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Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.
Standard use of adjuvant immunotherapy has significantly improved clinical outcomes in melanoma. Neoadjuvant immunotherapy has further enhanced these benefits in the setting of advanced disease. Lack of a reliable biomarker to monitor treatment response or disease progression has severely limited prognostication accuracy and the individualization of treatment regimens. A reliable biomarker that indicates treatment response or disease progression could guide clinical decision making to benefit patients with high-risk features or significant disease burden by enhanced activation of the innate antitumor immune response or altered gene expression are areas of active investigation to further improve clinical management of melanoma.
Merkel cell carcinoma is a rare, aggressive cutaneous neuroendocrine tumor, often diagnosed in later stages. Most of cases are related to either ultraviolet exposure or infection with the Merkel cell polyomavirus. Immunocompromised patients are at higher risk for the development of the disease. Treatment in the initial stages consists of resection and radiotherapy. Metastatic disease has a very poor prognosis and shows a limited durable response to chemotherapy. Combination of surgery, radiation therapy, and systemic therapy is used for the treatment of metastatic disease. Recently, the advent of programmed cell death protein 1 axis agents has improved outcomes in metastatic disease. There are ongoing clinical trials evaluating these agents in resected disease.
Retroperitoneal sarcoma is composed of a heterogeneous group of mesenchymal neoplasms that has poor prognosis. Although surgery remains the mainstay of treatment, achieving complete surgical resection with adequate margins is challenging, given anatomic constraints. Evidence on the use of adjunctive treatment modalities for retroperitoneal sarcoma is sparse, with the treatment rationale often based on data extrapolated from other soft tissue sarcomas. Recent studies demonstrate some benefits of neoadjuvant radiotherapy for histologic subtypes with high locoregional recurrence rates. Ongoing studies are evaluating various novel adjunctive treatment modalities.
Gynecologic malignancies are a heterogenous group of tumors driven by a wide variety of molecular alterations. Molecular profiling has become increasingly useful in the development of novel biomarkers, screening tools, and targeted therapeutic agents. The purpose of this article is to provide an overview of the current usage of personalized medicine in the field of gynecologic oncology.
Childhood cancer survivors cite reproductive health and future fertility as important to their quality of life in survivorship. The discipline of oncofertility has made significant progress in recent decades. With the development of risk stratification guidelines and multidisciplinary teams to facilitate counseling and expanding options for fertility preservation, fertility considerations in patients are being increasingly prioritized. However, various barriers continue to exist, and long-term success rates of certain fertility preservation methods remain unknown. It is essential to continue research and advocacy efforts to ensure all patients have access to reproductive health care throughout the continuum from cancer diagnosis through survivorship.
Hodgkin lymphoma is the most common hematologic malignancy diagnosed during pregnancy, attributed to overlapping peak incidence with the reproductive years. Management during pregnancy requires a multidisciplinary team including hematology/oncology, maternal fetal medicine, anesthesiology, and neonatology. Treatment is driven by gestational age and symptoms in accordance with the patient's wishes. Ultimately, the goal is to maximize the cure rate of the mother while allowing for term delivery of a healthy child. This article provides practical recommendations on staging and management of Hodgkin lymphoma in pregnancy, including the optimal choice and timing of therapy by gestational age, along with supportive care considerations.
The treatment landscape of classical Hodgkin lymphoma continues to evolve with earlier use of novel agents. Most recently, the addition of PD-1 inhibitors into frontline therapy has improved cure rates but introduced new challenges at relapse. How prior exposure to these agents impacts disease biology and response to salvage regimens remains unclear, thereby complicating second-line treatment decisions. This review discusses current considerations for selecting a salvage therapy in the era of frontline novel agents.
Dermatofibrosarcoma protuberans is a rare, low-grade sarcoma characterized by lateral tentacle-like extensions into the surrounding subcutaneous tissue. Although surgical resection remains that mainstay of treatment, achieving negative margins is often challenging due to these irregular growth patterns and is similarly associated with high local recurrence. Different surgical approaches for dermatofibrosarcoma protuberans include wide local excision, Mohs micrographic surgery, and a multidisciplinary combined approach.
Stem cell transplantation remains a cornerstone in managing relapsed/refractory classic Hodgkin lymphoma, though its role is evolving with the integration of targeted therapies. Autologous stem cell transplantation achieves cure rates of 50% to 60%, enhanced significantly with the introduction of novel agents including brentuximab vedotin and checkpoint inhibitor-based salvage and consolidation regimens. Allogeneic transplantation with reduced-intensity conditioning offers curative potential for patients with disease that relapses after autologous stem cell transplantation. This article reviews the evidence for autologous and allogeneic stem cell transplantation, their integration with novel agents, and the emerging transplant-sparing strategies.
Primary liver cancer, encompassing hepatocellular carcinoma and cholangiocarcinoma, represents a growing global health burden with significant morbidity and mortality. Imaging is central to the clinical management of these malignancies, informing surveillance, diagnosis, staging, and treatment response assessment. A comprehensive overview of current imaging modalities-including ultrasound, computed tomography, MRI, and PET/CT-and their respective roles across the spectrum of hepatic and biliary neoplasms is presented. Established diagnostic frameworks such as LI-RADS and staging systems including BCLC are reviewed, alongside emerging applications of radiomics and artificial intelligence in liver oncology.
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.
Gynecologic cancer treatments often lead to increased sexual concerns, which often are not addressed. Screening should be performed in a standardized fashion both routinely and frequently. Various treatment options are available and should be offered to improve quality of life. Referrals to specialty clinics can be made when available.
Childhood cancer survivors are at risk for neurocognitive deficits because of the past treatment received and, if involving the central nervous system, the malignancy itself. It is vital to maintain a holistic perspective in caring for childhood cancer survivors to identify and address the multiple factors associated with neurocognitive outcomes in this patient population in addition to the cancer and treatment received. In this review, we provide an overview of the many factors of a cancer experience that can impact neurocognition and discuss opportunities for clinician screening.
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a common entity with a prevalence in the general population that increases with age. Depending on the involvement of the main pancreatic duct, they can be divided into main-duct (MD), mixed-duct, and branch-duct (BD) variants. Most BD-IPMNs are low-risk and surveilled, while MD-IPMNs are generally resected. When necessary, a standard pancreatic resection with lymphadenectomy is recommended. The use of molecular profiling, intraoperative pancreatoscopy, and surveillance end points are discussed.
Radiation therapy is an integral part of treatment of many pediatric cancers, but is associated with long-term side effects. Recent advances in radiation therapy, and in particular in the use of particle therapy with protons, have allowed the delivery of more effective doses of radiation with fewer late effects. The physical properties of protons allow for significantly lower doses to be given to normal tissues outside of the intended treatment volume, which provides meaningful long-term benefits across multiple disease sites, including better neurocognitive outcomes, less ototoxicity, fewer endocrine abnormalities, reduced risks of cardiovascular or pulmonary complications, and lower risks of second malignant neoplasms.
Radiation therapy (RT) has played a central role in the management of classic Hodgkin lymphoma (cHL) for over a century and remains an integral component of modern, risk-adapted treatment strategies. Advances in systemic therapy, molecular imaging, and radiation technique have enabled substantial reductions in treatment fields and dose while maintaining excellent disease control. This article reviews the evolution of RT in cHL, contemporary evidence guiding its use in early-stage and in advanced-stage disease, and its evolving role in relapsed and refractory settings, including peritransplant and emerging transplant-alternative approaches.
Gastrointestinal stromal tumors (GISTs) are rare neoplasms originating in the mesenchyme of the gastrointestinal tract. An evolving treatment paradigm in the management of GISTs is the usage of neoadjuvant therapy (NAT). Prior to undergoing NAT, GISTs must be genetically tested. The main benefit of NAT is reduction of operative morbidity. Response to NAT is generally assessed by contrast-enhanced computed tomography or MRI at regular intervals. Patients are treated to maximal response, which is often 8 to 12 months. After resection, selected patients should continue systemic treatment, for a total of 3 years of therapy before entering posttreatment surveillance.
Antibody-drug conjugates are a class of novel antineoplastic drugs that deliver potent cytotoxic agents directly into tumor cells by targeting tumor-specific antigens. Two of these drugs are currently approved for treatment of gynecologic cancers and many more are under investigation. Along with the expected toxicities associated with chemotherapy drugs, antibody-drug conjugates can cause more atypical adverse events; the treating oncologist should be aware of these toxicities and their management.
Approximately 10% of patients with melanoma develop in-transit disease (ITM). Although resection may be performed in patients with limited, fully resectable disease, many patients with ITM present with bulky, unresectable disease, which can pose a significant therapeutic challenge. Regional perfusion chemotherapy procedures and intralesional therapy have high response rates and can provide durable locoregional control while limiting systemic toxicity. Systemic therapies, including immune checkpoint inhibitors and targeted therapies, may also be used especially in patients with concomitant distant metastatic disease. In this article, we review the available treatment options for ITM.