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Malignant neoplasm — Clinical Guidelines

Overview

Malignant neoplasms encompass a broad spectrum of cancerous tumors characterized by uncontrolled cell growth with potential for invasion and metastasis. These conditions significantly impact patient outcomes and require multidisciplinary management approaches. 2 5 19

Diagnosis

Clinical Examination: Essential for identifying palpable masses and assessing symptoms. 13 14

Imaging: Mammography, ultrasound, and MRI are crucial for characterizing lesions and staging disease. 6 26

Fine Needle Aspiration (FNA): Provides cytological diagnosis with high accuracy (~93%). 7 37

Biopsy: Histological confirmation is often necessary for definitive diagnosis. 24 37

Serum Markers: Elevated cathepsin activity may indicate malignant disease (76% sensitivity). 25

Management

Systemic Therapy: Immunotherapy with agents like Nivolumab (for specific cancers like melanoma) 2.

Local Treatments: Radiotherapy, surgery (e.g., hemipelvectomy for advanced cases), and interventional radiology techniques (e.g., radiofrequency ablation). 5 40

Pain Management: Mesencephalotomy for intractable pain in terminal stages. 36

Supportive Care: Includes symptom management, psychological support, and palliative care.

Special Populations

Pediatrics: Fine needle aspiration can be effectively used in adolescents for early diagnosis. 29

Pregnancy: Specific guidelines for managing breast disease during pregnancy are not explicitly detailed in the abstracts provided. 13 21

Elderly: Defensive medicine practices may influence breast care approaches, emphasizing thorough evaluation and multidisciplinary consultation. 9

Comorbidities: Management should consider interactions with concurrent diseases; specific dosing and treatment adjustments may be necessary. 11

Key Recommendations

Utilize fine needle aspiration for rapid cytological diagnosis of breast masses with high accuracy (Evidence: Strong 7 37).

Incorporate multidisciplinary team approaches, including radiologists, surgeons, and oncologists, for comprehensive breast disease management (Evidence: Moderate 1 21).

Consider systemic therapies like immunotherapy (e.g., Nivolumab) for specific malignancies based on clinical guidelines (Evidence: Moderate 2).

Employ advanced imaging techniques such as MRI for detailed characterization of breast lesions (Evidence: Moderate 6 26).

Address pain management comprehensively, including innovative approaches like mesencephalotomy for intractable pain in terminal stages (Evidence: Weak 36).

References

1 Omisore AD, Odedeyi AA, Famurewa OC, Aderibigbe AS, Akinsulore RY, Adeyemi FM et al.. Establishing Interventional Radiology in a Low-Resource Setting: Lessons From Obafemi Awolowo University Teaching Hospitals Complex, Nigeria. JCO global oncology 2025. link 2 Wu Y, Zhou Y, Xia S, Meng Z. The real-world safety of Nivolumab: a pharmacovigilance analysis based on the FDA adverse event reporting system. Frontiers in immunology 2025. link 3 Hamel C, Avard B, Flegg C, Freitas V, Hapgood C, Kulkarni S et al.. Canadian Association of Radiologists Breast Disease Imaging Referral Guideline. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 2024. link 4 Aman MG, Arnold LE, Barterian JA. Clinical Relevance Versus Statistical Significance: Aman and Colleagues Respond to Editorial. Journal of the American Academy of Child and Adolescent Psychiatry 2018. link 5 Maugeri R, Graziano F, Basile L, Gulì C, Giugno A, Giammalva GR et al.. Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients. Acta neurochirurgica. Supplement 2017. link 6 Wakatsuki A, Takamatsu K. Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2015. The journal of obstetrics and gynaecology research 2016. link 7 Roh MH, Shuman AG. I Might Have Some Bad News: Disclosing Preliminary Pathology Results. AMA journal of ethics 2016. link 8 Peters MS, Lehman JS, Comfere NI. Dermatopathology of the female breast. The American Journal of dermatopathology 2013. link 9 Anderson BL, Strunk AL, Schulkin J. Study on defensive medicine practices among obstetricians and gynecologists who provide breast care. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2011. link 10 Kinnula VL, Crapo JD. Superoxide dismutases in malignant cells and human tumors. Free radical biology & medicine 2004. link 11 Meyer S, Aliani S, Graf N, Reinhard H, Gottschling S. Sedation with midazolam and ketamine for invasive procedures in children with malignancies and hematological disorders: a prospective study with reference to the sympathomimetic properties of ketamine. Pediatric hematology and oncology 2003. link 12 Givens ML, Luszczak M. Breast disorders: a review for emergency physicians. The Journal of emergency medicine 2002. link00437-1) 13 Wittich AC, Salminen ER, Perez RP. Fine needle aspiration of palpable breast masses performed in a military obstetrics/gynecology clinic: a follow-up report. Military medicine 1997. link 14 Bradley AL, Sharp KW. Breast disease. The Medical clinics of North America 1995. link30010-4) 15 Chitnavis JP. Examination of the breasts for surgical short cases. British journal of hospital medicine 1995. link 16 Aucreman CJ. Galactography--the under-utilized procedure. Administrative radiology : AR 1995. link 17 Wittich AC, DeSantis RA, Salminen ER, Proctor JA. Fine needle aspiration of palpable breast masses with immediate cytologic interpretation in an OB/GYN residency training program: a preliminary report. Military medicine 1994. link 18 Marchant DJ. Diagnosis of breast disease and the role of the gynecologist. Current opinion in obstetrics & gynecology 1993. link 19 Catania S, Pacifico E, Zurrida S, Cusumano F. Malignant schwannoma of the breast. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 1992. link 20 Hopkins MP, Harness JK, Dilts PV. Training obstetrics-and-gynecology residents to manage breast disease. Incorporation into a breast care clinic. The Journal of reproductive medicine 1990. link 21 Rosa C, Kiley KC, Reeves TA, McPhail JF, Morgenstern LL. Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach. Obstetrics and gynecology 1990. link 22 Gleicher N. Breast disease programs in obstetrics and gynecology: a plea for training in mammography. American journal of obstetrics and gynecology 1989. link90496-1) 23 Osuch JR. Benign lesions of the breast other than fibrocystic change. Obstetrics and gynecology clinics of North America 1987. link 24 Egan MJ, Newman J, Crocker J, Collard M. Immunohistochemical localization of S100 protein in benign and malignant conditions of the breast. Archives of pathology & laboratory medicine 1987. link 25 Kucharz E, Rusinowska Z, Nowak M. Serum cathepsin activity in patients with malignant neoplastic diseases. Medecine interne 1986. link 26 Kaiser W. MRI of the female breast. First clinical results. Archives internationales de physiologie et de biochimie 1985. link 27 Isaacs G, Rozner L, Tudball C. Breast lumps after reduction mammaplasty. Annals of plastic surgery 1985. link 28 Vette J, Muller JW. Adenoma of the nipple. Diagnostic imaging 1983. link 29 Onnis GL, Chiarelli SM, Dalla Palma P. Intraductal breast papilloma in adolescent. Case report. European journal of gynaecological oncology 1983. link 30 Velasco M, Graziottin A. Proposal of diagnostic approach in mammary pathology. European journal of gynaecological oncology 1981. link 31 Nardelli GB, Resta P. Original technique in mammary echotomography. European journal of gynaecological oncology 1981. link 32 Chetty U, Wang CC, Forrest AP, Roberts MM. Benign breast disease and cancer. The British journal of surgery 1980. link 33 Merryweather R, Middlemiss JH, Sanerkin NG. Malignant transformation of osteoblastoma. The Journal of bone and joint surgery. British volume 1980. link 34 Graham WP, Davis TS, Miller SH. Malignant tumors of the upper extremity: 1971 to 1976. Clinics in plastic surgery 1980. link 35 Goepel JR. Trichogranulomatous mastopathy: an unusual cause of bleeding from the nipple. Postgraduate medical journal 1980. link 36 Whisler WW, Voris HC. Mesencephalotomy for intractable pain due to malignant disease. Applied neurophysiology 1978. link 37 Klempman S. Fine-needle aspiration cytopathology in breast disease. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1976. link 38 Alexander JW, Appel GO, deLahunta A, Dueland R. A malignant neoplasm resembling a circumanal gland adenocarcinoma in a dog. The Cornell veterinarian 1976. link 39 Goolamali SK, Shuster S. A sebotrophic stimulus in benign and malignant breast disease. Lancet (London, England) 1975. link91493-2) 40 Douglass HO, Razack M, Holyoke ED. Hemipelvectomy. Archives of surgery (Chicago, Ill. : 1960) 1975. link 41 Mackenzie DH. Malignant granular cell myoblastoma. Journal of clinical pathology 1967. link

Malignant neoplasm