Preface

The surgeon is in a unique position with respect to the assessment and management of cancer patients. Often we are the consultants who initially evaluate the patient for the presence and extent of malignancies. It is incumbent on the surgeon to carefully and completely diagnose the malignancy and determine the operative options and the extent of disease. The information obtained allows us to construct a treatment plan appropriate to that patient's disease. The skills that we learn in cancer diagnosis and staging are different and complimentary to the skills our colleagues in nonsurgical specialties possess in disease assessment. We are similarly in a position to evaluate the patients after surgical treatment to look for recurrent disease.

In its earliest and most curable stages, cancer is often an occult disease. Evaluation of local, regional, and distant disease may depend on imaging modalities. The clinician must be familiar with the broad range of imaging modalities that are available to accomplish these assessments. Although once we relied on radiographs as the only way to interrogate the human body, we now use light, sound, magnetism, and metabolism to probe in ways not previously available.

It is not practical, effective, or economical, however, to order every imaging test that is available. The astute clinician must determine whether or not the results of each test ordered will result in a better patient outcome with respect to good clinical care, quality of life, and sustainable expense. Every imaging modality has limitations associated with it. There are always false positives and negatives. No imaging modality exists that is 100% sensitive and specific. Real patient harm can come from the inappropriate use of such tests. Patients might be denied potentially curative therapy when overzealous imaging detects abnormalities that might be of no clinical significance. Unneeded biopsies and delays can also result.

This issue of Surgical Oncology Clinics of North America is divided into two sections. In the first part I have asked the authors to describe advances in innovative imaging modalities. In the second part I have asked experts in particular cancers to summarize appropriate imaging for those diseases. Much of the information is evidence-based. In areas in which the “right” answer is not crystal clear, I have asked the authors to tell the reader what their particular practice is and why.

The goal of this issue therefore is to aid the surgeon in appropriately choosing and using imaging to deliver appropriate and cost-effective care. Certainly newer imaging technologies will become available; the surgeon should be positioned to learn how to use these as well.