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malignant neoplasm (cancer)

Cancer is a generic term generally used in reference to malignant neoplasms. See neoplasm. Classification: - genetic classification of malignant neoplasms may better estimate prognosis & facilitate treatment [12] Etiology: risk factors 1) risk of cancer in different tissues is correlates (0.81) with the total number of stem cell divisions [26] - 2/3 of cancers due to bad luck [26] 2) smoking & other tobacco use causes about 30% of all cancer-related deaths in the USA 3) smoking in association with asbestos exposure increases risk of lung cancer & mesothelioma 4) radiation therapy is associated with lifelong risk of cancers originating in the irradiated field 5) alcoholic beverage a) although not carcinogenic, associated with risk of cancer in the upper respiratory tract as well as hepatocellular carcinoma in the setting of cirrhosis b) responsible for about 3.5% of all cancer deaths in the U.S. in 2009 [10] 6) infectious agents may be associated with cancer a) papilloma virus 1] cervical cancer 2] anal cancer 3] oropharyngeal cancer b) hepatitis B, hepatitis C -> hepatocellular carcinoma c) Helicobacter Pylori 1] gastric MALT lymphoma 2] gastric adenocarcinoma d) Epstein-Barr virus -> Hodgkin's lymphoma 7) genetic predisposition a) defects in tumor suppressor b) defects promoting autonomous traverse of the cell-cycle c) both early-onset & late-onset cancer in a parent is associated with excess risk for the same cancer in offspring [8] 8) taller women may be at greater risk for many cancers a) includes colorectal cancer, breast cancer, melanoma b) lung cancer is not included [15] 9) work stress is not a risk factor [11] 10) 40% of cancer case & ~50% if cancer deaths among U.S. adults >= 30 years in 2019 were associated with modifiable risk factors [47] - smoking (#1), drinking, poor diet, failure to receive vaccination(s) [47] - excess body weight (#2) [47] Epidemiology: 1) most common cancers* in men (all ages) [42] cancer % prostate cancer 29% lung cancer 12% colorectal cancer 8% bladder cancer 6% cutaneous melanoma 6% kidney cancer, ureteral cancer 5% non-Hodgkin's lymphoma 4% oropharyngeal cancer, laryngeal cancer 4% leukemia 4% pancreatic cancer 3% 2) most common cancers* in women (all ages) [42] cancer % breast cancer 40% lung cancer 17% colorectal cancer 14% uterine cancer* 7% cutaneous melanoma 4% non-Hodgkin's lymphoma 4% thyroid cancer 3% pancreatic cancer 3% kidney cancer, ureteral cancer 3% leukemia 3% * cervical cancer & endometrial cancer 3) most common tumors by < 15 years of age - leukemia - primary CNS neoplasm - endocrine neoplasm - male: lymphoma; female: bone cancer - sarcoma 4) most common tumors by 15-34 years of age - male: leukemia; female: breast cancer - male: lymphoma; female: leukemia - male: primary CNS neoplasm; female: cervical cancer - male: skin cancer; female: primary CNS neoplasm - male: Hodgkin's disease; female: lymphoma 5) most common tumors by 35-54 years of age - male: lung cancer; female: breast cancer - male: colorectal cancer; female: lung cancer - male: lymphoma; female: colorectal cancer - male: primary CNS neoplasm; female: ovarian cancer - male: pancreatic cancer; female: cervical cancer 6) most common tumors by 55-74 years of age - lung cancer - male: colorectal cancer; female: breast cancer - male: prostate cancer; female: colorectal cancer - male: pancreatic cancer; female: ovarian cancer - male: lymphoma; female: pancreatic cancer 7) most common tumors by > 75 years of age - lung cancer - male: prostatic cancer; female: colorectal cancer - male: colorectal cancer; female: breast cancer - pancreatic cancer - male: leukemia; female: ovarian cancer 8) mortality from malignant neoplasms in men, 2023 [42] cancer % lung cancer 21% prostate cancer 11% colorectal cancer 9% pancreatic cancer 8% liver cancer & biliary cancer 6% leukemia 4% esophageal cancer 4% bladder cancer 4% non-Hodgkin's lymphoma 4% brain cancer & other nervous system cancers 3% 9) mortality from malignant neoplasms in women, 2023 [42] cancer % lung cancer 21% breast cancer 15% colorectal cancer 8% pancreatic cancer 8% ovarian cancer 5% uterine cancer* 5% liver cancer & biliary cancer 4% leukemia 3% non-Hodgkin's lymphoma 3% brain cancer & other nervous system cancers 3% * cervical cancer & endometrial cancer 10) cancer mortality - 33% reduction in cancer mortality 1991-2020 [42] - declined by 20% between 1980-2014 [32] & 1991-2010 [17] from 240 to 192 deaths per 100,000 - substantial geographic variability within in U.S. - Summit County, Colorado with lowest cancer mortality in 2014, at 71 deaths per 100,000 [32] - Union County, Florida with highest cancer mortality in 2014, at 503 per 100,000 [32] - testicular cancer, pancreatic cancer & colorectal cancer contributory [32] - overall cancer incidence was lower in nonmetropolitan areas than metropolitan areas 2006-2015 [33] - incident cases of lung, colorectal, & cervical cancer higher in nonmetropolitan areas - mortality higher for these cancers plus prostate cancer in nonmetropolitan areas [33] 11) incidence of invasive cancer: 451 per 100,000 population - incidence higher in men than women - mortality similar among men & women [27] - older adults & black Americans of all ages are likely to develop cancer & present with more advanced disease [18,27] - aggressiveness of malignancy shows variable association with age [18] - ethnic differences in cancer rates & mortality [23] 12) populations living in extremely cold or high-altitude nvironments have genes that increase survival but predispose individuals to cancer later in life, especially lung cancer, breast cancer, & colorectal cancer [36] 13) in the Chinese community, cancer has traditionally been the 'unspeakable' diagnosis from which elders have been shielded [18,22] 14) incidence of 17 of 34 cancers have increased in younger cohorts (born after 1990), vs older cohort including pancreatic cancer & kidney cancer [48] * leukemias & lymphomas together rank under bladder cancer in men & endometrial cancer in women (about 6% of all cancers) Pathology: - malignant neoplasms apparently originate from stem cells [2,7] - stem cell mutations drive neoplasm growth (driver mutations) - present in all cells of the primary cancer - almost universally present in primary cancers* * ependymomas may be entirely epigenetic Genetics: - c-Myc is an oncogenic transcription factor frequently dysregulated in human cancer [4] Clinical manifestations: 1) local - pain - swelling 2) regional & distant a) pain b) swelling c) edema d) organ dysfunction e) obstruction of flow - air - blood - urine - CSF - bile - stool 6) compression of nerves 7) weakening or breach of structural integrity - bone - blood vessels - bowel 3) paraneoplastic syndromes a) metabolic disorders - hypercalcemia - cachexia - fever - hyponatremia b) ectopic hormone production - ACTH c) neuropathy & CNS abnormalities d) dermatologic conditions e) hematologic abnormalities - thrombosis - hemorrhage f) immunosuppression g) autoimmunity 4) psychosocial effects - anxiety - depression - loss of autonomy - fear of death & dying - fear of pain & altered body image - alienation 5) symptoms that increase the likelihood of cancer [3] - hematuria - dysphagia - hemoptysis - rectal bleeding Laboratory: - cancer 92 mRNA expression analysis (CPT) Complications: - in the 1st week after a cancer diagnosis a) increased risk of suicide (HR=10) b) increased risk of death from cardiovascular event (HR=5) [6] - increased risk for myocardial infarction or ischemic stroke 6 months after cancer diagnosis (4.7% vs 2.2%) [34] - greater manifestations of cognitive symptoms* associated with greater severity of symptoms from cancer & treatment [49] - fatigue & depression associated with moderate-severe cognitive symptoms* [49] * cognitive symptons include: memory impairment, inattention, impaired concentration, diminished processing speed, executive dysfunction Management: - geriatric assessment prior to palliative care consult in elderly [45] - palliative care consult for patients with newly diagnosed advanced cancer [9,31,41] - patients who have cancer with poor prognosis who enter hospice use less intensive medical care & cost less to care for (median hospice duration 11 days) [25] - surgical resection is the primary treatment modality for most malignancies - cure for nearly all solid tumors is usually related to whether of not the tumor can be completely resected [9] - if cure is unlikely, a palliative approach to prolong life & improve the quality of life is indicated [9,41] - fertility options should be offered befor cancer treatment for patients who wish future child-bearing [9] - an era of personalized cancer treatment based upon genomics. proteomics & tumor microenvironments is emerging [9] - newer chemotherapeutic agents include - growth factor inhibitors - receptor tyrosine kinase inhibitors - aromatase inhibitors - see specific cancer - see cancer survivor - treatment of symptoms [29,30] including - cancer pain - chemotherapy-induced nausea/vomiting * - treat depression - collaborative care more effective for treating depression than usual care [24] - attributes of high-value oncology practices [35] - conservative approach to diagnostic testing; - patient engagement & shared decision making - early discussion with patients about the limitations & goals of cancer care - early involvement & normalization of palliative care - allowing staff to practice at the highest level of their license & competence - affiliation of smaller units of care delivery with a larger healthcare system [35] - eliminating unnecessary emergency department visits [38] - identify patients at high risk for unplanned acute care - enhance access & care coordination among healthcare providers - standardize clinical pathways for symptom management - develop alternative means for urgent cancer care - use early palliative care [38] - exercise should be prescribed to all cancer patients per Clinical Oncology Society of Australia (COSA) [39] * - vaccinations - adults with solid & hematologic cancers traveling to an area of risk should follow the CDC standard recommendations for the destination - non-live vaccines are safe - hepatitis A vaccine, typhoid vaccine, inactivated polio vaccine, hepatitis B vaccine, rabies vaccine, meningococcal vaccine, Japanese encephalitis vaccine [46] Notes: - overdiagnosis is common & occurs more freauently with screening for cancer [16] - overdiagnosis results in overtreatment - cost of cancer treatment have increased significantly [9]

Interactions

disease interactions

Related

aberrantly expressed proteins/genes in cancer cancer alternative therapy cancer complication cancer pain cancer survivor cancer treatment chemotherapy genomic approach in cancer treatment metastasis prevention of cancer screening for cancer staging of cancer

Specific

cancer during pregnancy cancer in the elderly cancer of infectious origin carcinoma CNS malignancy eye cancer; intraocular cancer head & neck cancer (HNC) malignancy with infectious etiology malignant carcinoid malignant endocrine neoplasm malignant histiocytosis; true histiocytic lymphoma; reticulosarcoma; histiocytic medullary reticulosis malignant neoplasm of bone, connective tissue, skin, & breast malignant neoplasm of digestive organs & peritoneum malignant neoplasm of lymphatic & hematopoietic tissue Malignant Neoplasm of Respiratory & Intrathoracic Organs malignant parotid gland neoplasm malignant salivary gland neoplasm metastatic neoplasm (metastatic cancer) obesity-related cancer sarcoma second cancer (subsequent cancer among cancer survivors) secondary malignant neoplasm urogenital malignancy (urogenital cancer)

General

neoplasm; tumor

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 360
  2. Journal Watch 25(1):3, 2005 Singh SK, Hawkins C, Clarke ID, Squire JA, Bayani J, Hide T, Henkelman RM, Cusimano MD, Dirks PB. Identification of human brain tumour initiating cells. Nature. 2004 Nov 18;432(7015):396-401. PMID: 15549107 - Houghton J, Stoicov C, Nomura S, Rogers AB, Carlson J, Li H, Cai X, Fox JG, Goldenring JR, Wang TC. Gastric cancer originating from bone marrow-derived cells. Science. 2004 Nov 26;306(5701):1568-71. PMID: 15567866
  3. Jones R, Latinovic R, Charlton J, Gulliford MC. Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database. BMJ. 2007 May 19;334(7602):1040. Epub 2007 May 10. PMID: 17493982
  4. Kessler JD et al. A SUMOylation-dependent transcriptional subprogram is required for Myc-driven tumorigenesis. Science 2012 Jan 20; 335:348. PMID: 22157079
  5. Journal Watch, Massachusetts Medical Society, March 12, 2012 Siegel R et al. Cancer Statistics, 2012. CA Cancer J Clin 2012 Jan/Feb; 62:10. PMID: 22237781
  6. Physician's First Watch for April 5, 2012 Massachesetts Medical Society
  7. Chen J et al. A restricted cell population propagates glioblastoma growth after chemotherapy. Nature 2012 Aug 23; 488:522 PMID: 22854781 - Driessens G et al. Defining the mode of tumour growth by clonal analysis. Nature 2012 Aug 23; 488:527 PMID: 22854777 - Gilbertson RJ and Graham TA. Cancer: Resolving the stem-cell debate. Nature 2012 Aug 23; 488:462 PMID: 22919708
  8. Kharazmi E et al. Familial risk of early and late onset cancer: Nationwide prospective cohort study. BMJ 2012 Dec 20; 345:e8076. PMID: 23257063
  9. Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19. American College of Physicians, Philadelphia 2012, 2018, 2021.
  10. Nelson DE et al Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States American Journal of Public Health. Feb 2013 PMID: 23409916 http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301199
  11. Heikkila K et al. Work stress and risk of cancer: Meta-analysis of 5700 incident cancer events in 116 000 European men and women. BMJ 2013 Feb 7; 346:f165 PMID: 23393080
  12. The Cancer Genome Atlas Research Network Genomic and Epigenomic Landscapes of Adult De Novo Acute Myeloid Leukemia. N Engl J Med May 1, 2013 PMID: 23634996 http://www.nejm.org/doi/full/10.1056/NEJMoa1301689 - Steensma DP The Beginning of the End of the Beginning in Cancer Genomics. N Engl J Med May 1, 2013 PMID: 23634995 http://www.nejm.org/doi/full/10.1056/NEJMe1303816 - The Cancer Genome Atlas Research Network Integrated genomic characterization of endometrial carcinoma. Nature 497, 67-73 (02 May 2013) PMID: 23636398 http://www.nature.com/nature/journal/v497/n7447/full/nature12113.html
  13. Jemal A, Siegel R, Xu J, Ward E Cancer statistics, 2010. CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300. PMID: 20610543
  14. decrecated reference
  15. Kobat GC et al Adult Stature and Risk of Cancer at Different Anatomic Sites in a Cohort of Postmenopausal Women. Cancer Epidemiology, Biomarkers & Prevention. July 25, 2012 PMID: 23887996 http://cebp.aacrjournals.org/content/early/2013/07/25/1055-9965.EPI-13-0305.abstract
  16. Esserman LJ et al Overdiagnosis and Overtreatment in Cancer. An Opportunity for Improvement. JAMA. July 29. 2013 PMID: 23896967 http://jama.jamanetwork.com/article.aspx?articleid=1722196
  17. Cancer Facts and Figures 2013 http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf - Siegel R et al Cancer statistics, 2014 CA: A Cancer Journal for Clinicians. Jan 7, 2014 PMID: 24399786 http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full
  18. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  19. Pal SK1, Katheria V, Hurria A. Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin. 2010 Mar-Apr;60(2):120-32 PMID: 20173172
  20. Pal SK, Hurria A. Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol. 2010 Sep 10;28(26):4086-93. PMID: 20644100
  21. Rodin MB, Mohile SG. A practical approach to geriatric assessment in oncology. J Clin Oncol. 2007 May 10;25(14):1936-44 PMID: 17488994
  22. Huang X, Butow P, Meiser B, Goldstein D Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust N Z J Med. 1999 Apr;29(2):207-13. PMID: 10342019
  23. McCracken M, Olsen M, Chen MS Jr et al Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin. 2007 Jul-Aug;57(4):190-205. PMID: 17626117
  24. Walker J et al Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2014 Oct;1(5):343-50 PMID: 26360998 http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2970313-X/abstract - Sharpe M et al Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. The Lancet, Early Online Publication, 28 August 2014 PMID: 25175478 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961231-9/abstract - Walker J et al Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. The Lancet Oncology, Early Online Publication, 28 August 2014 PMID: 25175097 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2814%2970343-2/abstract
  25. Obermeyer Z et al Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer. JAMA. 2014;312(18):1888-1896. PMID: 25387186 http://jama.jamanetwork.com/article.aspx?articleid=1930818 - Teno JM, Gozalo PL Quality and Costs of End-of-Life CareThe Need for Transparency and Accountability. JAMA. 2014;312(18):1868-1869 PMID: 25387185 http://jama.jamanetwork.com/article.aspx?articleid=1930801
  26. Tomasetti C, Vogelstein B Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 2 January 2015: Vol. 347 no. 6217 pp. 78-81 PMID: 25554788 http://www.sciencemag.org/content/347/6217/78.abstract
  27. Henley JS, Singh SD, King J et al Invasive Cancer Incidence and Survival - United States, 2011 MMWR Weekly. March 13, 2015 / 64(09);237-242 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6409a1.htm
  28. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013 Jan;63(1):11-30. PMID: 23335087
  29. Shoemaker LK, Estfan B, Induru R, Walsh TD Symptom management: an important part of cancer care. Cleve Clin J Med. 2011 Jan;78(1):25-34. Review. PMID: 21199904 Free Article
  30. von Gunten CF, Gafford E. Treatment of non-pain-related symptoms. Cancer J. 2013 Sep-Oct;19(5):397-404. Review. PMID: 24051612 Free PMC Article
  31. Otsuka M, Koyama A, Matsuoka H Early palliative intervention for patients with advanced cancer. Jpn J Clin Oncol. 2013 Aug;43(8):788-94. PMID: 23737605 Free Article
  32. Mokdad AH, Dwyer-Lindgren L, Fitzmaurice C et al Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014. JAMA. 2017;317(4):388-406 PMID: 28118455 http://jamanetwork.com/journals/jama/fullarticle/2598772 - Wheeler SB, Basch E Translating Cancer Surveillance Data Into Effective Public Health Interventions. JAMA. 2017;317(4):365-367. PMID: 28118434 http://jamanetwork.com/journals/jama/article-abstract/2598750
  33. Henley SJ, Anderson RN, Thomas CC et al Invasive Cancer Incidence, 2004-2013, and Deaths 2006-2015, in Nonmetropolitan and Metropolitan Counties - United States. MMWR Surveill Summ 2017;66(No. SS-14):1-13 https://www.cdc.gov/mmwr/volumes/66/ss/ss6614a1.htm
  34. Navi BB, Reiner AS, Kamel H et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol 2017 Aug 22; 70:926. PMID: 28818202 http://www.sciencedirect.com/science/article/pii/S0735109717379408 - Yeh ETH, Chang HM. Cancer and clot: Between a rock and a hard place. J Am Coll Cardiol 2017 Aug 22; 70:939. PMID: 28818203 http://www.sciencedirect.com/science/article/pii/S0735109717387867
  35. Nelson R. High-Value Cancer Care Keeps Costs Down? Yes, It's Possible! Medscape - Nov 16, 2017. https://www.medscape.com/viewarticle/888751 - Blayney DW, Simon MK, Podtschaske P et al Critical Lessons From High-Value Oncology Practices. JAMA Oncol. Published online November 16, 2017 PMID: 29145584 https://jamanetwork.com/journals/jamaoncology/article-abstract/2663285 - Sox HC, Basch EM, Berwick D Strategies to Achieve High-Value Oncology Care - A Beginning. JAMA Oncol. Published online November 16, 2017 PMID: 29145560 https://jamanetwork.com/journals/jamaoncology/article-abstract/2663283
  36. Jenkins K Living in Very Cold Climate and Increased Cancer Risk. Medscape - Dec 05, 2017 https://www.medscape.com/viewarticle/889635
  37. Feinberg AP The Key Role of Epigenetics in Human Disease Prevention and Mitigation. N Engl J Med 2018; 378:1323-1334. April 5, 2018 PMID: 29617578 http://www.nejm.org/doi/full/10.1056/NEJMra1402513 - Mack SC, Witt H, Piro RM, Epigenomic alterations define lethal CIMP-positive ependymomas of infancy. Nature. 2014 Feb 27;506(7489):445-50. PMID: 24553142 Free PMC Article
  38. Nelson R Five Steps to Keep Patients With Cancer Out of ED. Medscape - Apr 26, 2018. https://www.medscape.com/viewarticle/895737 - Handley NR, Schuchter LM, Bekelman JE Best Practices for Reducing Unplanned Acute Care for Patients With Cancer. Journal of Oncology Practices. April 2018 http://ascopubs.org/doi/abs/10.1200/JOP.17.00081?journalCode=jop
  39. Mulcahy N Prescribe Exercise to All Cancer Patients, Says New Guideline. Medscape - May 16, 2018. https://www.medscape.com/viewarticle/896686 - Cormie P, Atkinson M, Bucci L et al. Clinical Oncology Society of Australia position statement on exercise in cancer care. Med J Aust. May 7, 2018. PMID: 29719196 https://www.mja.com.au/journal/2018/209/6/clinical-oncology-society-australia-position-statement-exercise-cancer-care
  40. Siegel RL, Miller KD, Jemal A Cancer statistics, 2020 CA: A Cancer Journal for Clinicans. Jan 8, 2020 https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21590 - American Cancer Society News Release. Jan 8, 2020 Facts & Figures 2020 Reports Largest One-year Drop in Cancer Mortality. https://www.cancer.org/latest-news/facts-and-figures-2020.html
  41. Bakitas M, Lyons KD, Hegel MT et al Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009 Aug 19;302(7):741-9 PMID: 19690306
  42. Siegel RL, Miller KD, Wagle NS, MHA, Jemal A. Cancer statistics, 2023 CA: A Cancer Journal for Clinicians. Jan 12, 2023 https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21763
  43. Cancer Facts and Statistics http://www.cancer.org/statistics
  44. National Comprehensive Cancer Network (NCCN) Clinical Guidelines https://www.nccn.org/professionals/physician_gls/f_guidelines.asp
  45. Puts MT, Santos B, Hardt J, An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol. 2014 Feb;25(2):307-15. PMID: 24256847 Free article. Review.
  46. Brooks M ASCO Releases Vaccination Guidelines for Adults With Cancer MDedge/Internal Medicine. March 28, 2024 https://www.mdedge.com/internalmedicine/article/268479/preventive-care/asco-releases-vaccination-guidelines-adults-cancer
  47. Islami R, Marlow EC, Thomson B et al Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA Cancer J Clin. 2024 Jul 11. PMID: 38990124 Free article. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21858
  48. Sung H, Chng C, Bandi P et al Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data. Lancet Public Health. 2024 August PMID: 39095135 Free article https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00156-7/fulltext
  49. Mayo SJ, Edelstein K, Atenafu EG, Ajaj R, Li M, Bernstein LJ. Cognitive Symptoms Across Diverse Cancers. JAMA Netw Open. 2024 Aug 1;7(8):e2430833. PMID: 39196555 PMCID: PMC11358862 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822904
  50. Naddaf M Ultra-precise 3D maps of cancer cells unlock secrets of how tumours grow. Charting the evolution of cancer at single-cell resolution could open up avenues for early diagnosis and treatment. Nature News. 2024. Oct 30. https://www.nature.com/articles/d41586-024-03539-3 - Human Tumor Atlas Network A collection of research articles, methods and datasets from a collaborative initative tracking human tumor evolution in space and time. Nature. 2024 https://www.nature.com/immersive/d42859-024-00059-y/index.html - Nature Portfolio The Human Tumor Atlas Network (HTAN): exploring tumor evolution in time and space. Nature. 2024. Oct 30 https://www.nature.com/collections/fihchcjehc