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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2008

Open Access 01-09-2008 | Gastrointestinal Oncology

Extra-Intestinal Manifestations of Familial Adenomatous Polyposis

Authors: Emma J. Groen, Annemieke Roos, Friso L. Muntinghe, Roelien H. Enting, Jakob de Vries, Jan H. Kleibeuker, Max J. H. Witjes, Thera P. Links, André P. van Beek, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2008

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Abstract

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, which results from a germ line mutation in the APC (adenomatous polyposis coli) gene. FAP is characterized by the formation of hundreds to thousands of colorectal adenomatous polyps. Although the development of colorectal cancer stands out as the most prevalent complication, FAP is a multisystem disorder of growth. This means, it is comparable to other diseases such as the MEN syndromes, Von Hippel-Lindau disease and neurofibromatosis. However, the incidence of many of its clinical features is much lower. Therefore, a specialized multidisciplinary approach to optimize health care—common for other disorders—is not usually taken for FAP patients. Thus, clinicians that care for and counsel members of high-risk families should have familiarity with all the extra-intestinal manifestations of this syndrome. FAP-related complications, for which medical attention is essential, are not rare and their estimated lifetime risk presumably exceeds 30%. Affected individuals can develop thyroid and pancreatic cancer, hepatoblastomas, CNS tumors (especially medulloblastomas), and various benign tumors such as adrenal adenomas, osteomas, desmoid tumors and dental abnormalities. Due to improved longevity, as a result of better prevention of colorectal cancer, the risk of these clinical problems will further increase.
We present a clinical overview of extra-intestinal manifestations, including management and treatment options for the FAP syndrome. Furthermore, we provide recommendations for surveillance of FAP complications based on available literature.
Literature
1.
Gardner EJ, Richards RC. Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 1953; 5:139–47.PubMed
2.
Galiatsatos P, Foulkes WD. Familial adenomatous polyposis. Am J Gastroenterol 2006; 101:385–98.PubMed
3.
Bisgaard ML, Fenger K, Bulow S, et al. Familial adenomatous polyposis (FAP): frequency, penetrance, and mutation rate. Hum Mutat 1994; 3:121–5.PubMed
4.
Bjork J, Akerbrant H, Iselius L, et al. Epidemiology of familial adenomatous polyposis in Sweden: changes over time and differences in phenotype between males and females. Scand J Gastroenterol 1999; 34:1230–5.PubMed
5.
Bulow S, Faurschou NT, Bulow C, et al. The incidence rate of familial adenomatous polyposis. Results from the Danish Polyposis Register. Int J Colorectal Dis 1996; 11:88–91.PubMed
6.
Nugent KP, Spigelman AD, Phillips RK. Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 1993; 36:1059–62.PubMed
7.
Bulow S. Results of national registration of familial adenomatous polyposis. Gut 2003; 52:742–6.PubMed
8.
Bjork J, Akerbrant H, Iselius L, et al. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology 2001; 121:1127–35.PubMed
9.
Gallagher MC, Phillips RK, Bulow S. Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis. Fam Cancer 2006; 5:263–73.PubMed
10.
Hirota WK, Zuckerman MJ, Adler DG, et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc 2006; 63:570–80.PubMed
11.
Matsumoto T, Lida M, Kobori Y, et al. Genetic predisposition to clinical manifestations in familial adenomatous polyposis with special reference to duodenal lesions. Am J Gastroenterol 2002; 97:180–5.PubMed
12.
Fearnhead NS, Britton MP, Bodmer WF. The ABC of APC. Hum Mol Genet 2001; 10:721–33.PubMed
13.
Goss KH, Groden J. Biology of the adenomatous polyposis coli tumor suppressor. J Clin Oncol 2000; 18:1967–79.PubMed
14.
Peifer M, Polakis P. Wnt signaling in oncogenesis and embryogenesis—a look outside the nucleus. Science 2000; 287:1606–9.PubMed
15.
Fodde R, Kuipers J, Rosenberg C, et al. Mutations in the APC tumour suppressor gene cause chromosomal instability. Nat Cell Biol 2001; 3:433–8.PubMed
16.
Fodde R, Smits R, Clevers H. APC, signal transduction and genetic instability in colorectal cancer. Nat Rev Cancer 2001; 1:55–67.PubMed
17.
Kaplan KB, Burds AA, Swedlow JR, et al. A role for the Adenomatous Polyposis Coli protein in chromosome segregation. Nat Cell Biol 2001; 3:429–32.PubMed
18.
Crail HW. Multiple primary malignancies arising in the rectum, brain and thyroid. Report of a case. US Navy Med Bull 1949; 49:123–8.
19.
Plail RO, Bussey HJ, Glazer G, et al. Adenomatous polyposis: an association with carcinoma of the thyroid. Br J Surg 1987; 74:377–80.PubMed
20.
Iwama T, Mishima Y, Utsunomiya J. The impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs. Its rational treatment. Ann Surg 1993; 217:101–8.PubMed
21.
Cetta F, Olschwang S, Petracci M, et al. Genetic alterations in thyroid carcinoma associated with familial adenomatous polyposis: clinical implications and suggestions for early detection. World J Surg 1998; 22:1231–6.PubMed
22.
Cetta F, Montalto G, Gori M, et al. Germline mutations of the APC gene in patients with familial adenomatous polyposis-associated thyroid carcinoma: results from a European cooperative study. J Clin Endocrinol Metab 2000; 85:286–92.PubMed
23.
Cetta F, Pelizzo MR, Curia MC, et al. Genetics and clinicopathological findings in thyroid carcinomas associated with familial adenomatous polyposis. Am J Pathol 1999; 155:7–9.PubMed
24.
Bulow C, Bulow S. Is screening for thyroid carcinoma indicated in familial adenomatous polyposis? The Leeds Castle Polyposis Group. Int J Colorectal Dis 1997; 12:240–2.PubMed
25.
Links TP, van Tol KM, Jager PL, et al. Life expectancy in differentiated thyroid cancer: a novel approach to survival analysis. Endocr Relat Cancer 2005; 12:273–80.PubMed
26.
Sigurdson AJ, Ronckers CM, Mertens AC, et al. Primary thyroid cancer after a first tumour in childhood (the Childhood Cancer Survivor Study): a nested case-control study. Lancet 2005; 365:2014–23.PubMed
27.
Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16:109–42.PubMed
28.
Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005; 237:794–800.PubMed
29.
Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002; 87:1941–6.PubMed
30.
Kingston JE, Herbert A, Draper GJ, et al. Association between hepatoblastoma and polyposis coli. Arch Dis Child 1983; 58:959–62.PubMedCrossRef
31.
Su LK, Abdalla EK, Law CH, et al. Biallelic inactivation of the APC gene is associated with hepatocellular carcinoma in familial adenomatous polyposis coli. Cancer 2001; 92:332–9.PubMed
32.
von Schweinitz D. Neonatal liver tumours. Semin Neonatol 2003; 8:403–10.
33.
Hughes LJ, Michels VV. Risk of hepatoblastoma in familial adenomatous polyposis. Am J Med Genet 1992; 43:1023–5.PubMed
34.
Giardiello FM, Offerhaus GJ, Krush AJ, et al. Risk of hepatoblastoma in familial adenomatous polyposis. J Pediatr 1991; 119:766–8.PubMed
35.
Iwama T, Mishima Y. Mortality in young first-degree relatives of patients with familial adenomatous polyposis. Cancer 1994; 73:2065–8.PubMed
36.
Thomas D, Pritchard J, Davidson R, et al. Familial hepatoblastoma and APC gene mutations: renewed call for molecular research. Eur J Cancer 2003; 39:2200–4.PubMed
37.
Hirschman BA, Pollock BH, Tomlinson GE. The spectrum of APC mutations in children with hepatoblastoma from familial adenomatous polyposis kindreds. J Pediatr 2005; 147:263–6.PubMed
38.
Aretz S, Koch A, Uhlhaas S, et al. Should children at risk for familial adenomatous polyposis be screened for hepatoblastoma and children with apparently sporadic hepatoblastoma be screened for APC germline mutations? Pediatr Blood Cancer 2006; 47:811–8.PubMed
39.
Giardiello FM, Petersen GM, Brensinger JD, et al. Hepatoblastoma and APC gene mutation in familial adenomatous polyposis. Gut 1996; 39:867–9.PubMed
40.
Phillips M, Dicks-Mireaux C, Kingston J, et al. Hepatoblastoma and polyposis coli (familial adenomatous polyposis). Med Pediatr Oncol 1989; 17:441–7.PubMed
41.
Schnater JM, Kohler SE, Lamers WH, et al. Where do we stand with hepatoblastoma? A review. Cancer 2003; 98:668–78.PubMed
42.
Wilson JMG, Jungner G. Principles and practice of screening for diseases. Geneva, WHO Chronicle 1968; 22:1–163.
43.
Sanders RP, Furman WL. Familial adenomatous polyposis in two brothers with hepatoblastoma: implications for diagnosis and screening. Pediatr Blood Cancer 2006; 47:851–4.PubMed
44.
Turcot J, Despres JP, St Pierre F. Malignant tumors of the central nervous system associated with familial polyposis of the colon: report of two cases. Dis Colon Rectum 1959; 2:465–8.PubMed
45.
Paraf F, Jothy S, Van Meir EG. Brain tumor-polyposis syndrome: two genetic diseases? J Clin Oncol 1997; 15:2744–58.PubMed
46.
Hamilton SR, Liu B, Parsons RE, et al. The molecular basis of Turcot’s syndrome. N Engl J Med 1995; 332:839–47.PubMed
47.
Rood BR, Macdonald TJ, Packer RJ. Current treatment of medulloblastoma: recent advances and future challenges. Semin Oncol 2004; 31:666–75.PubMed
48.
Van Meir EG. “Turcot’s syndrome”: phenotype of brain tumors, survival and mode of inheritance. Int J Cancer 1998; 75:162–4.PubMed
49.
Lonser RR, Glenn GM, Walther M, et al. von Hippel-Lindau disease. Lancet 2003; 361:2059–67.PubMed
50.
Reynolds RM, Browning GG, Nawroz I, et al. Von Recklinghausen’s neurofibromatosis: neurofibromatosis type 1. Lancet 2003; 361:1552–4.PubMed
51.
Giardiello FM, Offerhaus GJ, Lee DH, et al. Increased risk of thyroid and pancreatic carcinoma in familial adenomatous polyposis. Gut 1993; 34:1394–6.PubMed
52.
Maire F, Hammel P, Terris B, et al. Intraductal papillary and mucinous pancreatic tumour: a new extracolonic tumour in familial adenomatous polyposis. Gut 2002; 51:446–9.PubMed
53.
Sudo T, Murakami Y, Uemura K, et al. Development of an intraductal papillary-mucinous neoplasm of the pancreas in a patient with familial adenomatous polyposis. Pancreas 2005; 31:428–9.PubMed
54.
Le Borgne J, Bouvier S, Fiche M, et al. Cystic and papillary tumor of the pancreas: diagnostic and developmental uncertainties. Apropos of a case. Chirurgie 1997; 122:31–4.PubMed
55.
Seket B, Saurin JC, Scoazec JY, et al. Pancreatic acinar cell carcinoma in a patient with familial adenomatous polyposis. Gastroenterol Clin Biol 2003; 27:818–20.PubMed
56.
Schneider NR, Cubilla AL, Chaganti RS. Association of endocrine neoplasia with multiple polyposis of the colon. Cancer 1983; 51:1171–5.PubMed
57.
Stewart CJ, Imrie CW, Foulis AK. Pancreatic islet cell tumour in a patient with familial adenomatous polyposis. J Clin Pathol 1994; 47:860–1.PubMed
58.
Chetty R, Salahshor S, Bapat B, et al. Intraductal papillary mucinous neoplasm of the pancreas in a patient with attenuated familial adenomatous polyposis. J Clin Pathol 2005; 58:97–101.PubMed
59.
Gupta C, Mazzara PF. High-grade pancreatic intraepithelial neoplasia in a patient with familial adenomatous polyposis. Arch Pathol Lab Med 2005; 129:1398–400.PubMed
60.
Komorowski RA, Tresp MG, Wilson SD. Pancreaticobiliary involvement in familial polyposis coli/Gardner’s syndrome. Dis Colon Rectum 1986; 29:55–8.PubMed
61.
Pho LN, Coffin CM, Burt RW. Abdominal desmoid in familial adenomatous polyposis presenting as a pancreatic cystic lesion. Fam Cancer 2005; 4:135–8.PubMed
62.
Lockhart AC, Rothenberg ML, Berlin JD. Treatment for pancreatic cancer: current therapy and continued progress. Gastroenterology 2005; 128:1642–54.PubMed
63.
Canto MI, Goggins M, Hruban RH, et al. Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 2006; 4:766–81.PubMed
64.
Devic A, Bussy MM. Un cas de polypose adénomateuse: Generalisée à tout l’intestin. Arch Mal Appar Dig 1912; 6:278–89.
65.
Alexander GL, Thompson GB, Schwartz DA. Primary aldosteronism in a patient with familial adenomatous polyposis. Mayo Clin Proc 2000; 75:636–7.PubMed
66.
Beuschlein F, Reincke M, Koniger M, et al. Cortisol producing adrenal adenoma–a new manifestation of Gardner’s syndrome. Endocr Res 2000; 26:783–90.PubMedCrossRef
67.
Chelaifa K, Bouzaidi K, Chouaib S, et al. Adrenal adenoma in a patient with Gardner’s syndrome. A case report. Acta Radiol 2003; 44:158–9.PubMed
68.
Kartheuser A, Walon C, West S, et al. Familial adenomatous polyposis associated with multiple adrenal adenomas in a patient with a rare 3′ APC mutation. J Med Genet 1999; 36:65–7.PubMed
69.
Marchesa P, Fazio VW, Church JM, et al. Adrenal masses in patients with familial adenomatous polyposis. Dis Colon Rectum 1997; 40:1023–8.PubMed
70.
Naylor EW, Gardner EJ. Adrenal adenomas in a patient with Gardner’s syndrome. Clin Genet 1981; 20:67–73.PubMed
71.
Ozuner G, Hull TL. Familial desmoids in association with adrenal and ovarian masses and leiomyomas: report of three cases. Dis Colon Rectum 1999; 42:529–32.PubMed
72.
Painter TA, Jagelman DG. Adrenal adenomas and adrenal carcinomas in association with hereditary adenomatosis of the colon and rectum. Cancer 1985; 55:2001–4.PubMed
73.
Pines Corrales PJ, Gonzalez-Albarran O, Peralta M, et al. Clinically inapparent adrenal mass in a patient with familial adenomatous polyposis Horm Res 2006; 66:207–10.PubMed
74.
Smith TG, Clark SK, Katz DE, et al. Adrenal masses are associated with familial adenomatous polyposis. Dis Colon Rectum 2000; 43:1739–42.PubMed
75.
Wakatsuki S, Sasano H, Matsui T, et al. Adrenocortical tumor in a patient with familial adenomatous polyposis: a case associated with a complete inactivating mutation of the APC gene and unusual histological features. Hum Pathol 1998; 29:302–6.PubMed
76.
Yamakita N, Murai T, Ito Y, et al. Adrenocorticotropin-independent macronodular adrenocortical hyperplasia associated with multiple colon adenomas/carcinomas which showed a point mutation in the APC gene. Intern Med 1997; 36:536–42.PubMed
77.
Herrera MF, Grant CS, van Heerden JA, et al. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991; 110:1014–21.PubMed
78.
Marshall WH, Martin FI, Mackay IR. Gardner’s syndrome with adrenal carcinoma. Australas Ann Med 1967; 16:242–4.PubMed
79.
Seki M, Tanaka K, Kikuchi-Yanoshita R, et al. Loss of normal allele of the APC gene in an adrenocortical carcinoma from a patient with familial adenomatous polyposis. Hum Genet 1992; 89:298–300.PubMed
80.
Traill Z, Tuson J, Woodham C. Adrenal carcinoma in a patient with Gardner’s syndrome: imaging findings. AJR Am J Roentgenol 1995; 165:1460–1.PubMed
81.
Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003; 138:424–9.PubMed
82.
Gurbuz AK, Giardiello FM, Petersen GM, et al. Desmoid tumours in familial adenomatous polyposis. Gut 1994; 35:377–81.PubMed
83.
Clark SK, Phillips RK. Desmoids in familial adenomatous polyposis. Br J Surg 1996; 83:1494–504.PubMed
84.
Knudsen AL, Bulow S. Desmoid tumour in familial adenomatous polyposis. A review of literature. Fam Cancer 2001; 1:111–9.PubMed
85.
Jarvinen HJ. Desmoid disease as a part of familial adenomatous polyposis coli. Acta Chir Scand 1987; 153:379–83.PubMed
86.
Bertario L, Russo A, Sala P, et al. Genotype and phenotype factors as determinants of desmoid tumors in patients with familial adenomatous polyposis. Int J Cancer 2001; 95:102–7.PubMed
87.
Heiskanen I, Jarvinen HJ. Occurrence of desmoid tumours in familial adenomatous polyposis and results of treatment. Int J Colorectal Dis 1996; 11:157–62.PubMed
88.
Clark SK, Neale KF, Landgrebe JC, et al. Desmoid tumours complicating familial adenomatous polyposis. Br J Surg 1999; 86:1185–9.PubMed
89.
Hansmann A, Adolph C, Vogel T, et al. High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors. Cancer 2004; 100:612–20.PubMed
90.
Church JM. Desmoid tumours in patients with familial adenomatous polyposis. Semin Colon Rectal Surg 1995; 6:29–32.
91.
Sturt NJ, Phillips RK, Clark SK. High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors. Cancer 2004; 101:652.PubMed
92.
Latchford AR, Sturt NJ, Neale K, et al. A 10-year review of surgery for desmoid disease associated with familial adenomatous polyposis. Br J Surg 2006; 93:1258–64.PubMed
93.
Middleton SB, Phillips RK. Surgery for large intra-abdominal desmoid tumors: report of four cases. Dis Colon Rectum 2000; 43:1759–62.PubMed
94.
Ballo MT, Zagars GK, Pollack A. Radiation therapy in the management of desmoid tumors. Int J Radiat Oncol Biol Phys 1998; 42:1007–14.PubMed
95.
Healy JC, Reznek RH, Clark SK, et al. MR appearances of desmoid tumors in familial adenomatous polyposis. AJR Am J Roentgenol 1997; 169:465–72.PubMed
96.
Gebert JF, Dupon C, Kadmon M, et al. Combined molecular and clinical approaches for the identification of families with familial adenomatous polyposis coli. Ann Surg 1999; 229:350–61.PubMed
97.
Vasen HF, van der Luijt RB, Slors JF, et al. Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis. Lancet 1996; 348:433–5.PubMed
98.
Vasen HF. Clinical diagnosis and management of hereditary colorectal cancer syndromes. J Clin Oncol 2000; 18:81S–92S.PubMed
99.
Wu JS, Paul P, McGannon EA, et al. APC genotype, polyp number, and surgical options in familial adenomatous polyposis. Ann Surg 1998; 227:57–62.PubMed
100.
Nieuwenhuis MH, De Vos Tot Nederveen Cappel W, Botma A, et al. Desmoid tumors in a Dutch cohort of patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 2008; 6:215–9.PubMed
101.
Wijn MA, Keller JJ, Brand HS. Oral and maxillofacial manifestations of familial adenomatosis polyposis. Gardner’s syndrome. Ned Tijdschr Tandheelkd 2005; 112:340–4.PubMed
102.
Kubo K, Miyatani H, Takenoshita Y, et al. Widespread radiopacity of jaw bones in familial adenomatosis coli. J Craniomaxillofac Surg 1989; 17:350–3.PubMed
103.
Gardner EJ, Plenk HP. Hereditary pattern for multiple osteomas in a family group. Am J Hum Genet 1952; 4:31–6.PubMed
104.
Takeuchi T, Takenoshita Y, Kubo K, et al. Natural course of jaw lesions in patients with familial adenomatosis coli (Gardner’s syndrome). Int J Oral Maxillofac Surg 1993; 22:226–30.PubMed
105.
Kimonis VE, Goldstein AM, Pastakia B, et al. Clinical manifestations in 105 persons with nevoid basal cell carcinoma syndrome. Am J Med Genet 1997; 69:299–308.PubMed
106.
Ramaglia L, Morgese F, Filippella M, et al. Oral and maxillofacial manifestations of Gardner’s syndrome associated with growth hormone deficiency: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103:e30–4.PubMed
107.
Giardiello FM, Hamilton SR, Krush AJ, et al. Nasopharyngeal angiofibroma in patients with familial adenomatous polyposis. Gastroenterology 1993; 105:1550–2.PubMed
108.
Traboulsi EI, Krush AJ, Gardner EJ, et al. Prevalence and importance of pigmented ocular fundus lesions in Gardner’s syndrome. N Engl J Med 1987; 316:661–7.PubMed
109.
Bertario L, Russo A, Sala P, et al. Multiple approach to the exploration of genotype-phenotype correlations in familial adenomatous polyposis. J Clin Oncol 2003; 21:1698–707.PubMed
110.
Valanzano R, Cama A, Volpe R, et al. Congenital hypertrophy of the retinal pigment epithelium in familial adenomatous polyposis. Novel criteria of assessment and correlations with constitutional adenomatous polyposis coli gene mutations. Cancer 1996; 78:2400–10.PubMed
111.
Cetta F, Montalto G, Petracci M. Hepatoblastoma and APC gene mutation in familial adenomatous polyposis. Gut 1997; 41:417.PubMedCrossRef
Metadata
Title
Extra-Intestinal Manifestations of Familial Adenomatous Polyposis
Authors
Emma J. Groen
Annemieke Roos
Friso L. Muntinghe
Roelien H. Enting
Jakob de Vries
Jan H. Kleibeuker
Max J. H. Witjes
Thera P. Links
André P. van Beek, MD, PhD
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 9/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-9981-3

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