
Uniformed Services University of the Health Sciences
Bethesda, Maryland

Robert A. Smith, PhD
Senior Director, Cancer Screening
Cancer Control Science Department
American Cancer Society
Atlanta, Georgia

Emily S. Tonorezos, MD, MPH
Assistant Professor
Department of Medicine
Weill Cornell Medical College
Assistant Member, Memorial Sloan-Kettering Cancer Center
New York, New York

Roy E. Smith, MD
Professor of Medicine
Division of Hematology/Oncology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Elaine B. Trujillo, MS, RD
Nutritional Science Research Group
Division of Cancer Prevention
National Cancer Institute
National Institutes of Health
Bethesda, Maryland

Jonas M. Sokolof, DO
Assistant Professor
Department of Rehabilitation Medicine
Rehabilitation Medicine Service
Weil Cornell Medical College
Assistant Clinical Member
Memorial Sloan-Kettering Cancer Center
New York, New York

Jaya Vijayan, MD
Palliative Care Physician
Department of Internal Medicine
Holy Cross Hospital
Silver Spring, Maryland
Adrienne Vincenzino, MD
Assistant Attending Physician
Department of Medicine

Memorial Sloan-Kettering Cancer Center
New York, New York

Corey Speers, MD, PhD
Department of Radiation Oncology
University of Michigan Health System
Ann Arbor, Michigan
David Spiegel, MD
Willson Professor
Associate Chair of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Medical Director
Center for Integrative Medicine
Stanford Hospital and Clinics
Stanford, California
Michael D. Stubblefield, MD
Associate Professor of Rehabilitation Medicine
Weill Cornell Medical College
Chief
Rehabilitation Medicine Service
Memorial Sloan-Kettering Cancer Center
New York, New York

Kate V. Viola, MD, MHS
Dermatology Resident
Albert Einstein College of Medicine/Montefiore
Medical Center
Bronx, New York
Michael A. Vogelbaum, MD, PhD, FAANS, FACS
Professor

Department of Surgery (Neurosurgery)
Cleveland Clinic Lerner College of Medicine of Case Western
Reserve University
Associate Director of Neurosurgical Oncology
Rose Ella Burkhardt Brain Tumor and NeuroOncology Center
Cleveland Clinic
Cleveland, Ohio

(c) 2015 Wolters Kluwer. All Rights Reserved.


CONTRIBUTORS

Huan N. Vu, MD
Associate Professor
Department of Surgery
Virginia Commonwealth University
Richmond, Virginia

xiii

Ellice Y. Wong, MD
Assistant Professor
Department of Medicine, Hematology, and Medical Oncology
Yale School of Medicine
New Haven, Connecticut
Physician
Department of Medicine, Comprehensive Cancer Center
Veterans Affairs Connecticut Healthcare System
West Haven, Connecticut

Beth A. Wagner, MSN, CRNP, ACHPN
Palliative Care Nurse Practitioner
Family and Community Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania
Richard C. Wender, MD
Alumni Professor & Chair
Department of Family & Community Medicine
Thomas Jefferson University
President, JeffCare (Jefferson’s Physician-Hospital Organization)
Thomas Jefferson University Hospitals, Inc.
Philadelphia, Pennsylvania
Andrew M. Wolf, MD
Associate Professor of Medicine
Division of General Medicine, Geriatrics, and Palliative Care
University of Virginia Health System
Charlottesville, Virginia

Mark W. Yeazel, MD, MPH
Associate Professor
Department of Family Medicine and Community Health
University of Minnesota Medical School
Minneapolis, Minnesota
Martha A. Zeiger, MD, FACS, FACE
Professor of Surgery, Oncology, Cellular, and Molecular Medicine
Chief of Endocrine Surgery
Associate Vice Chair of Research
Department of Surgery
The Johns Hopkins University School of Medicine

Baltimore, Maryland

(c) 2015 Wolters Kluwer. All Rights Reserved.



Preface

We were inspired to write and edit this book by the growing
number of cancer survivors and patients living with cancer
who require the long-term management of primary care clinicians (PCCs) and by the absence, until now, of a practical and
concise source of information on cancer care aimed specifically at the needs of PCCs.
Our associate editors—Dr. Richard C. Wender from the
Department of Family and Community Medicine at Jefferson
Medical College, Dr. Kevin C. Oeffinger, the director of the
Long-Term Follow-Up Program at Memorial Sloan-Kettering
Cancer Center, and Dr. Thomas L. Schwenk, who was the
chair of Family Medicine at the University of Michigan for
25 years—provided indispensable advice as we designed
this book.
Section I describes the shifting landscape of the epidemiology of cancer and the many roles PCCs play in cancer prevention and care. Section II discusses risk factors for cancer
and approaches to cancer prevention. Section III is a comprehensive review of the principles of cancer screening and
their applications to the individual cancers. In Section IV, we
review the different ways patients with cancer present and the
principles of cancer diagnosis and staging. Section V covers

the management and treatment of patients with cancer, with an
emphasis on symptom control, doctor–patient communication,
hospice and palliative care, and the principles of antineoplastic therapy. Section VI is devoted to cancer survivorship and
the role of PCCs in the management of the short- and longterm effects of cancer and its therapy. In Section VII, we cover

cancers of individual sites, with emphasis on the roles the
PCC plays in the diagnosis and management of each type of
cancer. Our book also includes a glossary of common cancerrelated terms and an annotated list of Internet and community
resources for cancer care.
It is our hope that this book will improve communication
between you and specialists who treat cancer, support you in
your role of promoting cancer screening and prevention, and
help you manage patients living with and surviving cancer, to
the ultimate benefit of all patients.
Michal G. Rose, MD
Vincent T. DeVita Jr, MD
Theodore S. Lawrence, MD, PhD
Steven A. Rosenberg, MD, PhD

xv

(c) 2015 Wolters Kluwer. All Rights Reserved.



Acknowledgment

We would like to acknowledge the extraordinary support of Zia Raven in guiding this book
from conception to print.
The Editors

xvii

(c) 2015 Wolters Kluwer. All Rights Reserved.

Contents

Contributors ....................................................................... vii
Preface ............................................................................... xv
Acknowledgment .............................................................. xvii

SECTION I

1

Cancer Prevention and Care—
The Evolving Role of Primary Care
2

2. The Risk of Cancer in the United
States and Globally: Implications for
Primary Care Clinicians
Tim Byers, Ahmedin Jemal

7

15

Cancer Risk Factors and Prevention
3. Genetic Risk and the Management
of the High-Risk Individual
Ellen T. Matloff, Danielle C. Bonadies

47

9. Nutrition
Elaine B. Trujillo, Peter Greenwald

51

SECTION III

1. The Role of the Primary Care Clinician in
Cancer Prevention and Care
Michal G. Rose, Kevin C. Oeffinger, Richard C. Wender

SECTION II

8. Obesity and Physical Activity
Peter Greenwald, Sasha Nunes, Elaine B. Trujillo

16

54

Cancer Screening
10. Principles of Cancer Screening
Robert A. Smith, Jack S. Mandel

55

11. Breast Cancer Screening
Laura J. Esserman, Christopher Ian Flowers

61

12. Screening for Gynecologic Malignancies
Diane M. Harper, Mack T. Ruffin IV

66

13. Colorectal Cancer Screening
Richard C. Wender

73

14. Screening for Hepatocellular Carcinoma
Tamar Hamosh Taddei

76

15. Barrett’s Esophagus
Anil B. Nagar

78

4. Medical Approaches to Cancer Prevention
Barbara K. Dunn, Peter Greenwald

24

5. Smoking
Peter Greenwald, Barbara K. Dunn

30

6. Infections and Inflammation

36

16. Primary and Secondary Prevention
of Skin Malignancies
Kate V. Viola, Robert S. Kirsner, Daniel G. Federman

42

17. Prostate Cancer Screening
Andrew M. Wolf

81

Peter Greenwald, Barbara K. Dunn
7. Chemicals and Radiation
Lindsay M. Morton, Mark P. Purdue

87

xix

(c) 2015 Wolters Kluwer. All Rights Reserved.


xx

Oncology in Primar y Care

18. Lung Cancer Screening
Lauren G. Collins, Richard C. Wender

90

30. Mucositis
Aaron W. Flanders, Ann M. Berger

SECTION IV

93

31. Anemia, Leukopenia, and
Thrombocytopenia
Michal G. Rose, Carlos Acevedo-Gadea

183

94

32. Hypercoagulable States Associated
with Cancer
Jill Lacy, Michal G. Rose, Aleagia Mercer-Falkoff

189

Clinical Presentations of Cancer

19. Does My Patient Have Cancer?
Presenting Symptoms
Kimberly S. Peairs, Larissa Nekhlyudov
20. Paraneoplastic Syndromes
Roy E. Smith, Michael Boyiadzis, Kenneth A. Foon
21. Incidentally Found Cancers
Theodore S. Lawrence, Nirav S. Kapadia,
Elon J. Granader

179

105

115

22. Principles of Cancer Diagnosis
and Staging
Daniel J. Boffa, Leslie Nowell

124

SECTION V

130

Management and Treatment of the
Patient with Cancer
23. Oncologic Emergencies
Aleagia Mercer-Falkoff, Jill Lacy

131

24. Pain Management
Jaya Vijayan, Ann M. Berger

144

25. Nausea and Vomiting
Alvin L. Reaves III, Ann M. Berger

150

26. Diarrhea and Constipation
Shannon Ryan-Cebula, Ann M. Berger

154

33. The Perioperative Management
of the Patient with Cancer
Adrienne Vincenzino, Anna Rita Marcelli,
Amsale Ketema, Steven C. Martin
34. Communication with Patients
with Cancer
Susan M. Parks, Kristine Swartz,
Beth A. Wagner

193

197

35. Principles of Hospice and
Palliative Care
Shalini Dalal, Eduardo Bruera

202

36. Rehabilitation in Patients
with Cancer
Jonas M. Sokolof, Michael D. Stubblefield

211

37. Principles of Antineoplastic
Therapy
Manish Kohli, Theodore S. Lawrence,
Nishitha M. Reddy, Wichai Chinratanalab,
Stacey A. Goodman, Bipin N. Savani,
Donald I. Abrams, Howard S. Hochster

SECTION VI

217

237

Cancer Survivorship
27. Shortness of Breath and Pleural
Effusion
Gayle L. Byker, Ann M. Berger

161

28. Fatigue, Depression, and Anxiety
David Spiegel, Michelle B. Riba, Thomas L. Schwenk
29. Cancer-Associated AnorexiaCachexia Syndrome
Christina Brzezniak, Ann M. Berger

166

174

38. Cancer Survivors, Oncologists,
and Primary Care Clinicians
Kevin C. Oeffinger

238

39. Cardiac and Pulmonary Sequelae
of Cancer and Its Treatment
Jennifer E. Liu, Kevin C. Oeffinger

242

40. Bone Health
Susan Hong, Marina Rozenberg, Kevin C. Oeffinger

(c) 2015 Wolters Kluwer. All Rights Reserved.

248

CONTENTS

xxi

41. Fertility
Joanne Frankel Kelvin, Glenn L. Schattman

252

54. Hepatocellular Carcinoma
Tamar Hamosh Taddei

312

42. Sexual Dysfunction
Shari Goldfarb, Kevin C. Oeffinger, Aarati D. Didwania

257

55. Prostate Cancer
Richard B. Alexander, Bryan W. Chang, Herta H. Chao

316

43. Endocrinopathies
Emily S. Tonorezos, Danielle N. Friedman,
Charles A. Sklar

260

56. Bladder Cancer
Richard B. Alexander, Herta H. Chao

322

57. Kidney Cancer
Richard B. Alexander, Jia Li

326

44. Neurocognitive Effects of Cancer and
Its Therapy
Elizabeth A. Kvale, Tim Ahles, Kevin C. Oeffinger
45. Survivors of Childhood Cancer
Tara O. Henderson, Emily S. Tonorezos, Kevin C. Oeffinger

263

267

58. Cancers of the Testicle, Urethra,
and Penis
Marisa A. Kollmeier

330

334

270

59. Breast Cancer
Gina G. Chung, Hamid Saadati,
Mohammad Ali Raza
60. Gynecologic Cancers
Panagiotis A. Konstantinopoulos, Chiara Battelli

343

276

348

280

61. Skin Cancers
David J. Leffell, Alicia J. Cool

281

62. Lymphoma
Iris Isufi, Stuart E. Seropian

355

48. Head and Neck Cancer
Shrujal S. Baxi, David G. Pfister

286

63. Plasma Cell Disorders
Stuart E. Seropian, Iris Isufi

363

49. Lung Cancer, Mesothelioma, Thymoma
Scott Nicholas Gettinger

294

64. Acute Leukemias and Myelodysplasia
Michal G. Rose

369

50. Gastric and Esophageal Cancers
Huan N. Vu

65. Myeloproliferative Neoplasms
Ellice Y. Wong, Michal G. Rose

376

66. Soft Tissue and Bone Sarcomas
Martin M. Malawer, Kristen Kellar-Graney

380

67. Cancers of the Nervous System
Manmeet S. Ahluwalia, Michael A. Vogelbaum

384

68. Endocrine Cancers
Konstantinos I. Makris, Martha A. Zeiger

389

46. Survivors of Hematopoietic
Cell Transplantation
Mark W. Yeazel, Smita Bhatia
47. Psychosocial Sequelae of Cancer
Briana L. Todd, Alton Hart Jr, Michael Feuerstein

SECTION VII
Cancers of Individual Sites

51. Cancer of the Pancreas and
Hepatobiliary Tracts
Richard E. Royal, Robert E. Roses

299

52. Colorectal Cancer
Richard J. Barth Jr, Allen J. Dietrich

303

53. Anal Cancer
Theodore S. Lawrence, Corey Speers

308

(c) 2015 Wolters Kluwer. All Rights Reserved.


xxii

Oncology in Primar y Care

69. Cancer of Unknown Primary
F. Anthony Greco, John D. Hainsworth

394

70. HIV and Other ImmunosuppressionRelated Malignancies
Nitya Nathwani, Amrita Y. Krishnan
71. Common Childhood Cancers
Barbara A. Degar, Laura C. McCullough

Glossary—Common Cancer-Related Terms
Michal G. Rose

409

397

Appendix—Useful Internet and Community
Resources for Cancer Care
Bonnie Indeck, Nora Rightmer

411

402

Index

415

(c) 2015 Wolters Kluwer. All Rights Reserved.


SECTION

I
Cancer Prevention
and Care—The
Evolving Role of
Primary Care

(c) 2015 Wolters Kluwer. All Rights Reserved.


CHAPTER

1 The Role of the
Primary Care Clinician
in Cancer Prevention
and Care
Michal G. Rose, MD • Kevin C. Oeffinger, MD • Richard C. Wender, MD

KEY POINTS
• By promoting a healthy lifestyle, vaccinations, and cancer
screening, PCCs play the key role in cancer prevention
and early detection.
• Because of the improvement in cancer care and the aging
of the population, PCCs are caring for an increasing number of cancer survivors.
• Specialists caring for patients with cancer should provide
the patient and his or her PCC with an individualized survivorship plan, which includes information on the cancer
and its treatment and a program for future cancer screening, surveillance, and prevention.
• PCCs and specialists must collaborate in multidisciplinary
teams to prevent cancer deaths and to deliver highquality cancer care.

The primary care clinician (PCC) is at the forefront of the
fight against cancer. He or she plays the main role in addressing negative health habits associated with cancer, administering cancer-preventing vaccinations, screening for cancer,
conducting the initial evaluation of the patient with symptoms
of cancer, and caring for survivors of cancer. PCCs also commonly comanage patients during the active cancer treatment
phase and at the end of their lives. To fulfill these critical roles,
PCCs require in-depth knowledge of the evolving landscape
of cancer prevention and care.

NEW FRONTIERS IN THE WAR
AGAINST CANCER
Cancer is the second leading cause of death in the United
States and worldwide. One in two American men and one
in three American women will develop cancer,1 and the
American Cancer Society estimates that 577,190 people will
die from cancer in the United States in 2012.2 Age-specific
cancer death rates peaked in 1990 for men and in 1991 for
women and since then have declined by 22.9% in men and

15.3% in women. Most of this decline in mortality occurred
among the most common cancers (lung, breast, colorectal, and prostate) and is attributed to a reduction in smoking
(lung), cancer screening (breast, colorectal, and prostate), and
improvements in treatment (multiple cancers).1–3
The 5-year overall survival rate for all invasive cancers
has increased from 50% in 1975–1977 to 67% in 1999–2005.
Survival now exceeds 80% for many common cancers, including breast, prostate, testicular, thyroid, bladder and endometrial cancer, melanoma, and Hodgkin lymphoma.4 In parallel,
the number of cancer survivors has quadrupled in the last
four decades and now exceeds 12 million.4
Excess weight and lack of physical activity are emerging as major risk factors for cancer in the United States and
other industrialized countries.2,5 Globally, the World Health
Organization estimates that more than 30% of cancer deaths
could be prevented by modifying risk factors alone.5 Vaccinations can prevent hepatitis B–related liver cancer, cervical cancer, and some oropharyngeal cancers; and antibiotics
can prevent Helicobacter pylori–related cancers.6 Medications that prevent cancer in high-risk populations, such as
tamoxifen, raloxifene, and exemestane for woman at high

2

(c) 2015 Wolters Kluwer. All Rights Reserved.