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Intussusception of the small or large intestine is defined by the telescoping of a segment of bowel on itself.

Breast lymphoma and mesenchymal neoplasms of the breast are rare entities. The large continuum of disease includes fibroepithelial, vascular, lipomatous, neural, myogenic, and osseous neoplasms. In this chapter, we explore these diseases in depth, in addition to diffuse large B-cell lymphoma, the most common breast lymphoma.

The practice of medicine, including health promotion and disease prevention, is on the verge of being revolutionized once again as the scientific and medical community transitions from evidence-based medicine to genomic medicine. Evidence-based medicine entails the systematic approach of formulating a question, developing literature search strategies, and evaluating and applying evidence to establish clinical practice guidelines. In 1982, when the National Research Council published the first comprehensive review of diet and cancer, the literature was primarily based on epidemiological studies, comparing dietary patterns between countries of low and high incidence for particular cancers. The American Institute for Cancer Research conducted an evidence-based review of the world literature and issued its first report in 1997, and the National Cancer Institute followed with evidence-based overviews of cancer prevention. The World Health Organization International Agency for Research on Cancer recently published a series of handbooks on cancer prevention in relation to dietary factors. The expert recommendations stemming from this extensive evidence subsequently influenced the clinical practice of medicine. In 2001, the complete sequencing of the human genome signified the beginning of the postgenomic era, in which new approaches and technologies are causing a shift in biomedical research. A widening understanding of the complex interactions among genotype, diet, lifestyle, and environment has evoked a change in clinical medical practice, where the evidence- and population-based protocol is evolving into a more personalized system that includes the analysis of individual genotype and phenotype. The implications of this evolution are considerable, because genomic medicine has the potential to give rise to personalized nutrition recommendations and specialized medical treatment.

The genomic era of human nutrition is upon us: the human genome and several plant genomes have been characterized, and genetically modified foods are now abundantly available in the marketplace. The link between diet and cancer is well established, and new genomic technologies have made possible the investigation of nutritional modulation of the carcinogenesis pathway with nutrients, micronutrients, and phytochemicals. Current study of nutrient-modulated carcinogenesis involves exploring the effect of nutrients on DNA damage and repair mechanisms; DNA methylation, which influences gene expression and cellular phenotypes; antioxidant rearranging and oxidative stress; target receptors and signal transduction pathways; cell cycle controls and check points; apoptosis; and antiangiogenic processes. With nutritional genomics, proteomics, and metabolomics, scientists are able to simultaneously elucidate the biological effects of dietary constituents on cell function and global gene expression. This generation of new knowledge on nutrient-gene interactions provides the justification for a research framework for diet and cancer prevention that is focused on identifying and developing new biomarkers as well as a novel and contemporary paradigm for dietary intervention.

61 Background: Patients with cancer often have complex symptoms and morbidity that prompt frequent Emergency Department visits. The length of stay in the ED for cancer patients exceeds that of patients without cancer. Patients with cancer are also more likely to be admitted, but are often discharged within 72h. Protracted ED visits, extensive investigations, and the burdens of even a short admission may be distressing and may not be aligned with patients’ care goals and preferences. Furthermore, the healthcare resources dedicated to these patients is considerable and has economic implications. We recently established a Supportive Care Infusion Center (SCIC), an on-campus outpatient unit where patients can receive treatments for symptom relief and comfort; they are assured integrated palliative care with routine oncologic care. We believe there is a subset of cancer patients who can be safely transferred from the ED to the SCIC for appropriate care. Methods: We are retrospectively evaluating cancer patients admitted through the ED to validate clinical parameters likely to lead to admission, and also identify any differences between patients admitted for 72h. Patients are analyzed based on symptoms, cancer type, prior cancer therapies, performance status, comorbidities, and presence/absence of advance care planning as well as previous contact with Palliative Care. Data are also being gathered on patient outcomes, including mortality within 60d of admission. Results: Previously established indicators predictive of admission included shortness of breath and SIRS criteria, which our current review validates. We also observe that patients admitted for >72h have greater symptom burden and comorbidities and have received multiple lines of therapy. They also less frequently have advance care planning in place. Data analysis is ongoing. Conclusions: There exists a difference between cancer patients admitted >72h and those discharged within 72h. Awareness of these characteristics may lead to improved workflow in the ED. Identifying patients who may be suitable for transfer to an outpatient supportive care unit rather than short-term admission will also facilitate cost-effectiveness. Future direction includes evaluation of outcomes such as mortality, quality of life, and patient-caregiver satisfaction.