Pituitary adenoma can be observed in up to 17% of the population but is often asymptomatic and found incidentally by magnetic resonance imaging or autopsy. Symptoms may include visual impairment, headache, or hormonal aberrations. Treatment options include surgery, medication, or stereotactic radiosurgery (SRS)/fractionated radiation therapy (RT) to relieve pressure on chiasm and correct hormonal abnormalities. The pituitary gland lies within the concave sella turcica of the sphenoid bone. Pituitary adenomas arise in the anterior lobe, which secretes follicle-stimulating hormone, luteinizing hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, prolactin, and growth hormone. Posterior lobe secretes oxytocin and antidiuretic hormone. Surgery is first-line treatment for all except prolactinoma and pituitary carcinoma. Hormone normalization appears to occur faster after SRS in some series. SRS cases usually have smaller volume tumors compared to fractionated RT cases, which may influence outcomes.

Ependymoma is an uncommon central nervous system tumor originating from glial stem cells most commonly in the fourth ventricle (children) or filum terminale (myxopapillary type, adults); 10-yr Overall Survival is ~80% in adults and ~65% in children. Most common presenting symptoms are those of increased intracranial pressure (children; headache, nausea, ataxia, vertigo, papilledema) or back pain (adults), depending on location. The treatment paradigm is maximal safe resection with attempt at gross total resection; the degree of resection classically represents the most important prognostic factor. Radiotherapy (RT) should be given postoperatively to the resection bed and any remaining disease to 59.4 Gy in 33 fractions. There is no clearly established role for chemotherapy but may be used in select cases to delay RT or attempt second-look surgery. Surgical resection is classically the most important prognostic factor.

Lung cancer is the most common noncutaneous cancer worldwide, the 2nd most common in the United States, and the leading cause of cancer mortality in the United States with an estimated 228,820 new cases and 135,720 deaths annually. This chapter describes epidemiology, risk factors, anatomy, pathology, genetics, screening, clinical presentation, prognostic factors, staging, and treatment paradigm of early-stage non-small-cell lung cancer (NSCLC). Surgical resection is the standard of care for operable early-stage NSCLC. “Active surveillance” is not an established option for NSCLC because even in medically-inoperable patients, lung cancer-specific mortality is 53%. Lung-reporting & data system is evolving standardization system for follow-up of indeterminate nodules on lung cancer screening computed tomography reporting. For highrisk operable patients, given the absence of completed randomized trials, there is controversy regarding whether surgery or stereotactic body radiotherapy is the preferred option with regard to the endpoint of overall survival.

The vast majority of cervical cancer cases are human papillomavirus -mediated. Incidence and mortality significantly declined with introduction of screening with Pap smears. Adenocarcinoma often presents with larger tumors (“barrel cervix”) with higher risk of local failure. Cervical cancers are often asymptomatic and detected on screening, or can present with abnormal vaginal discharge, post-coital bleeding, dyspareunia, or pelvic pain. Three Food and Drug Administration approved vaccines are available that prevent the development of cervical cancer. Imaging includes positron emission tomography/computed tomography (nodal staging), pelvic magnetic resonance imaging (to delineate local disease extent and guide decisions on fertility vs. non-fertility sparing approaches). Treatment at early stages is often surgical, while Radiation therapy (RT)+/− Chemotherapy (CHT) is employed in later stages. When treating definitively, External beam radiation therapy is followed by an intracavitary or interstitial brachytherapy boost. Post-operative RT +/− CHT is occasionally indicated for adverse pathologic features.

This chapter describes epidemiology, risk factors, anatomy, pathology, screening, clinical presentation, prognostic factors, staging, and treatment paradigm of anal cancer. Approximately 8,600 new diagnoses with 1,400 anal cancer-related deaths in the United States in 2020. Incidence of anal cancer is more than twice as high in females as it is in males. High-risk human papillomavirus DNA has been detected in up to 84% of specimens in large-scale anal cancer studies. Squamous cell carcinoma of the anal canal is a relatively rare but often curable cancer. Other, more rare anal cancers include adenocarcinoma (treated like rectal cancer), melanoma, neuroendocrine, carcinoid, Kaposi’s, leiomyosarcoma, and lymphoma. Other risk factors include HIV infection, history of cervical, vulvar, or vaginal cancer, immunosuppression after organ transplant, smoking, history of receptive anal intercourse. Definitive treatment with concurrent chemoradiation alone is effective treatment for anal cancer.

Meningiomas are the most common primary brain tumors in adults, representing approximately 40% of all primary brain tumors with ~30,500 cases per year in the US, 80% of which are World Health Organization grade I. Recurrent meningiomas are generally managed with re-resection followed by radiation therapy (RT) when no previous RT has been administered. Unresectable meningiomas are managed with fractionated RT or stereotactic radiosurgery, depending on grade, size and location. Similar strategies are employed in the setting of spinal meningiomas. Incidentally appreciated meningiomas may not require additional intervention. Maximal safe surgical resection provides the greatest opportunity for minimizing recurrence rates. The extent of resection is graded according to the Simpson grading system, which was the foundational study in meningioma. Gross-total resection (GTR) is generally considered definitive and patients may be followed with surveillance imaging. Adjuvant RT is generally recommended after GTR and strongly recommended after subtotal resection.

Hepatocellular carcinoma (HCC) is associated with liver disease, particularly cirrhosis and hepatitis B and C. HCC can be diagnosed clinically based on alpha fetoprotein and radiographic criteria or less commonly with biopsy. Patients on the transplant waiting list should continue to be screened to ensure they do not develop HCC while awaiting transplant. HCC can be associated with cutaneous features including dermatomyositis, pemphigus foliaceus, sign of Leser-Trelat, pityriasis rotunda, and porphyria cutanea tarda although these are not specific to HCC. Vaccination of infants reduces rates of development of hepatitis B virus infection and reduces incidence of HCC. Chemotherapy is difficult to administer in patients with HCC who often have associated poor liver function. This chapter describes epidemiology, risk factors, anatomy, pathology, clinical presentation, prognostic factors, natural history, staging, and treatment paradigm of HCC.

Neuroblastoma (NB) is a small round blue cell tumor arising from the neural crest cells of the sympathetic nervous system. Neuroblastoma is the most common malignancy in infants and the most common pediatric extracranial solid tumor. Clinical presentation includes abdominal mass, abdominal pain, fever, malaise, weight loss, micturition, dyspnea, and dysphagia. Approximately 1/3 experience fatigue, anorexia, irritability, and pallor. Bone pain frequent in patients with skeletal metastasis (most often skull/posterior orbit). Workup includes history and physical examination, labs including urinary catecholamines (VMA/HVA), computed tomography (CT)/Magnetic resonance imaging (MRI) of primary site, CT chest/abdomen/pelvis, metaiodobenzylguanidine scan, and bilateral bone marrow biopsy. Patients are stratified into risk groups based on stage, age, N-myc status, DNA ploidy, and Shimada classification. Risk group determines treatment. Radiotherapy is delivered to the primary tumor and persistent metastatic sites in high-risk patients.

Squamous cell carcinoma of oropharynx (OPX) is currently the most common head and neck cancer in the United States. Its incidence continues to rise with increasing prevalence of HPV. There are two distinct etiologies: those associated with tobacco and alcohol, which are often human papillomavirus (HPV)-negative, and those associated with HPV infection. Oropharynx consists of base of tongue, vallecula, palatine tonsil, soft palate, and posterior oropharyngeal wall. The superior border of the OPX is the soft palate and the inferior border is the hyoid/lingual surface of the epiglottis. The base of tongue is separated from the oral tongue by the circumvallate papillae. HPV-positive tumors often originate from lymphoid tissue of tonsil or base of tongue and are more likely to be poorly differentiated/nonkeratinizing and basaloid in appearance. HPV-negative tumors have no predilection for location and are often keratinizing. Most common presentation of oropharyngeal cancer is painless neck mass.

Medulloblastoma is the most common malignant pediatric central nervous system tumor, accounting for 20% of all childhood brain cancers. It typically arises in the cerebellum, most commonly in the cerebellar vermis, leading to obstruction of cerebrospinal fluid flow and hydrocephalus, with presenting symptoms related to increased intracranial pressure. Multimodality therapy is currently the standard of care, as surgery alone confers dismal prognosis. Surgery alone leads to poor outcomes with multiple studies showing an improvement with the use of radiotherapy and chemotherapy (CHT). Attempts to reduce Craniospinal irradiation (CSI) dose and its associated growth and neurocognitive toxicities have been facilitated by optimized CHT regimens. The recommended treatment paradigm is determined by patients’ risk status (average vs. high). In the average risk setting, clinicians are transitioning to CSI + involved field boost vs. historic standard of complete posterior fossa boost based on promising results from ACNS0331.