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Malignant neoplastic disease — Clinical Guidelines

Overview

Malignant neoplastic diseases encompass a broad spectrum of cancers characterized by uncontrolled cell growth and potential metastasis. These conditions require multidisciplinary management to address both the primary tumor and systemic effects. 1 2 3 10 21

Diagnosis

Clinical Evaluation: Comprehensive assessment including history, physical examination, and symptomatology. 1 2 21

Imaging Studies: CT, MRI, PET scans for tumor localization and staging. 1 2 15

Biopsy and Cytology: Histopathological confirmation via biopsy or fine needle aspiration cytology. 18 27 30

Molecular Testing: Utilization of PCR, in situ hybridization, and proteomic technologies for precise diagnosis and classification. 7 28 22

Laboratory Tests: Blood tests for tumor markers, vitamin D levels, and calcitonin in specific cases. 8 36

Management

Primary Treatments: Surgery, radiation therapy, and chemotherapy tailored to tumor type and stage. 1 2 15 21

Targeted Therapy: Use of angiogenesis inhibitors (AGIs) and immune checkpoint inhibitors (ICIs) based on tumor characteristics. 2

Immunotherapy: Natural killer cell therapy and other immunotherapies for specific indications. 3

Supportive Care: Management of complications such as hemorrhagic risks, renal impairment, and cardiovascular issues. 1 2 15

Palliative Care: Integration of palliative care to manage symptoms and improve quality of life. 29 35

Special Populations

Pediatrics: Tailored approaches including pediatric oncology protocols and psychological support. 11 31

Elderly: Consideration of comorbidities and frailty in treatment planning. 21

Comorbidities: Management of concurrent conditions like cardiovascular disease and renal impairment. 1 15 21

Key Recommendations

Integrate Onconephrology Consultation for patients with pre-existing or therapy-induced renal impairment to optimize management. (Evidence: Moderate) 1

Assess and Manage Hemorrhagic Risks in patients receiving combination therapy with AGIs and ICIs due to increased bleeding complications. (Evidence: Moderate) 2

Consider Vitamin D Status in pediatric solid tumor patients as it may influence long-term prognosis. (Evidence: Moderate) 8

Utilize Molecular Diagnostics for accurate diagnosis and personalized treatment planning in solid tumors. (Evidence: Strong) 7 28

Implement Palliative Care Early in the course of malignant disease to enhance symptom management and quality of life. (Evidence: Moderate) 29 35

References

1 Campus A, Vischini G, Vetrano D, Di Nunzio M, Croci Chiocchini AL, Stalteri L et al.. Renal Complications in Solid Tumor Patients Referred to an Onconephrology Clinic: A Three-Year Italian Experience. Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 2025. link 2 Yang Y, Long P, Tuo Y, Wang X. Assessing hemorrhagic risks in combination therapy: implications of angiogenesis inhibitors and immune checkpoint inhibitors. Frontiers in immunology 2025. link 3 Park H, Kim G, Kim N, Ha S, Yim H. Efficacy and safety of natural killer cell therapy in patients with solid tumors: a systematic review and meta-analysis. Frontiers in immunology 2024. link 4 Gowkielewicz M, Lipka A, Zdanowski W, Waśniewski T, Majewska M, Carlberg C. Anti-Müllerian hormone: biology and role in endocrinology and cancers. Frontiers in endocrinology 2024. link 5 Culp WTN. Veterinary Interventional Oncology. The Veterinary clinics of North America. Small animal practice 2024. link 6 Ridley A, Vial-Cholley E, Robert G, Jounis-Jahan F, Lervat C, Betremieux P et al.. Nationwide Study of Continuous Deep Sedation Practices Among Pediatric Palliative Care Teams. Journal of pain and symptom management 2023. link 7 Turner SA, Abou Shaar R, Yang Z. The basics of commonly used molecular techniques for diagnosis, and application of molecular testing in cytology. Diagnostic cytopathology 2023. link 8 Kárász N, Juhász O, Imrei M, Garami M. Long-Term Prognosis in Relation to Vitamin D Status in Pediatric Solid Tumor Patients. Nutrients 2023. link 9 Bartley AN, Mills AM, Konnick E, Overman M, Ventura CB, Souter L et al.. Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: Guideline From the College of American Pathologists in Collaboration With the Association for Molecular Pathology and Fight Colorectal Cancer. Archives of pathology & laboratory medicine 2022. link 10 Wong Y, Meehan MT, Burrows SR, Doolan DL, Miles JJ. Estimating the global burden of Epstein-Barr virus-related cancers. Journal of cancer research and clinical oncology 2022. link 11 Driedger MR, Puig CA, Thiels CA, Bergquist JR, Ubl DS, Habermann EB et al.. Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients. BMC surgery 2020. link 12 Adamová Z, Adam Z. Psychological aspects in surgical oncology. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti 2019. link 13 Saito T, Tomitaka E, Toya R, Oya N. Possible Dose-Response Relationship in Palliative Radiotherapy for Non-bone Painful Lesions. Clinical oncology (Royal College of Radiologists (Great Britain)) 2019. link 14 Underwood JC. More than meets the eye: the changing face of histopathology. Histopathology 2017. link 15 Sueta D, Tabata N, Akasaka T, Yamashita T, Ikemoto T, Hokimoto S. The dawn of a new era in onco-cardiology: The Kumamoto Classification. International journal of cardiology 2016. link 16 Izdebska M, Natorska-Chomicka D, Jagiełło-Wójtowicz E. Preliminary studies evaluating cytotoxic effect of combined treatment with methotrexate and simvastatin on green monkey kidney cells. Acta poloniae pharmaceutica 2014. link 17 Hubert E, Schulte N, Belle S, Gerhardt A, Merx K, Hofmann WK et al.. Cancer patients and advance directives: a survey of patients in a hematology and oncology outpatient clinic. Onkologie 2013. link 18 Malami SA, Iliyasu Y. Fine needle aspiration cytology in Nigeria. Acta cytologica 2008. link 19 DeWitt CA, Siroy AE, Stone SP. Acneiform eruptions associated with epidermal growth factor receptor-targeted chemotherapy. Journal of the American Academy of Dermatology 2007. link 20 Krueger G, Canellos G. Where does hematology end and oncology begin? Questions of professional boundaries and medical authority. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2006. link 21 Paydaş S, Balal M, Paydaş S, Oto O, Gonlusen G. Glomerular disease in patients with malignant disease: four cases and review of literature. Renal failure 2005. link 22 Angeletti C. Application of proteomic technologies to cytologic specimens. A review. Acta cytologica 2003. link 23 Comin CE, Franchi A, Pasquinelli G. Electron Microscopy What Izzits revisited: an Ultrapath X quiz. Ultrastructural pathology 2001. link 24 Strohl RA. Cutaneous manifestations of malignant disease. Dermatology nursing 1998. link 25 Boaz TL, Lewin JS, Chung YC, Duerk JL, Clampitt ME, Haaga JR. MR monitoring of MR-guided radiofrequency thermal ablation of normal liver in an animal model. Journal of magnetic resonance imaging : JMRI 1998. link 26 Nguyen D, Diamond LW, Cherubino P, Koala WB, Imbert M, Andreeff M. A diagnostic workstation for neoplastic bone marrow diseases: evaluation on 526 cases. Medinfo. MEDINFO 1995. link 27 Olsson S, Busch C. A national telepathology trial in Sweden feasibility and assessment. Archives d'anatomie et de cytologie pathologiques 1995. link 28 Pan LX, Diss TC, Isaacson PG. The polymerase chain reaction in histopathology. Histopathology 1995. link 29 Ellershaw JE, Peat SJ, Boys LC. Assessing the effectiveness of a hospital palliative care team. Palliative medicine 1995. link 30 Denijn M, Schuurman HJ, Jacobse KC, De Weger RA. In situ hybridization: a valuable tool in diagnostic pathology. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica 1992. link 31 James JA, Harris DJ, Mott MG, Oakhill A. Paediatric oncology information pack for general practitioners. British medical journal (Clinical research ed.) 1988. link 32 Mori S, Itoyama S, Mohri N, Shibuya A, Hirose T, Takanashi R et al.. Cellular characteristics of neoplastic angioendotheliosis. An immunohistological marker study of 6 cases. Virchows Archiv. A, Pathological anatomy and histopathology 1985. link 33 Kitagawa M, Matsubara O, Song SY, Kurashima C, Okeda R, Kasuga T. Neoplastic angioendotheliosis. Immunohistochemical and electron microscopic findings in three cases. Cancer 1985. link56:5<1134::aid-cncr2820560530>3.0.co;2-j) 34 Walker CR. Surgical immunology: a historical review of its role in the armamentarium of the surgical oncologist. Journal of the National Medical Association 1979. link 35 Zimmerman JM. Experience with a hospice-care program for the terminally ill. Annals of surgery 1979. link 36 Mulder H, Hackeng WH. Ectopic secretion of calcitonin. Acta medica Scandinavica 1978. link 37 Thomas JH, Panoussopoulos D, Jewell WR. The metastatic potential of metastases: a case report. Journal of surgical oncology 1976. link 38 Godfrey TE. Mithramycin for hypercalcemia of malignant disease. California medicine 1971. link 39 Kronman BS, Wepsic HT, Churchill WH, Zbar B, Borsos T, Rapp HJ. 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Malignant neoplastic disease