Originally published as JCO Early Release 10.1200/JCO.2005.99.008 on February 22 2005

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ACCO: ASCO Core Curriculum Outline

From the University of Vermont, Burlington, VT; Northwestern University, Chicago, IL; University of California-San Francisco, San Francisco; Scripps Clinic; Moores UCSD Cancer Center, San Diego, CA; Memorial Sloan-Kettering Cancer Center; New York University Medical Center, New York; Albert Einstein Cancer Center, Bronx, NY; Wayne State University, Detroit, MI; University of Wisconsin, Madison, WI; University of Colorado Health Science Center, Denver, CO; Texas Oncology PA, Dallas; University of Texas M.D. Anderson Cancer Center, Houston, TX; Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Mayo Clinic, Jacksonville, FL; Massachusetts General Hospital, Boston, MA.

Address reprint requests to Karen M. McCaffrey, Education, Science and Career Development, American Society of Clinical Oncology, 1900 Duke Street, Suite 200, Alexandria, VA 22314; mccaffrk{at}asco.org

	INTRODUCTION

TOP INTRODUCTION COMPETENCY COMPRISING CURRICULUM Appendix Authors' Disclosures of...

 
Purpose.
Medical Oncology is a rapidly growing specialty, not only in its membership, but in its knowledge base as well. In order to keep pace with the changing profile of health care delivery and still ensure uniform quality subspecialty training, a template for education is needed.

Design and Results.
An Ad Hoc Committee was created from the American Society of Clinical Oncology (ASCO) membership in 1997. Goals of training were discussed, and curriculum guidelines were created. The great expansion in knowledge related to cancer care has led to this current revision of the initial curriculum. The goals of this second edition of ASCO curriculum remain the same and emphasize formal instruction in the following:

(1) the treatment of individual malignancies, with an emphasis on a coordinated multidisciplinary approach;

(2) a clinical experience that emphasizes patient management in both the inpatient and outpatient settings;

(3) the ability to perform specified procedures; and

(4) the key tools in basic science that apply to patient management.

This document should be considered the educational framework around which a training program is developed. The American Society of Clinical Oncology was founded in 1965, and by 1979, the membership had grown to 2,950. Today, more than 20,000 physicians are members of ASCO. Since the first subspecialty examination in medical oncology was offered in 1973, the number of certified medical oncologists has risen to over 8,000. Medical Oncology is not only one of the youngest subspecialties in internal medicine, but also one of the fastest growing.

The recent years have witnessed an explosion in medical technology. The pharmacopoeia of chemotherapeutic agents has grown from the three available agents in 1950 to over 50 antineoplastic agents. Molecular diagnostic testing is now commonplace, and more widespread use of genetic screening is on the horizon. Moreover, an entirely new area of clinical research trials has been initiated in pharmacologic cancer prevention.

At the same time, health care has become an "industry" that has resulted in the shift of the majority of cancer care to the outpatient setting, with a focus on cost-containment. It is a challenge to develop a curriculum for training physicians in so dynamic an environment.

While the American Board of Internal Medicine (ABIM) and Accreditation Council on Graduate Medical Education (ACGME) create a basic structure for subspecialty training, the specific items that are to be included in the training curriculum are not within their purview. ASCO leadership has thus taken on the task of creating a "Competence Comprising Curriculum" forMedical Oncology subspecialty training, which emphasizes formal instruction in the following:

1. Basic Scientific Principles; including cancer biology and genetics, cancer etiology, tumor immunology, and epidemiology
   
2. Basic Principles in the Management and Treatment of Cancer; including pathology and laboratory medicine, radiology, surgical and radiation oncology, chemotherapy, biologic therapy, and hormonal therapy
   
3. Clinical Research; including design of clinical trails
   
4. Cancer Types and Sites; 37 cancer types and sites, in alphabetical order
   
5. Other Treatment Related Issues; including oncological emergencies, paraneoplastic syndromes, bone marrow transplantation, local therapy of metastatic cancers, and management of malignant effusions
   
6. Complications; including infections and other complications of treatment
   
7. Supportive Care; including pain management, hematopoietic growth factors, transfusion therapy, nutritional support, sexual problems, end-of-life care, complementary and alternative medicine, and unproven methods of treatment
   
8. Survivorship; including follow-up care at end of treatment, prevention of second malignancies, employment and insurance, information and education, and advocacy
   
9. Psychosocial Aspects of Cancer; including psychological stages of cancer, cultural issues, spirituality, adaptive and maladaptive behavior, coping, and the use of psychotropic drugs
   
10. Bioethics, Legal, and Economic Issues; including informed consent, research ethics, conflict of interest
    
11. Communication Skills; including communication along the disease trajectory, delivering bad news, communication within the multidisciplinary team
    
12. Procedures; including chemotherapy administration, tumor assessment, bone marrow aspiration, biopsy and interpretation
    
13. Information Systems in Oncology; including resources for patients and professionals, locating an oncologist, locating a clinical trial
    
14. Geriatric Oncology; including unique issues of cancer and aging, patient assessment, psychosocial implications
    

The following curriculum should be considered as the educational framework for the training of physicians in medical oncology.

	COMPETENCY COMPRISING CURRICULUM

TOP INTRODUCTION COMPETENCY COMPRISING CURRICULUM Appendix Authors' Disclosures of...

 
I. BASIC SCIENTIFIC PRINCIPLES
A. Cancer Biology and Genetics

1. Biology of normal cells and the basic processes of carcinogenesis
   
2. Genomics
   1. Gene structure
      
   2. Organization
      
   3. Expression
      
   4. Regulation
      
   
   
3. Cell cycle
   1. Mechanisms
      
   2. Control by oncogenes
      
   3. Interactions with therapies
      
   
   
4. Receptors and signal transduction
   
5. Tumor cells
   1. Kinetics
      
   2. Proliferation
      
   3. Programmed cell death
      
   
   
6. Cell proliferation and apoptosis
   
7. Tumor invasion and metastases
   
8. Angiogenesis
   
9. Molecular techniques
   1. Polymerase chain reaction (PCR)
      
   2. Chromosomal analyses and cytogenetics
      
   3. Tissue microarray analysis
      
   4. Other techniques of molecular and tumor cell biology
      
   
   

B. Carcinogenesis

1. Inherited and acquired genetic abnormalities
   
2. Environmental, chemical, and physical factors
   

C. Tumor Immunology

1. Cellular and humoral components of the immune system
   
2. Immune system recognition of substances including normal and malignant cells as "self" and "nonself"
   
3. Regulatory action of cytokines on the immune system
   
4. Interrelationship between tumor and host immune systems
   1. Tumor antigenicity
      
   2. Immune-mediated antitumor cytotoxicity
      
   3. Direct effect of cytokines on tumors
      
   
   

D. Epidemiology of Cancer

1. Cancer statistics
   1. Incidence rates
      
   2. Mortality rates
      
   3. International differences in incidence and mortality rates for different cancers
      
   
   
2. Staging of cancer
   1. Tumor-node-metastasis (TNM) system
      
   2. Other systems for specific tumor types
      
   
   
3. Epidemiologic methods
   

II BASIC PRINCIPLES IN THE MANAGEMENT AND TREATMENT OF CANCER
A. General

1. Contributions of each different subspecialty in diagnosis, staging and treatment
   
2. Multidisciplinary approach to cancer treatment
   
3. Effects of age and comorbidity on treatment
   
4. Physical assessment
   
5. Response assessment
   1. Response Evaluation Criteria in Solid Tumors (RECIST)
      
   2. Quality of life
      
   3. Other criteria
      
   
   

B. Pathology/Laboratory Medicine

1. Pathologist in cancer diagnosis
   
2. Histopathologic techniques in diagnosis
   1. Immunostaining
      
   2. Cytology
      
   3. Fine needle aspiration
      
   4. Cytogenetics and polymerase chain reaction (PCR)
      
   5. Flow cytometry
      
   
   
3. Prognostic factors and predictive markers
   

C. Radiology

1. Imaging/staging techniques in diagnosis, staging, and follow-up
   1. Radiographic
      
   2. Computed tomography (CT)
      
   3. Ultrasound
      
   4. Magnetic resonance imaging (MRI)
      
   5. Positron emission tomography (PET)
      
   6. Endoscopic imaging techniques
      
   7. Other imaging procedures
      
   
   
2. Use of imaging to assess treatment response
   

D. Surgical Oncology

1. Preoperative evaluation
   
2. Surgery for specific types and sites
   1. See section IV
      
   
   

E. Radiation Oncology

1. Principles of radiation biology
   
2. Normal tissue tolerance and toxicity
   
3. Interactions
   1. Chemotherapy
      
   2. Hormone therapy
      
   3. Biologic therapy
      
   4. Sequencing of therapy
      
   
   
4. Fractionation and dosing
   
5. Brachytherapy
   
6. Focused radiation therapies
   1. Gamma knife
      
   2. Intensity-modulated radiation therapy (IMRT)
      
   3. Other ablative techniques
      
   
   
7. Potentiation and protection
   1. Host and other physical factors
      
   2. Pharmacologic agents
      
   
   

F. Chemotherapy

1. Indications and goals
   1. Primary cancer
      
   2. Recurrent cancer
      
   
   
2. Pharmacology
   1. Pharmacokinetics
      
   2. Pharmacodynamics
      
   3. Metabolism and clearance
      
   4. Pharmacogenomics
      
   5. List of drugs
      
   
   
3. Dose and schedule
   1. Metronomic
      
   2. Dose-density
      
   3. Dose-intensity
      
   4. High-dose
      
   5. Other
      
   
   
4. Cancer drug development and testing
   
5. Drug resistance
   
6. Predicting response and toxicity
   

G. Hormonal Therapies

1. Estrogens
   
2. Selective estrogen response modifiers
   
3. Progestins and antiprogestins
   
4. Aromatase inhibitors
   
5. Androgens and antiandrogens
   
6. Gonadotropin-releasing hormone analogs
   
7. Glucocorticoids
   
8. Miscellaneous agents
   

H. Biologic/Targeted Therapy

1. Basic concepts of targeted molecular therapies
   
2. Monoclonal antibodies
   
3. Tumor vaccines
   
4. Cellular therapy
   
5. Antiangiogenic agents
   
6. Cytokines
   
7. Gene-directed therapy
   

III. CLINICAL RESEARCH
A. Design of Phase I, II, and III Trials

1. Protocol development and implementation
   1. Defining trial objectives and outcomes (response criteria)
      
   2. Defining patient populations
      
   3. Use of surrogate end points
      
   4. Toxicity assessment and grading
      
   5. Quality of life assessment and end points
      
   6. Reporting responsibilities
      
   7. Data collection

      (1) Data capture and database development
      

      (2) Maintaining quality and integrity
      

      
      
   8. Statistical analysis

      (1) Sample size determination
      

      
      
   9. Early stopping roles
      
   
   
2. Meta-Analysis
   
3. Ethical, regulatory, and legal issues
   1. Institutional Review Board
      
   2. Informed consent
      
   3. Conflict of interest
      
   4. Other groups in trial development

      (1) National Cancer Institute and cooperative groups
      

      (2) Cancer centers
      

      (3) Industry
      

      
      
   
   

B. Tumor Assessment

1. Measurement of masses
   
2. Imaging
   1. CT
      
   2. MRI
      
   3. Nuclear medicine
      
   4. Other imaging
      
   
   
3. Surrogate end points
   1. biomarkers/pharmacodynamic end points
      
   
   

IV. CANCER TYPES AND SITES
A. Acute Leukemia and Myelodysplasia

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Exposures

      (1) Radiation
      

      (2) Chemicals
      

      (3) Drugs
      

      
      
   2. Specific associations of chromosomal translocations

      (1) Duplications and deletions with disease subtypes
      

      
      
   3. Activation of specific oncogene expression

      (1) RAS
      

      (2) MYC
      

      (3) MDR
      

      (4) Other
      

      
      
   
   
3. Diagnosis
   1. Peripheral blood morphology
      
   2. Bone marrow aspirate and biopsy
      
   3. Flow cytometry and immunophenotyping
      
   4. Cytogenetics, including karyotyping and fluorescent in situ hybridization
      
   5. PCR for specific gene rearrangements (eg, bcr-abl)
      
   
   
4. Acute myeloid leukemia
   1. Staging, prognostic factors, natural history

      (1) French-American-British classification
      

      (2) CNS, mediastinal involvement
      

      (3) Prognostic factors
      

      (4) Elderly

      (a) Antecedent hematologic abnormalities
      

      (b) Cytogenetic abnormalities
      

      (c) Expression of drug-resistant genes
      

      
      

      
      
   2. Treatment

      (1) Current recommendations

      (a) Induction
      

      (b) Consolidation
      

      (c) Bone marrow/stem cell transplantation
      

      (d) Differentiation therapy
      

      
      

      (2) Management of relapse
      

      (3) Special problems in the elderly
      

      
      
   
   
5. Acute lymphoblastic leukemia
   1. Staging, prognostic factors, natural history

      (1) French-American-British classification
      

      (2) CNS, mediastinal involvement
      

      (3) Prognostic factors
      

      (4) CNS, mediastinal or testicular involvement
      

      (5) Molecular markers
      

      
      
   2. Treatment

      (1) Current recommendations

      (a) Induction
      

      (b) Consolidation
      

      (c) CNS prophylaxis
      

      (d) Bone marrow/stem cell transplantation
      

      
      

      (2) Management of relapse
      

      
      
   
   
6. Myelodysplasia
   1. Staging, prognostic factors, natural history

      (1) French-American-British classification
      

      (2) CNS involvement
      

      (3) Prognostic factors

      (a) Chromosomal abnormalities
      

      (b) International Prognostic Scoring System
      

      
      

      (4) Curability by age

      (a) Likelihood of durable response in elderly

      1. MDR
         
      2. Prognostic cytogenetics
         

      
      

      (b) Treatment-related mortality in elderly
      

      (c) Alternative treatment/supportive care options for elderly
      

      
      

      
      
   2. Treatment

      (1) Current recommendations

      (a) Low-intensity therapy
      

      (b) High-intensity therapy
      

      (c) Bone marrow/stem cell transplantation
      

      (d) Supportive care
      

      (e) Standard adult population
      

      
      

      
      
   
   
7. Supportive care
   1. Transfusions

      (1) Red cell
      

      (2) Platelet
      

      
      
   2. Growth factors
      
   3. Antibiotics/antifungal agents
      
   4. Psychosocial
      
   
   

B. AIDS-Related Malignancies

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   3. Lifestyle factors
      
   4. Epidemiology of HIV infection
      
   5. Highly active antiretroviral therapy
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Natural history of HIV infection
      
   2. AIDS-defining

      (1) Kaposi's sarcoma
      

      (2) Systemic lymphoma
      

      (3) Primary CNS lymphoma
      

      (4) Cervical cancer
      

      
      
   3. Non-AIDS defining malignancies

      (1) Anogenital neoplasia
      

      (2) Other malignancies
      

      
      
   4. Risk factor

      (1) Immunosuppression
      

      (2) Organ transplantation
      

      
      
   
   
3. Prevention
   1. HIV Prevention
      
   2. Education on sexually transmitted diseases
      
   
   
4. Diagnosis
   1. HIV
      
   2. HIV-associated malignancy

      (1) Kaposi's sarcoma
      

      (2) Systemic lymphoma
      

      (3) Primary CNS lymphoma
      

      (4) Cervical cancer
      

      
      
   3. Non-AIDS defining malignancies

      (1) Anogenital neoplasia
      

      (2) Other malignancies
      

      
      
   
   
5. Staging
   1. Kaposi's sarcoma
      
   2. Systemic lymphoma
      
   3. Primary CNS lymphoma
      
   4. Cervical cancer
      
   
   
6. Treatment and follow-up
   1. Kaposi's sarcoma
      
   2. Systemic lymphoma
      
   3. Primary CNS lymphoma
      
   4. Cervical cancer
      
   
   
7. Special issues
   1. Antiretroviral therapy
      
   2. Infection prophylaxis
      
   3. Colony-stimulating factors
      
   
   

C. Anal Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Premalignant lesion
      

      (2) Histology

      (a) Cloacogenic
      

      (b) Squamous cell
      

      
      

      
      
   2. Risk factors

      (1) HPV infection
      

      (2) Sexual activity
      

      (3) Condylomata
      

      (4) HIV infection
      

      
      
   3. Assessment of risk

      (1) Lifestyle factors
      

      (2) HIV infection
      

      
      
   
   
3. Prevention
   1. Lifestyle changes
      
   
   
4. Screening
   1. Anal Papanicolaou tests
      
   
   
5. Diagnosis
   1. Physical examination
      
   2. Biopsy
      
   3. Anoscopy/proctoscopy
      
   4. Transrectal ultrasound
      
   5. Aspiration of palpable inguinal nodes
      
   
   
6. Staging and Prognostic factors
   1. TNM system
      
   2. Symptoms
      
   
   
7. Treatment by stage
   1. Stage 1

      (1) Surgery
      

      
      
   2. Local disease

      (1) Combined modality
      

      
      
   3. Positive inguinal nodes

      (1) Combined modality
      

      
      
   4. Recurrent or residual disease

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy
      

      
      
   5. Metastatic disease

      (1) Chemotherapy
      

      
      
   
   
8. Follow-up
   
9. Special issues
   1. Anorectal melanoma
      
   
   

D. Biliary Tree Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Risk factors

      (1) Primary sclerosing cholangitis
      

      (2) Gallstones
      

      (3) Choledochal cysts
      

      
      
   
   
3. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. ERCP
      
   4. Endoscopic biopsy
      
   
   
4. Staging and prognostic factors
   1. TNM
      
   2. Histologic grade
      
   
   
5. Treatment by stage
   1. Resectable disease

      (1) Surgery
      

      (2) Radiation therapy
      

      
      
   2. Unresectable disease

      (1) Liver transplantation
      

      
      
   3. Advanced or recurrent disease

      (1) Chemotherapy

      (a) Intravenous
      

      (b) Hepatic infusion
      

      
      

      (2) Radiation therapy
      

      
      
   
   
6. Supportive care
   1. Biliary drainage
      
   
   

E. Bladder and Other Urothelial Cancers (ureter, renal, pelvis)

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Lifestyle and environmental exposures

      (1) Cigarette smoking
      

      (2) Phenacetin
      

      (3) Schistosomiasis infection
      

      (4) Chemical exposure
      

      
      
   3. Field change in urothelium
      
   4. Genetic and molecular abnormalities
      
   
   
3. Prevention
   1. Smoking cessation
      
   2. Environmental (OSHA) protection
      
   3. Monitoring medication use
      
   
   
4. Screening
   1. Urine cytology
      
   2. CT/MRI
      
   
   
5. Diagnosis
   1. Urine cytology
      
   2. Cystoscopy and biopsy
      
   3. CT/MRI scanning
      
   
   
6. Staging and prognostic factors
   1. TNM system, tumor grading
      
   2. Localized versus invasive disease
      
   3. Histologic type
      
   
   
7. Treatment by stage
   1. Superficial bladder cancer

      (1) Intravesical
      

      
      
   2. Early-stage and locally advanced

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy

      (a) Neoadjuvant
      

      (b) Adjuvant
      

      
      

      (4) Combination therapy for organ preservation
      

      
      
   3. Recurrent and metastatic

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy

      (a) Neoadjuvant
      

      (b) Adjuvant
      

      (c) Concurrent with radiation
      

      
      

      
      
   
   
8. Follow-up
   1. Urine cytology
      
   2. Cystoscopy
      
   3. Imaging
      
   
   
9. Supportive care
   1. Urinary diversion

      (1) Ileal conduit
      

      (2) Continent urinary diversions
      

      
      
   
   
10. Special issues
    1. Urachal carcinoma
       
    
    

F. Bone Sarcomas

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Histologic types

      (a) Osteosarcoma
      

      (b) Chondrosarcoma
      

      (c) Ewing's
      

      (d) Other
      

      
      

      
      
   2. Cytogenetics and genetic syndromes

      (1) Li-Fraumeni syndrome
      

      (2) Retinoblastoma
      

      (3) Chromosomal signatures/gene mutations
      

      
      
   3. Radiation
      
   
   
3. Diagnosis
   1. Clinical presentation
      
   2. Radiologic-pathologic correlations
      
   3. Biopsy
      
   4. Special considerations
      
   
   
4. Staging and prognostic factors
   1. Staging: TNM and tumor grade
      
   2. Prognostic factors
      
   3. Radiographic evaluation
      
   4. Restaging after preoperative chemotherapy
      
   
   
5. Treatment
   1. Localized primary disease

      (1) Osteosarcoma
      

      (2) Chondrosarcoma
      

      (3) Ewing's
      

      (4) Other
      

      (5) Limb sparing treatment
      

      
      
   2. Local recurrence
      
   3. Metastatic disease

      (1) Clinical presentation
      

      (2) Surgical resection
      

      (3) Chemotherapy
      

      
      
   
   
6. Follow-up
   1. Radiographic evaluation
      
   
   

G. Breast Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Premalignant
      

      (2) Malignant

      (a) Histologic types
      

      
      

      
      
   2. Genetics

      (1) BRCA-1
      

      (2) BRCA-2
      

      (3) Other genetic syndromes
      

      (4) Counseling and testing
      

      
      
   3. Assessment of risk

      (1) Family history
      

      (2) Lifestyle factors
      

      (3) Hormone replacement therapy
      

      (4) Gail, Claus, and other models
      

      
      
   
   
3. Prevention
   1. Lifestyle changes
      
   2. Chemoprevention

      (1) Tamoxifen and other SERMs
      

      (2) Other agents
      

      
      
   3. Prophylactic bilateral mastectomies
      
   4. Prophylactic bilateral oophorectomy
      
   
   
4. Screening
   1. Mammography
      
   2. Other imaging techniques

      (1) Ultrasound
      

      (2) MRI
      

      
      
   3. Breast examination

      (1) Self-examination
      

      (2) Examination by a health-care provider
      

      
      
   4. Ductal lavage
      
   5. Genetic screening
      
   
   
5. Diagnosis
   1. Management of a palpable mass
      
   2. Management of nonpalpable, image-detected abnormalities
      
   3. Biopsy techniques

      (1) Fine-needle aspiration
      

      (2) Core, excision, and needle localization biopsy
      

      
      
   4. Axillary dissection

      (1) Complete
      

      (2) Sentinel node
      

      
      
   
   
6. Staging and prognostic factors
   1. TNM system
      
   2. Histologic type
      
   3. Estrogen and progesterone receptors
      
   4. Other biologic and molecular markers
      
   5. Staging recommendations
      
   
   
7. Treatment by stage
   1. Premalignant

      (1) Atypical hyperlasia
      

      
      
   2. Carcinoma-in-situ

      (1) Lobular
      

      (2) Ductal
      

      
      
   3. Early-stage invasive carcinoma

      (1) Primary lesion

      (a) Surgery
      

      (b) Radiation
      

      (c) Chemotherapy

      1. Preoperative
         
      2. Postoperative
         

      
      

      (d) Endocrine

      1. Preoperative
         
      2. Postoperative
         

      
      

      (e) Trastuzumab and other biologic therapy
      

      (f) Estimating the benefits of systemic adjuvant therapy
      

      
      

      
      
   4. Locally advanced and inflammatory breast cancer

      (1) Multimodal therapy
      

      
      
   5. Locally recurrent

      (1) In breast recurrence
      

      (2) Chest wall recurrence
      

      (3) Surgery
      

      (4) Radiation therapy
      

      (5) Systemic therapy
      

      
      
   6. Metastatic breast cancer

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Systemic therapy

      (a) Endocrine therapy
      

      (b) Chemotherapy
      

      (c) Single-agent Versus combination therapy
      

      (d) Monoclonal antibody therapy
      

      
      

      
      
   
   
8. Follow-up
   1. ASCO and other guidelines
      
   
   
9. Supportive care
   1. Psychosocial issues and support groups
      
   2. Lymphedema
      
   3. Bisphosphonates for bone metastases
      
   4. Menopausal symptoms
      
   5. Health maintenance for premature menopause

      (1) Bone health
      

      
      
   6. Sexuality and fertility
      
   7. Cognitive dysfunction
      
   8. h. Surgical reconstruction
      
   
   
10. Other/Special issues
    1. Special problems in breast cancer management

       (1) Male breast cancer
       

       (2) Breast cancer in pregnancy
       

       (3) Breast cancer in elderly women
       

       (4) Breast cancer in very young women

       (a) Oophorectomy
       

       
       

       (5) Breast cancer presenting as axillary metastases
       

       (6) Phyllodes tumors
       

       (7) Paget's disease of the nipple
       

       
       
    
    

H. Central Nervous System Malignancies

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Histologic types

      (1) Progression from low-grade to high-grade tumors
      

      (2) Cell type
      

      (3) WHO grading system
      

      
      
   2. Genetic syndromes
      
   3. Environmental factors
      
   
   
3. Diagnosis
   1. Clinical symptoms and signs
      
   2. Imaging

      (1) CT/MRI
      

      (2) Magnetic resonance spectroscopy
      

      (3) PET/single-photon emission computed tomography
      

      
      
   
   
4. Staging and prognostic factors
   1. Staging

      (1) Radiographic
      

      (2) CSF evaluation
      

      
      
   2. Prognostic factors

      (1) Functional neurologic status
      

      (2) Tumor histology
      

      (3) Patient age
      

      (4) Extent of tumor resection
      

      (5) Tumor location
      

      (6) Biogenetic markers
      

      
      
   
   
5. Treatment of primary CNS tumors
   1. Low-grade astrocytoma

      (1) Surgery
      

      (2) Observation
      

      (3) Immediate treatment

      (a) Astrocytoma
      

      
      

      (4) Radiation therapy
      

      
      
   2. Malignant astrocytomas

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy

      (a) Systemic
      

      (b) Intracavitary
      

      
      

      
      
   3. Malignant oligodendrogliomas

      (1) Surgery
      

      (2) Chemotherapy

      (a) Predictive factors
      

      
      

      (3) Radiation therapy
      

      
      
   4. Meningiomas

      (1) Observation
      

      (2) Surgery
      

      (3) Radiation therapy
      

      (4) Other
      

      
      
   5. Primary CNS lymphomas

      (1) Stereotactic biopsy
      

      (2) Chemotherapy

      (a) Intrathecal
      

      (b) Systemic
      

      
      

      (3) Radiation therapy
      

      
      
   6. Medulloblastoma

      (1) Surgery
      

      (2) Neuraxis radiation therapy
      

      (3) Chemotherapy
      

      
      
   7. Ependymoma
      
   8. h. Pinealoma
      
   9. i. Metastases to CNS

      (1) Brain

      (a) Whole brain radiation therapy
      

      (b) Focal brain radiation therapy
      

      (c) Surgery
      

      (d) Chemotherapy
      

      
      

      (2) Leptomeninges

      (a) Radiation therapy
      

      (b) Chemotherapy

      1. Intrathecal
         1. Access devices
            
         
         
      2. Systemic
         

      
      

      
      

      
      
   
   
6. Follow-up
   1. Serial imaging
      
   
   
7. Supportive care
   1. Corticosteroids
      
   2. Anticonvulsants
      
   3. Deep vein thrombosis
      
   4. Pneumocystis carinii pneumonia prophylaxis
      
   5. Radiation toxicity

      (1) Neurocognitive
      

      (2) Radionecrosis
      

      
      
   
   

I. Cervical Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. HPV and oncogenic types
      
   3. Immunosuppression/HIV
      
   4. Lifestyle factors

      (1) Tobacco use
      

      (2) Dietary
      

      (3) Sexual history
      

      
      
   
   
3. Prevention
   1. Education on sexually transmitted diseases
      
   2. Treat precursor (cervical intraepithelial neoplasia) lesions
      
   3. HPV vaccines
      
   
   
4. Screening
   1. Cytology (routine Papanicolaou tests, Bethesda system, other)
      
   
   
5. Diagnosis
   1. Pelvic examination
      
   2. Cytology
      
   3. Colposcopy and biopsy
      
   4. Radiographic imaging
      
   
   
6. Staging and prognostic factors
   1. Clinical FIGO staging
      
   2. Surgical staging
      
   3. Histologic factors
      
   
   
7. Treatment by stage
   1. Microinvasive stage I
      
   2. Other stage IA
      
   3. Stage IB-IIA

      (1) Surgery
      

      (2) Radiation therapy
      

      
      
   4. Locally advanced stages

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy
      

      
      
   
   
8. Recurrent and metastatic disease
   1. Chemotherapy
      
   2. Radiation therapy
      
   3. Surgery
      
   
   
9. Supportive care
   1. Treatment-related complications

      (1) Lymphedema
      

      (2) Vaginal stenosis
      

      (3) Premature menopause
      

      (4) Other
      

      
      
   2. Ureteral obstruction
      
   
   
10. Other/special issues
    1. Cervical cancer during pregnancy
       
    
    

J. Chronic Leukemias: Chronic Myeloid Leukemia (CML) and Chronic Lymphocytic Leukemia (CLL)

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. CML

      (1) Bcr-abl and other genetic factors
      

      (2) Radiation exposure
      

      
      
   2. CLL

      (1) Genetic and molecular abnormalities
      

      
      
   
   
3. Diagnosis
   1. Peripheral blood smear
      
   2. Genetic and molecular markers
      
   3. PCR or FISH for specific gene rearrangements (CML)
      
   
   
4. Staging and prognostic factors
   1. CML

      (1) Chronic phase
      

      (2) Accelerated phase
      

      (3) Blast phase
      

      (4) Sokol, synthesis prognostic model and others
      

      
      
   2. CLL

      (1) Rai and Binet staging classifications
      

      (2) Genetic and molecular markers
      

      
      
   
   
5. Treatment
   1. CML

      (1) Observation
      

      (2) Chemotherapy
      

      (3) Monoclonal antibodies
      

      (4) Biologic agents

      (a) Imatinib
      

      (b) Interferon
      

      (c) Other
      

      
      

      (5) Bone marrow/stem cell transplantation
      

      (6) Management of blast phase and accelerated phase
      

      (7) Chloroma (granulocytic sarcoma)
      

      
      
   2. CLL

      (1) Observation
      

      (2) Purine analogs
      

      (3) Alkylating agents
      

      (4) Combination chemotherapy
      

      (5) Monoclonal antibodies
      

      (6) Bone marrow/stem cell transplantation
      

      (7) Radiation therapy
      

      (8) Splenectomy
      

      (9) Transition to high-grade lymphoma (Richter’s syndrome)
      

      (10) Other

      (a) Hypogammaglobulinemia and infection
      

      (b) Autoimmune hemolytic anemia and thrombocytopenia
      

      
      

      
      
   
   

K. Colorectal Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Genetics and genetic syndromes

      (1) Familial adenomatous polyps
      

      (2) Hereditary nonpolyposis colorectal cancer
      

      (3) Other
      

      
      
   3. Pathogenesis
      
   4. Assessment of risk

      (1) Family history
      

      (2) Dietary factors
      

      (3) Lifestyle factors
      

      (4) Medical history

      (a) Inflammatory bowel disease
      

      (b) Diabetes mellitus
      

      
      

      
      
   
   
3. Prevention
   1. Lifestyle changes
      
   2. Chemoprevention

      (1) Anti-inflammatories
      

      
      
   3. Colectomy
      
   
   
4. 4. Screening
   1. Rectal examination
      
   2. Fecal occult blood test
      
   3. Colonoscopy surveillance (general population)
      
   4. Virtual colonoscopy
      
   5. High-risk populations

      (1) Inflammatory bowel disease
      

      (2) Genetic abnormalities
      

      (3) Use of risk criteria and models
      

      
      
   
   
5. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Endoscopic biopsy
      
   
   
6. Staging and prognostic factors
   1. TNM system
      
   2. Histology and grade
      
   3. Genetic and molecular abnormalities
      
   
   
7. Treatment
   1. Treatment by stage

      (1) Cancer in a polyp
      

      (2) Stage II colorectal cancer

      (a) Surgery
      

      (b) Chemotherapy
      

      (c) Radiation therapy
      

      
      

      (3) Stage III colorectal cancer

      (a) Surgery
      

      (b) Chemotherapy
      

      (c) Radiation therapy
      

      
      

      (4) Metastatic and recurrent colorectal cancer

      (a) Surgery

      1. Resectable regional metastases
         1. Liver only
            
         2. Lung only
            
         3. Liver plus lung
            
         
         
      2. Anastomotic recurrence
         

      
      

      (b) Chemotherapy

      1. Regional perfusion of chemotherapy
         
      2. Chemoembolization
         
      3. Chemotherapy
         

      
      

      (c) Radiation therapy
      

      
      

      (5) Special surgical issues

      (a) Laparoscopy
      

      (b) Sentinel node biopsy
      

      (c) Total mesorectal excision in rectal surgery
      

      
      

      
      
   
   
8. Follow-up after curative resection
   1. ASCO and other guidelines
      
   
   
9. Supportive care
   1. Treatment-related toxicities

      (1) Ostomy care
      

      (2) Radiation proctitis
      

      (3) Diarrhea
      

      
      
   
   

L. Esophageal Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Squamous cell
      

      (2) Adenocarcinoma
      

      
      
   2. Assessment of risk

      (1) Barrett's esophagus
      

      (2) Gastroesophageal reflux disease
      

      (3) Smoking and alcohol use
      

      
      
   3. Genetic and molecular abnormalities
      
   
   
3. Prevention
   1. Lifestyle changes
      
   
   
4. Diagnosis
   1. Clinical signs and symptoms
      
   2. Endoscopy and biopsy
      
   3. Imaging
      
   
   
5. Staging and prognostic factors
   1. TNM staging
      
   
   
6. Treatment
   1. Local-regional disease

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy
      

      
      
   2. Recurrent and metastatic disease

      (1) Chemotherapy
      

      (2) Radiation therapy
      

      (3) Surgery
      

      
      
   
   
7. Supportive care
   1. Management of obstruction

      (1) Endoscopic stenting
      

      (2) Other
      

      
      
   2. Supportive management
      
   
   

M. Gallbladder Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Risk factors

      (1) Inflammatory bowel disease
      

      (2) Gallstones (cholesterol-type)
      

      (3) Chronic inflammation
      

      
      
   
   
3. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Surgery
      
   4. Cholangiography
      
   5. Bile cytology
      
   
   
4. Staging and prognosis
   1. TNM
      
   
   
5. Treatment by stage
   1. T1/T2 tumors

      (1) Surgery
      

      
      
   2. T3/T4 tumors

      (1) Surgery
      

      (2) Radiation therapy
      

      (3) Chemotherapy
      

      
      
   3. Evaluation after laparoscopic cholecystectomy

      (1) Surgery
      

      
      
   4. Recurrent or metastatic disease

      (1) Chemotherapy
      

      (2) Radiation therapy
      

      
      
   
   
6. Supportive care
   1. Biliary drainage
      
   
   

N. Gastric Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Genetic and molecular factors

      (1) Precursor lesions
      

      (2) Adenomatous and gastric polyps
      

      
      
   3. Nutritional factors

      (1) Vitamin B12/pernicious anemia
      

      (2) Other
      

      
      
   4. Lifestyle

      (1) Tobacco use
      

      (2) Occupational exposure
      

      (3) Helicobacter pylori and other infections
      

      
      
   
   
3. Screening
   1. Endoscopy
      
   2. Imaging
      
   
   
4. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Endoscopy and biopsy
      
   
   
5. Staging
   1. TNM staging
      
   
   
6. Treatment
   1. Resectable

      (1) Surgery
      

      (2) Chemotherapy
      

      (3) Radiation therapy
      

      (4) Laparoscopy
      

      (5) Combined modality
      

      
      
   2. Unresectable and metastatic

      (1) Chemotherapy
      

      (2) Radiation therapy
      

      
      
   
   

O. Germ Cell Tumors

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Seminoma
      

      (2) Nonseminoma
      

      
      
   2. Genetics and molecular characteristics

      (1) Kleinfelter's syndrome
      

      
      
   3. Risk factors

      (1) Cryptorchism
      

      
      
   4. Location

      (1) Testes
      

      (2) Pineal
      

      (3) Mediastinum
      

      (4) Retroperitoneum
      

      
      
   
   
3. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Molecular markers
      
   4. Biopsy
      
   5. Serum markers
      
   
   
4. Staging and prognostic factors
   1. TNM, International Germ Cell Consensus Classification, other systems
      
   2. Histologic type
      
   3. Serum markers
      
   4. Clinical Versus surgical staging
      
   
   
5. Treatment
   1. Management of testicular mass

      (1) Inguinal orchiectomy
      

      
      
   2. Seminoma

      (1) Stage 1 disease

      (a) Surgery
      

      (b) Radiation therapy
      

      
      

      (2) Stage II disease

      (a) Surgery
      

      (b) Radiation therapy
      

      (c) Chemotherapy
      

      
      

      (3) Stage III disease

      (a) Surgery
      

      (b) Radiation therapy
      

      (c) Chemotherapy
      

      
      

      (4) Metastatic or recurrent disease

      (a) Chemotherapy
      

      (b) Surgery
      

      
      

      
      
   3. Nonseminoma

      (1) Stage 1 disease

      (a) Surgery
      

      
      

      (2) Stage II disease

      (a) Chemotherapy
      

      
      

      (3) Stage III disease

      (a) Chemotherapy
      

      
      

      (4) Metastatic or recurrent disease

      (a) Chemotherapy
      

      
      

      (5) Late relapse
      

      
      
   4. Management of residual disease
      
   5. Observation
      
   6. Surgery
      
   7. Radiation therapy
      
   
   
6. Follow-up
   1. Tumor markers
      
   2. Imaging studies in patients treated by observation
      
   
   
7. Supportive care
   1. Fertility and sexuality issues
      
   2. Gynecomastia
      
   
   
8. Special issues
   1. Growing teratoma
      
   2. False-positive serum markers
      
   3. Tumor sanctuary sites (CNS, testes)
      
   4. Secondary malignancies
      
   5. Non–germ cell testicular tumors
      
   
   

P. Hairy Cell Leukemia

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   
   
3. Diagnosis
   1. Peripheral blood smear
      
   2. Bone marrow biopsy and aspirate
      
   3. Immunophenotyping
      
   
   
4. Treatment
   1. Observation
      
   2. Chemotherapy

      (1) Purine analogs
      

      (2) Other
      

      
      
   3. Interferon and other biologics
      
   
   
5. Supportive care
   1. Infection
      
   
   

Q. Head and Neck Cancers

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Squamous cell
      

      (2) Adenomatous
      

      (3) Other
      

      
      
   2. Genetic and molecular factors

      (1) First-degree relatives
      

      
      
   3. Lifestyle

      (1) Tobacco
      

      (2) Alcohol
      

      
      
   4. Field cancerization
      
   5. Viral factors

      (1) HPV
      

      (2) EBV
      

      
      
   
   
3. Prevention
   1. Tobacco cessation
      
   2. Alcohol cessation
      
   
   
4. Screening
   1. Oral examination
      
   
   
5. Diagnosis
   1. Clinical signs and symptoms

      (1) Head and neck examination

      (a) Oral examination
      

      
      

      
      
   2. Endoscopy and biopsy

      (1) Primary lesion
      

      (2) Nodal sites
      

      
      
   3. Imaging
      
   
   
6. Staging and prognostic factors
   1. TNM system
      
   
   
7. Treatment
   1. General principles

      (1) Surgery

      (a) Organ preservation strategies
      

      (b) Postradiation neck dissection
      

      
      

      (2) Radiation therapy
      

      (3) Chemotherapy
      

      (4) Combined modality
      

      
      
   2. Specific sites

      (1) Hypopharynx
      

      (2) Larynx
      

      (3) Nasal cavity
      

      (4) Nasopharynx
      

      (5) Oral cavity
      

      (6) Oropharynx
      

      (7) Paragangliomas
      

      
      
   3. Nasopharyngeal tumor
      
   4. Locally recurrent disease
      
   5. Nodal presentation
      
   6. Metastatic disease
      
   
   
8. Follow-up
   1. Second malignancies
      
   
   
9. Supportive care
   1. Dental care
      
   2. Enteral and parenteral nutrition
      
   3. Radioprotectants

      (1) ASCO clinical practice guidelines
      

      
      
   4. Rehabilitation

      (1) Speech
      

      (2) Swallow
      

      (3) Voice
      

      
      
   5. Disfigurement and dysfunction
      
   
   

R. Hepatocellular Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Histologic variants
      

      (2) Grade
      

      
      
   2. Genetics and molecular markers

      (1) Hemachromatoses
      

      (2) Wilson's disease
      

      (3) Alpha1-antitrypsin deficiency
      

      
      
   3. Viral factors

      (1) Hepatitis B
      

      (2) Hepatitis C
      

      
      
   4. Chemical exposure

      (1) Alcohol
      

      (2) Aflatoxin
      

      
      
   5. Cirrhosis
      
   
   
3. Prevention
   1. Hepatitis B vaccination
      
   2. Alcohol cessation
      
   3. Tobacco cessation
      
   
   
4. Screening
   1. Alpha-fetoprotein
      
   
   
5. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Biopsy
      
   4. Tumor markers
      
   
   
6. Staging and prognostic factors
   1. TNM staging
      
   2. Histologic features
      
   3. Grade
      
   4. Fibrosis score
      
   5. Alpha-fetoprotein
      
   
   
7. Treatment
   1. Resectable disease

      (1) Surgery
      

      (2) Liver transplantation
      

      
      
   2. Unresectable liver-only disease

      (1) Ablative procedures
      

      (2) Hepatic arterial embolization
      

      (3) Chemotherapy
      

      
      
   3. Metastatic disease

      (1) Chemotherapy
      

      
      
   
   

S. Hodgkin's Lymphoma

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Histologic types (WHO classification)
      

      
      
   2. Lymphocyte predominant
      
   3. Lymphocyte depleted
      
   4. Mixed cellularity
      
   5. Nodular sclerosis
      
   6. Nodular lymphocyte predominant
      
   7. Viral factors

      (1) Epstein Barr virus
      

      
      
   
   
3. Diagnosis
   1. Clinical signs and symptoms
      
   2. Imaging
      
   3. Biopsy

      (1) Immunophenotypic profile
      

      
      
   
   
4. Staging and prognostic factors
   1. Ann Arbor staging system with the Cotswold modifications

      (1) Evaluation for B symptoms
      

      
      
   2. Staging procedures

      (1) Serum albumin
      

      (2) Imaging
      

      
      
   3. Gallium scan
      
   4. PET scan
      
   5. CT imaging

      (1) Bone marrow evaluation
      

      
      
   6. International Prognostic System

      (1) Prognostic factors
      

      
      
   
   
5. Treatment by stage
   1. Low stage (IA/IIA)

      (1) Very favorable disease

      (a) Extended field radiation therapy
      

      
      

      (2) Favorable disease

      (a) Short course chemotherapy plus involved field radiation therapy
      

      
      

      
      
   2. Stage IB/IIB

      (1) Full course chemotherapy
      

      
      
   3. Stage I/II with bulky mediastinal mass

      (1) Full course chemotherapy plus involved field radiation therapy
      

      
      
   4. Stage III/IV

      (1) Full course chemotherapy
      

      
      
   5. Persistent disease after primary chemotherapy

      (1) Radiation therapy
      

      
      
   6. Primary refractory or relapsed disease

      (1) Chemotherapy
      

      (2) Radiation therapy
      

      (3) Bone marrow/stem cell transplantation
      

      
      
   7. Frail patients

      (1) Radiation therapy for palliation
      

      
      
   
   
6. Follow-up
   1. International Lymphoma Consensus Panel recommendations
      
   
   
7. Supportive care
   1. Fertility and sexuality issues
      
   2. Treatment-related toxicities

      (1) Second malignancies
      

      (2) Cardiovascular
      

      (3) Hypothyroidism
      

      
      
   
   
8. Other/special issues
   1. Infertility (amenorrhea and azoospermia)
      
   2. Secondary malignancies
      
   3. Elderly patients
      
   4. Long-term cardiac complications
      
   5. Radiation therapy-related hypothyroidism
      
   6. Hodgkin's during pregnancy
      
   
   

T. Lung Cancer

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology
      
   2. Non-small-cell histology and biology

      (1) Adenocarcinoma

      (a) Bronchioalveolar
      

      
      

      (2) Squamous cell
      

      (3) Large-cell
      

      
      
   3. Small-cell histology and biology
      
   4. Risk factors

      (1) Lifestyle

      (a) Active and passive smoking
      

      
      

      (2) Environmental

      (a) Asbestos
      

      (b) Radon
      

      (c) Other
      

      
      

      
      
   5. Genetic and molecular markers
      
   
   
3. Prevention
   1. Smoking cessation
      
   2. Chemoprevention
      
   
   
4. Screening
   
5. Diagnosis
   1. Clinical signs and symptoms
      
   2. Sputum cytology
      
   3. Imaging
      
   4. Biopsy
      
   5. Immunohistochemistry
      
   
   
6. Staging and prognostic factors
   1. Non-small-cell lung cancer (NSCLC)

      (1) TNM system
      

      
      
   2. Small cell lung cancer (SCLC)

      (1) TNM system and/or limited versus extensive
      

      
      
   
   
7. Treatment
   1. Non-small-cell lung cancer

      (1) Preoperative evaluation
      

      (2) Carcinoma-in-situ
      

      (3) Early-stage disease (stage I, II, III, N0-1)

      (a) Surgery
      

      (b) Radiation therapy
      

      (c) Chemotherapy
      

      
      

      (4) Stage IIIA and IIIB

      (a) Combined chemotherapy and radiation therapy
      

      (b) Surgery
      

      
      

      (5) Stage IIIB (with pleural effusion) and stage IV

      (a) Chemotherapy

      1. First-line
         
      2. Second-line
         
      3. Third-line and beyond
         

      
      

      (b) Biologic agents
      

      (c) Isolated metastases
      

      
      

      
      
   2. Small-cell lung cancer

      (1) Limited stage

      (a) Combined chemotherapy and radiation therapy
      

      (b) Prophylactic brain irradiation
      

      (c) Solitary pulmonary nodule
      

      
      

      (2) Extensive disease

      (a) First-line chemotherapy
      

      (b) Second-line treatment
      

      (c) Treatment of brain metasteses
      

      
      

      
      
   
   
8. Follow-up
   1. ASCO and other guidelines
      
   
   
9. Supportive care
   1. Pulmonary rehabilitation post resection and/or radiation therapy
      
   
   
10. Other/Special issues
    1. Bronchoalveolar carcinoma
       
    2. Pancoast tumors
       
    
    

U. Melanoma

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Dysplastic nevi
      

      (2) Melanoma in situ
      

      (3) Invasive melanoma
      

      
      
   2. Risk factors

      (1) Skin type
      

      (2) Precursor lesions
      

      (3) Sun exposure
      

      (4) Family history (affected relatives)
      

      
      
   3. Genetics - p16 mutations

      (1) CDKN2A, MTS-1
      

      (2) CDK4
      

      (3) FAMM (DNS)
      

      
      
   
   
3. Prevention
   1. Lifestyle changes

      (1) Sun avoidance
      

      
      
   2. Use of sunscreen
      
   
   
4. Screening
   1. Skin examination
      
   2. Genetic testing and genetic counseling
      
   
   
5. Diagnosis
   1. Clinical signs and symptoms

      (1) ABCD of melanoma identification
      

      
      
   2. Biopsy of suspicious lesion (excisional versus incisional versus shave)
      
   3. Imaging
      
   
   
6. Staging and prognostic factors
   1. TNM system
      
   2. Location of primary
      
   
   
7. Treatment by stage
   1. Melanoma in situ

      (1) Surgery
      

      
      
   2. Invasive melanoma

      (1) Surgery

      (a) Wide local excision
      

      (b) Sentinel node mapping
      

      
      

      (2) Adjuvant therapy

      (a) Interferon
      

      (b) Vaccines
      

      
      

      (3) Estimating the benefits of adjuvant therapy
      

      
      
   3. Regional nodal metastasis/in-transit metastasis

      (1) Surgery
      

      (2) Adjuvant therapy

      (a) Interferon
      

      (b) Other
      

      (c) Limb perfusion
      

      
      

      
      
   4. Metastatic disease

      (1) Surgical resection (solitary metastasis)
      

      (2) Chemotherapy
      

      (3) Biologic therapies

      (a) Interferon
      

      (b) Interleukin-2
      

      
      

      (4) Biochemotherapy
      

      (5) Radiation therapy
      

      
      
   
   
8. Follow-up
   1. National Comprehensive Cancer Network (NCCN) guidelines
      
   
   
9. Supportive care
   1. Lymphedema
      
   
   
10. Other/special issues
    1. Unknown primary
       
    2. Mucosal primary

       (1) Oral
       

       (2) Anorectal
       

       (3) Vaginal/vulvar
       

       
       
    3. Ocular primary
       
    
    

V. Mesothelioma (pleural)

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Epithelioid
      

      (2) Sarcomatoid
      

      (3) Mixed
      

      
      
   2. Risk factors

      (1) Asbestos
      

      
      
   
   
3. Prevention
   1. Decrease occupational exposure
      
   
   
4. Diagnosis
   1. Signs and symptoms
      
   2. Imaging
      
   3. Cytology

      (1) Effusion
      

      
      
   4. Biopsy

      (1) Thoracoscopy
      

      
      
   
   
5. Staging and prognostic factors
   1. International Mesothelioma Interest Group
      
   
   
6. Treatment by stage
   1. Stage I

      (1) Extrapleural pneumonectomy
      

      (2) Adjuvant chemotherapy
      

      (3) Adjuvant radiation therapy
      

      
      
   2. Unresectable disease

      (1) Rad iation therapy
      

      (2) Chemotherapy
      

      (3) Combination chemoradiotherapy
      

      
      
   3. Recurrent and metastatic disease

      (1) Chemotherapy
      

      (2) Radiation therapy
      

      
      
   
   
7. Supportive care
   1. Management of effusions
      
   
   
8. Special issues
   1. Peritoreal mesothelioma

      (1) Presentation and diagnosis
      

      (2) Pathology
      

      (3) Treatment
      

      
      
   2. Benign mesotheliomas
      
   
   

W. Multiple Myeloma and Plasma Cell Dyscrasias

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Clonal B-cell origin
      

      
      
   2. Risk factors

      (1) Radiation
      

      (2) Aromatic and organic compounds
      

      
      
   3. Pathogenesis

      (1) IL-6 and other cytokines
      

      (2) Molecular and genetic alterations
      

      (3) Adhesion molecules
      

      
      
   
   
3. Diagnosis
   1. Clinical signs and symptoms
      
   2. Serum and urine evaluations for paraproteins
      
   3. Bone marrow aspirate and biopsy
      
   4. Skeletal survey
      
   5. Tissue biopsy if plasmacytoma suspected
      
   6. Quantitative analysis of serum immunoglobulins
      
   7. Laboratory studies
      
   8. h. Criteria for the different plasma cell dyscrasias

      (1) Multiple myeloma
      

      (2) Plasmacytoma
      

      (3) Plasma cell leukemia
      

      (4) Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS)
      

      (5) Primary amyloid
      

      (6) Cryoglobulinemia
      

      (7) Monoclonal gammopathy of uncertain significance (MGUS)
      

      (8) Waldenstrom's macroglobulinemia (lymphoplasmacytic lymphoma with serum immunoglobulin-M)
      

      
      
   
   
4. Staging and prognostic factors
   1. Durie-Salmon staging system
      
   2. Serum creatinine substaging
      
   3. Prognostic factors

      (1) Paraprotein type and levels
      

      (2) B2-microglobulin
      

      (3) Bone marrow plasma cell labeling index
      

      (4) Bone marrow cytogenetics
      

      (5) Thrombocytopenia
      

      (6) C-reactive protein
      

      
      
   
   
5. Treatment by stage and type
   1. Multiple myeloma/plasma cell leukemia/POEMS

      (1) Uncomplicated stage I

      (a) Observation
      

      
      

      (2) Complicated stage I, or stage II-III

      (a) Chemotherapy
      

      (b) Biologics

      1. Thalidomide with/without dexamethasone + full-dose warfarin
         
      2. Antiproteosome therapy
         

      
      

      (c) Bone marrow/stem cell transplantation
      

      (d) Solitary plasmacytoma
      

      
      

      (3) Relapsed or refractory disease

      (a) Chemotherapy
      

      (b) Corticosteroids
      

      (c) Thalidomide
      

      (d) Bortezomib
      

      (e) Combination therapy
      

      
      

      
      
   2. Solitary plasmacytoma

      (1) Soft tissue

      (a) Radiation therapy
      

      
      

      (2) Bone
      

      
      
   3. Primary amyloid

      (1) Autologous stem-cell transplant
      

      (2) Chemotherapy
      

      (3) Thalidomide
      

      (4) Interferon and dexamethasone
      

      
      
   4. Cryoglobulinemia

      (1) Systemic therapy with/without plasma exchange
      

      (2) Hepatitis C
      

      
      
   5. MGUS (monoclonal gammopathy of unknown significance)

      (1) Observation
      

      
      
   6. Waldenstrom's marcoglobulinemia

      (1) Plasma exchange for hyperviscosity signs/symptoms
      

      (2) Chemotherapy with or without rituximab
      

      
      
   
   
6. Follow-up
   1. No consensus
      
   
   
7. Supportive care
   1. Bisphosphonates
      
   2. Hemodialysis for renal failure
      
   3. Infection

      (1) Penicillin (or appropriate substitute) for infection prophylaxis
      

      (2) Hypogammaglobulinemia
      

      (3) Vaccinations against common infectious agents
      

      
      
   4. Hyperviscosity
      
   
   

X. Neuroendocrine (carcinoid) Tumors

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   3. Hereditary syndromes

      (1) MEN
      

      
      
   4. Second neuroendocrine tumor
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) Defined by amine precursor uptake and decarboxylation (APUD) cell of origin
      

      (2) Classification by site of primary

      (a) GI tract

      1. Foregut
         
      2. Midgut
         
      3. Hindgut
         

      
      

      (b) Lung
      

      (c) Pancreas
      

      (d) Thymus
      

      
      

      (3) Histochemistry and products

      (a) Serotonin
      

      (b) Calcitonin
      

      (c) Gastrin
      

      (d) VIP
      

      (e) Glucagon
      

      (f) Insulin
      

      (g) Other
      

      
      

      
      
   2. Genetic factors

      (1) MEN
      

      
      
   
   
3. Prevention
   1. Genetic counseling
      
   
   
4. Diagnosis
   1. Clinical signs and symptoms

      (1) Symptoms related to hormone produced
      

      (2) Carcinoid syndrome
      

      (3) Carcinoid crisis
      

      
      
   2. Biopsy

      (1) Positive staining for chromogranin and neuron-specific enolase
      

      
      
   3. Measurement of secretary product

      (1) 24-hour 5-hydroxy-indole acetic acid
      

      
      
   4. Imaging
      
   5. Endoscopy as appropriate by site
      
   6. Radiolabeled octreotide for somatostatin receptor scintigraphy
      
   
   
5. Screening and prognostic factors
   1. No standard staging
      
   2. Prognostic factors

      (1) 5HIAA levels
      

      (2) Primary site
      

      (3) Liver metastases
      

      (4) Histologic features
      

      
      
   
   
6. Treatment
   1. Observation
      
   2. Surgery
      
   3. Somatostatin analog
      
   4. Chemotherapy
      
   5. Palliation of symptoms

      (1) Diarrhea
      

      (2) Bronchospasm
      

      (3) Cardiac disease
      

      
      
   6. Interferon
      
   7. Liver directed therapy
      
   
   
7. Follow-up
   1. No standard follow-up
      
   
   

Y. Non-Hodgkin's Lymphoma

1. Epidemiology
   1. Incidence rates
      
   2. Mortality rates
      
   
   
2. Pathogenesis, pathology, and tumor biology
   1. Pathology

      (1) WHO classification

      (a) Lymphocyte lineages

      1. B-cell (pre- and mature types)
         
      2. T-cell [pre- and mature (peripheral)] types
         
      3. NK-cell
         

      
      

      
      

      
      
   2. Genetic factors

      (1) Chromosomal translocations
      

      (2) Oncogene amplification
      

      
      
   3. Immunodeficiency

      (1) Inherited immunodeficiency states
      

      (2) Acquired immunodeficiency states
      

      
      
   4. Infectious agents

      (1) Viral
      

      (2) Bacterial
      

      
      
   
   
3. Prevention
   1. Treatment of Helicobacter pylori benign gastric disease
      
   
   
4. Diagnosis
   1. Clinical signs and symptoms
      
   2. Biopsy

      (1) Fine needle aspiration
      

      (2) Excisional lymph node biopsy (gold standard)
      

      (3) Bone marrow aspirate and biopsy
      

      (4) Typical diagnostic profiles

      (a) Morphology/histology
      

      (b) Immunophenotyping
      

      (c) Cytogenetic analysis
      

      (d) Molecular diagnostics
      

      
      

      
      
   3. Imaging
      
   
   
5. Staging and prognostic factors
   1. Ann Arbor Staging system with Cotswold modifications

      (1) Procedures

      (a) Serum LDH
      

      (b) Bone marrow biopsy
      

      (c) Lumbar puncture
      

      (d) PET scan
      

      (e) CT scan
      

      
      

      
      
   2. Prognostic factors

      (1) Indolent versus aggressive disease
      

      (2) Histology

      (a) Low-grade
      

      (b) Intermediate-grade
      

      (c) High-grade
      

      
      

      
      
   3. International Prognostic Index
      
   
   
6. Treatment by histologic grade
   1. Indolent disease

      (1) Observation
      

      (2) Chemotherapy
      

      (3) Radi