Outcomes for patients with breast cancer have improved over time due to increased screening and the availability of more effective therapies. It is important to recognize that breast cancer is a heterogeneous disease that requires treatment based on molecular characteristics. Early endpoints such as pathologic complete response correlate with event-free survival, allowing the opportunity to consider de-escalation of certain cancer treatments to avoid overtreatment. This article discusses clinical trials of tailoring treatment (eg, I-SPY2) and screening (eg, WISDOM) to individual patients based on their unique risk features.
Precision medicine is used to treat gastrointestinal malignancies including esophageal, gastric, small bowel, colorectal, and pancreatic cancers. Cutting-edge assays to detect and treat these cancers are active areas of research and will soon become standard of care. Colorectal cancer is a prime example of precision oncology as disease site is no longer the final determinate of treatment. Here, the authors describe how leveraging an understanding of tumor biology translates to individualized patient care using evidence-based practices.
Proposed uses of "big data" in pediatric oncology are growing alongside the notoriety that big data has achieved from uses outside of medicine. While big data approaches hold promise to revolutionize how we collect, analyze, and act upon biomedical data, a number of distinct challenges constrain our ability fully to leverage big data to improve human health. In this article, we focus on applications of big data approaches in pediatric oncology. We highlight challenges that limit our ability to leverage big data using existing methods and discuss promising ways using big data.
Primary liver and biliary tract cancers remain major causes of global cancer mortality, with liver and intrahepatic bile duct cancers accounting for 866,136 new cases and 758,725 deaths worldwide in 2022. Curative surgery, transplantation, ablation, embolotherapy, and systemic therapy have improved outcomes, but many patients remain limited by cirrhosis, liver reserve, vascular invasion, biliary obstruction, anatomic constraints, or advanced presentation; population-level survival remains poor for both liver and bile duct cancers. Modern radiation therapy has emerged as an important local and regional modality for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder cancer.
Liver and biliary tumors often impose a high symptom burden from pain, obstructive jaundice, pruritus, hepatic encephalopathy, bleeding, and ascites. Pain management requires a multimodal approach including procedural and pharmacologic interventions. Jaundice and pruritus are managed through biliary drainage and medications. Encephalopathy is addressed by avoiding triggers, reducing ammonia via lactulose or interventional shunt modification. Endoscopic and embolization procedures are the mainstay to palliate bleeding. Ascites requires distinguishing cirrhosis-related from malignant causes to determine effective diuretic or procedural interventions. Integrating these "state-of-the-art" palliative strategies improves quality of life.
The most common primary and metastatic liver tumors include hepatocellular carcinoma and colorectal liver metastasis, both of which remain the leading cause of cancer-related deaths worldwide. While surgical liver resection and transplantation have been considered the gold standard for curative treatment, the use of minimally invasive locoregional ablative therapies for treatment of primary and metastatic liver tumors has emerged as an alternative, increasing the chances of cure and reducing morbidity. Ablative therapies play a significant role in the management of liver tumors. Advances in technology should be used to carefully select patients and subsequent modalities to achieve best tumor outcomes.
This review begins with a brief overview of liver anatomy and histology, followed by a summary of the classification of primary hepatic tumors. It then focuses on hepatocellular carcinoma and cholangiocarcinoma, the 2 most common primary hepatic malignancies. In this section, emphasis is placed on key molecular features and histologic variants with important clinical implications. The review next addresses diagnostic challenges from the pathologist's perspective, providing practical insights into how these scenarios can be approached. Finally, the focus shifts to therapy-related changes in liver tumors, an increasingly important area for assessing treatment response across various therapeutic modalities.
Malignant biliary obstruction commonly arises from cholangiocarcinoma, pancreatic cancer, ampullary cancer, or metastatic disease, leading to jaundice, cholangitis, and impaired liver function. Management centers on achieving adequate biliary drainage to improve symptoms, enable surgery or chemotherapy, and prevent sepsis. Endoscopic and percutaneous transhepatic approaches each offer distinct advantages depending on anatomy, disease extent, and patient factors. Percutaneous techniques allow targeted drainage, tissue diagnosis, and therapeutic interventions such as stenting and endobiliary ablation. Emerging percutaneous cholangioscopic methods enhance visualization and biopsy accuracy. Optimal management requires multidisciplinary decision-making informed by obstruction level, planned oncologic therapy, and overall clinical goals.
Liver and biliary tract cancers represent some of the most therapeutically challenging malignancies, with rising global incidence. Hepatocellular carcinoma remains the most common primary liver cancer, typically developing in the context of cirrhosis and chronic liver injury, whereas biliary tract cancers encompassing gallbladder, intrahepatic, perihilar, and distal subtypes, arises from the biliary epithelium demonstrating aggressive biological behavior. Systemic therapy has undergone substantial evolution over the last decade, shifting from minimally effective cytotoxic chemotherapy toward a diverse therapeutic landscape that includes molecularly targeted agents, immune checkpoint inhibitors, antiangiogenic therapy, and combination regimens.
Primary liver neoplasms, primarily hepatocellular carcinoma and intrahepatic cholangiocarcinoma, remain a major global health burden with poor survival and limited systemic therapy options. Determining resectability requires comprehensive preoperative assessment, including high-quality imaging, liver function evaluation, and future liver remnant volume calculations. Surgical resection with negative margins offers the best chance for long-term survival, and minimally invasive approaches are increasingly used in selected patients. For those with advanced but potentially resectable disease, strategies such as neoadjuvant chemotherapy, portal vein embolization, radiation lobectomy, and hepatic artery infusion chemotherapy provide opportunities for downstaging and potential resection.
Biliary tract malignancies, including perihilar and distal cholangiocarcinoma and gallbladder cancer, are anatomically complex tumors for which resection remains the only curative treatment. Optimal management requires multidisciplinary evaluation, careful patient selection, and meticulous preoperative planning, including biliary drainage and assessment of the future liver remnant. Major hepatectomy with en bloc bile duct excision is the standard approach for peri-hilar cholangiocarcinoma, while pancreaticoduodenectomy is required for distal tumors. Gallbladder cancer is frequently diagnosed incidentally, and definitive re-resection improves outcomes for T1b or greater tumors.
Primary and secondary liver tumors represent a significant global health challenge and are often diagnosed at stages where curative options are not feasible. Transarterial therapies (TATs) have emerged as key locoregional treatment options for patients with unresectable liver tumors, using the liver's unique dual blood supply to selectively target tumor tissue while sparing healthy parenchyma. These therapies include transarterial embolization, transarterial chemoembolization, and transarterial radioembolization, each with distinct mechanisms, technical considerations, and clinical applications. This review provides a comprehensive overview of TATs, with focus on patient selection, procedural principles, and clinical effectiveness across primary and secondary liver malignancies.
Biliary tract neoplasms comprise a heterogeneous group of malignancies associated with diagnostic complexity, and high morbidity and mortality. Hence, timely diagnosis, accurate staging, and effective therapeutic modalities are crucial to patient outcomes. Endoscopy plays is crucial in the multidisciplinary management of biliary neoplasms including cholangiocarcinoma, gallbladder carcinoma, ampullary neoplasms, and intraductal papillary neoplasms of the bile duct. Diagnostically, endoscopy allows for fluoroscopic mapping, endoscopic retrograde cholangiopancreatography-based tissue acquisition, direct visualization with cholangioscopy, and detailed lesion evaluation with endoscopic ultrasound. Therapeutically, biliary stenting, endoscopic ultrasound-guided biliary drainage, gastroenterostomy, and intraductal ablative therapies can be used in managing biliary neoplasms.
