Donald Earl Henson

Liver, gallbladder, extrahepatic bile ducts, and pancreas

Background. The liver, gallbladder, bile ducts, and pancreas have a common embryologic origin; cancers that arise from these sites therefore are expected to share a similar spectrum of histologic types. These cancers are known for their extremely poor prognoses.

Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates

Data on patients with gallbladder cancer listed in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed. Between 1977 and 1986, 3038 patients were recorded in the Program. Histologic grade, histologic type, stage of disease, and vascular invasion were correlated with outcome. Compared with all other histologic types of cancer, papillary carcinomas had the most favorable prognosis. The 2‐year survival rate for patients with papillary carcinoma was 47%. A correlation with survival existed between grade, stage of disease, and vascular invasion. The study confirmed that cancers of the gallbladder occur more often in older age groups and are more common in women. Almost 40% of cases are found at an advanced stage. For patients whose enolase tumor was limited to the gallbladder at the time of surgery, the 2‐year survival rate was 45% and the 5‐year rate was 32%.

Carcinoma of the extrahepatic bile ducts : histologic types, stage of disease, grade, and survival rates

Data on patients with extrahepatic bile duct carcinomas recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed, We analyzed the records of 1766 patients reported during a 10‐year period (1977–1986). These tumors occurred primarily in older age groups and were slightly more common in males. Histologic grade, histologic types, and stage of disease are useful prognostic indicators. The 5‐year survival rate for patients with Stage I disease was 11%. Although carcinomas of the extrahepatic bile ducts are better differentiated than carcinomas arising in the gallbladder, they have a less favorable prognosis.

The WHO histological classification of tumors of the gallbladder and extrahepatic bile ducts. A commentary on the second edition

The second edition of the WHO Histological Classification of Tumors of the Gallbladder and Extrahepatic Bile Ducts is more comprehensive and detailed than the previous one. Advances in our understanding of dysplasia, carcinoma in situ, various lines of differentiation among the carcinomas, and the recognition of a variety of tumor‐like lesions have resulted in more than three times as many entities in the current classification as in the previous one. The new edition should facilitate pathologic, epidemiologic, and therapeutic comparisons. Cancer 1992; 70:410–414.

The histologic grading of cancer

Background. The histologic grade of a tumor provides prognostic information in addition to that provided by stage of disease. Poorly differentiated tumors are known to pursue a more aggressive course than their well differentiated counterparts.

Conditional survival of 56,268 patients with breast cancer

Background. Survival rates calculated from the date of diagnosis may not be predictive of future outcome for patients who have already survived several years after diagnosis. Conditional survival rates are more informative clinically because they take into account survival after diagnosis.

Cancer and the Internet.

In this issue, Biermann et al. bring a new topic to the readers of Cancer : the inaccuracies of cancer patient information found on the Internet. Specifically, the authors systematically evaluated the information available on the Internet for Ewing sarcoma, a relatively rare tumor occurring in young adults. The authors focused on Ewing sarcoma because the information listed on the Internet was manageable. The authors take the reader through a comprehensive evaluation, including the results of different search engines, spellings, the use of the apostrophe in the term “Ewing’s,” types of treatment, survival rates, accuracy of the information, source of the information, and peer-reviewed information. For example, according to the search, survival rates reported on the Internet for patients with Ewing sarcoma ranged from 5– 85%. The issues raised by the authors go far beyond Ewing sarcoma. With the results of these issues in mind, one needs only to consider the information and number of web pages that are available regarding breast carcinoma (60,548) or lung carcinoma, or even nonneoplastic conditions such as the chronic fatigue syndrome. Although it has enormous potential to educate the public and to comfort individual patients, the Internet in some cases may actually lead to adverse medical care by spreading misleading or even fraudulent information. Clearly, those who provide information on the Internet want to be helpful, informative, supportive, and perhaps even sympathetic. Consequently, these Internet sites are powerful sources for education and information. However, such widely available information may lead some patients to obtain misleading or incorrect information by assuming that all sites are equal, by searching for only one or two sites at random, or by searching for what they hope to be true. Information obtained from the Internet may conflict with recommendations provided by physicians, thus leading to confusion and uncertainty in the mind of the patients. The consequences of this uncertainty may lead to a delay in treatment or the patient turning to inappropriate forms of therapy. On the Internet, there is no separation of peer-reviewed, scientifically proven conclusions from anecdotal information or personal reflections. There are many resourceful cancer information sites located on the Internet. Those sponsored by the National Cancer Institute (http://cancernet.nci.nih.gov) and the American Cancer Society (http://www.cancer.org) immediately come to mind. What about a solution to the inaccurate or misleading information present on the Internet? It appears reasonable to conclude that 373