Atlas of Clinical Oncology - Endocrine TumorsBy American Cancer Society (9.34 MB file)
Preface:
Surgical endocrinology or endocrine surgical oncology is an important component of general surgery and in some areas of head and neck surgery. As reported in Richard Welbourne’s book History of Endocrine Surgery, the term “endocrine” is from the Greek endo, meaning within, and kpiveiv, meaning “separate,” documenting the relationship of endocrine surgery and general surgery. Endocrine glands and tumors often make and secrete hormones; “hormone” is a term derived from the Greek word “to excite.” Theodur Kocher and Theodor Bilroth contributed much to general surgery in the late nineteenth and early twentieth centuries. Many of their writings and medical contributions concerned thyroid surgery.
Today endocrine surgeons traditionally operate on patients with tumors of the thyroid, parathyroid, and adrenal and endocrine pancreas, as well as on carcinoid or neuroendocrine tumors of the gastrointestinal tract. Virtually all organs of the body, including gastrointestinal tracts, heart, kidney, and skin, secrete hormones, so endocrine surgery could include all of general surgery.
During the past decade, there have been numerous advances in our understanding of the etiology of endocrine tumors, the ability to identify some endocrine tumors such as medullary thyroid cancer, multiple endocrine neoplasia (MEN) type II, and MEN type I by screening family members of these patients for RET or MENIN mutations, respectively. This enables these individuals to know whether they are at risk of developing these tumors. In some individuals prophylactic treatment can then be done before cancer develops.
Blood testing for tumor markers and hormones such as thyroglobulin, calcitonin, gastrin, serotonin, and chromogranin also helps with tumor diagnosis and for follow-up care. Provocative testing of patients with possible tumors with calcium, pentagastrin, and recombinant thyroid-stimulating hormone helps to unmask or identify occult tumors, as do various localization tests.
Advances in preoperative tumor localization tests and intraoperative parathyroid hormone testing have resulted in a dramatic change in the surgical approach to patients with primary hyperparathyroidism. More epidemiologic and clinical information is also available that provides evidence-based medicine supporting parathyroidectomy
even in “asymptomatic” patients with mild hypercalcemia.
Osteopenia and osteoporosis are now two of the most common indications for parathyroidectomy in patients with primary hyperparathyroidism.
Major advances have also occurred both in our understanding of how to select patients with incidentally discovered (incidentalomas) adrenal tumors, for operation, and in the surgical treatment of patients with adrenal incidentalomas. Laparoscopic adrenalectomy has become the treatment of choice for patients with small to moderate (less than 6 cm) adrenal tumors.
The current book is by experts in the field of endocrine surgery and provides up-to-date information on the management of patients with endocrine and neuroendocrine tumors.
----- Orlo H. Clark, MD January 2003
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