Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

492 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

ANSWERS

Answer 37.1. The answer is D.

Peritoneal carcinomatosis can arise from tumors of all these structures

with or without concurrent systemic metastases.

Answer 37.2. The answer is E.

Intraperitoneal viscera, including the ovary and appendix, are the most

common source of tumors presenting with isolated peritoneal carcino-

matosis.

Answer 37.3. The answer is C.

Low-grade, well-differentiated tumors disseminate via a pressure-burst

phenomenon, common to slow-growing tumors such as mucinous tumors

of the appendix and ovary, where the slow tumor growth permits the sheer

volume of tumor cells to rupture through viscera and contaminate the

peritoneum with tumor cells. In contrast, high-grade, poorly differenti-

ated tumors spread through primary organ invasion with subsequent cell

shedding and distant organ attachment, often with concurrent lymphatic

or hematologic metastases.

Answer 37.4. The answer is A.

Identification of free-floating tumor cells within the peritoneal cavity (e.g.,

after cytological examination of ascitic fluid) does not always mean peri-

toneal carcinomatosis. Attachment, implantation, and proliferation are

all necessary steps in the establishment and growth of intraperitoneal

disease.

Answer 37.5. The answer is B.

MRI has been shown to be superior to helical CT in the assessment

of bowel and mesenteric thickening. Sensitivity and specificity for MRI

were demonstrated to be 84% and 100%, respectively, for the detection

of peritoneal recurrence in ovarian carcinoma. PET has gained grow-

ing acceptance for assessing intraperitoneal carcinomatosis; however, its

major drawback is the lack of efficacy in the evaluation of lesions less

than 1 cm in diameter.

Answer 37.6. The answer is A.

The presence of tumor cells in peritoneal washings obtained at the time of

surgical resection correlates with increased local recurrence and decreased

survival, even in the absence of nodal or systemic metastases. In DPAM,

the absence of malignant cells is associated with significantly improved

disease-free and overall survival.