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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary hepatocellular carcinoma (HCC) is a common malignancy with a dismal prognosis; new modalities of treatment as alternatives to surgery have been developed for unresectable patients. The authors obtain baseline data for the natural history of HCC so that the efficacy of new treatments may be evaluated. A retrospective study of 157 untreated patients with tissue-proven or serodiagnosed HCC was conducted. Clinical characteristics including laboratory investigation, treatment received, survival from the time of diagnosis, and prognostic factors were evaluated. There were 129 men and 28 women (ratio, 4.6:1). Median age was 50.9 years (range, 14.1-85.3 years). The most common symptoms and signs were weight loss (68.2%), abdominal fullness (62.5%), abdominal pain (51.6%), hepatomegaly (73.7%), ascites (45.2%), and jaundice (40.6%). Eighteen percent had extrahepatic metastases of which the lungs were the most common site. Seventy percent were hepatitis B virus related. Overall median survival was 8.7 weeks after the time of diagnosis. Survivals by stages were: TNM II, 16.6 weeks; TNM III, 7.3 weeks; TNM IVA, 9.7 weeks; TNM IVB, 7.6 weeks; Okuda II, 10.7 weeks; and Okuda III, 7.3 weeks. Multivariate analysis revealed serum total bilirubin and albumin as independent prognostic factors of survival. Common causes of death were upper gastrointestinal hemorrhage (34.1%), cancer-related causes (cachexia, HCC rupture, metastatic disease, 31.8%), and hepatic failure (25.0%). Patients with HCC were diagnosed at late stages of their disease and the advanced nature of the tumor precluded effective therapy. Earlier tumor detection at a time when patients are better candidates for treatment may be aided by an active surveillance program of high risk groups.
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PMID:Natural history of untreated primary hepatocellular carcinoma: a retrospective study of 157 patients. 970 39

Between January 1983 and August 1998, a total of 18 patients (14 men, 4 women; median age 58 years, range 36-75 years) with primary adenocarcinoma of the duodenum underwent surgical therapy. Main clinical symptoms were upper abdominal pain (61%), weight loss (44%) and anaemia (38%). The tumors were resectable in 10 patients (56%), and eight Whipple operations and two segmental duodenectomies were performed. Tumor classification according to the TNM system was pT2 (n = 2), pT3 (n = 6) and pT4 (n = 2). In eight patients, local lymph nodes were tumor positive (pN1), and in two patients synchronous liver metastases were excised. The UICC stage of the resected tumors was: stage I (n = 1), stage II (n = 1), stage III (n = 6) and stage IV (n = 2). In irresectable cases (n = 8), the patients underwent palliative (n = 6) or explorative (n = 2) operations. With no operative mortality, overall morbidity was 22% (4/18). Patients' survival was 90%, 66.7% and 53.3%, respectively, at 1, 3 and 5 years after resection. None of the patients with irresectable tumors survived longer than 25 months. Survival was significantly better for the resection group (P = 0.0027). Due to the often unspecific symptoms, the diagnosis of duodenal adenocarcinoma is frequently established at advanced tumor stages, resulting in a low resectability rate. Radical surgical resection of the tumors, however, is able to provide a more favorable prognosis for duodenal carcinoma than for other periampullary tumors.
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PMID:[Results of surgical therapy of primary adenocarcinoma of the duodenum]. 1041 1

Primary tumors of the jejunum-ileum are rare and constitute about 2% of gastrointestinal neoplasms. The first clinically reported small bowel tumor was a jejunal carcinoma described in 1824 by Sorlin. The authors reviewed our surgical experience of 9 patients treated at the Department of General Surgery of the "E. Franchini" Hospital of Montecchio Emilia (Re) during a 13-years period from 1984 to 1997. On the basis of literature on the topic, the following are taken into consideration, the history, the incidence, the epidemiology, the aetiopathogenesis, the clinical characteristics, the diagnostic, the surgical therapy of these tumors. The subjects included 6 males and 3 females. The average age of the patients was 66 years, with a male predominance ratio of 2:1. Of the seven primary malignant tumors observed, two patients had adenocarcinomas, two had leiomyosarcomas, two had lymphomas and one carcinoid. The benign tumors were respectively leiomyomas and small intestinal stromal tumor. The most common signs and symptoms were abdominal pain and obstruction of the intestine. Preoperative diagnosis was established in 4 of these patients only by roentgenographic examinations, in 2 by ultrasound scan, in 2 by ultrasound scan and computed tomography, in 1 by endoscopic examination. All the 9 tumors were resected: in 7 patients (77.7%) the resection were considered as curative and in 2 patients (22.3%) palliative. All operated patients were staged by the TNM-classification using pathological and surgical reports. The staging of the disease was the following: 2 patients with stage 1 (T2N0M0), 2 patients with stage II (T4N0M0), 3 patients with stage III (1 with T3N1M0 and 2 with T4N1M0), 2 patients with stage IV (T4N1M1). Survival correlated with the different TNM stage: the median survival time was 60 months for stage I, 60.5 months for stage II, 40 months for stage III and 18 months for stage IV.
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PMID:[Primary neoplasms of the jejunum-ileum. The clinico-diagnostic and surgical therapy considerations: the clinical cases and a retrospective study of our experience]. 1050 68

Eighteen patients with confirmed pancreatic carcinoma without endoscopic evidence of mechanical gastroduodenal obstruction were included in the study. Aim was to determine changes in gastric myoelectric activity and liquid emptying (LGE) induced by pancreatic tumor growth. According TNM/UICC classification patients were divided in two groups A (T2) and B (T3) due to extend of expansion. Dyspeptic symptoms were observed in 4 patients of group A and 8 in group B. In group A dysrhythmic patterns of gastric myoelectric activity mostly bradygastria type were observed in 5 of patients and 8 in group B. LGE were delayed in 2 in group A and 5 in group B respectively. Disordered gastric myoelectric activity and emptying correlated with tumor stage and location. Delayed gastric emptying may be attributed to gastric dysrhythmia and abdominal pain that occur during the course of disease due to splamchnic plex infiltration.
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PMID:[Gastric motility disturbances in pancreatic cancer patients]. 1090 76

Since the first description of the carcinoma of the gallbladder, about two centuries ago, this disease has evaded all attempts at early detection and a potential cure. There are only a few studies involving the Indian population, which has a high incidence of gallbladder cancer. Indians are ethnically and culturally different from their Western counterparts, for whom the incidence of this disease is comparatively low. The present study was conducted prospectively on 99 consecutive cases of carcinoma of the gallbladder of 736 patients with biliary diseases admitted to one surgical unit at the University Hospital. The staging, histological type, and grade were correlated with the clinical outcome. Abdominal pain (82.8%) and abdominal mass (73.7%) were the main presenting features. The diagnosis was obtained by ultrasonography (USG) in 93 of 99 cases and confirmed by fine-needle aspiration cytology (FNAC) in 70 patients. Ultrasonography, however, was found to be inadequate for accurate staging of the disease. Based on the TNM classification, 3 (3.0%), 12 (12.1%), 14 (14.1%), 12 (12.1%), and 58 (58.6%) patients had stage 0, I, II, III, and IV disease, with a corresponding mean survival of 28.3, 13.8, 7.5, 5.2, and 3.7 months, respectively. Carcinoma of the gallbladder is difficult to diagnose early due to its vague symptomatology. A high index of suspicion and health education seem to be the only answers available for early detection and improvement of survival.
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PMID:Carcinoma of the gallbladder: a retrospective review of 99 cases. 1141 85

Anemia is common in cancer patients and is associated with reduced survival. Recent studies document that treatment of anemia with blood transfusion in cancer patients is associated with increased infection risk, tumor recurrence, and mortality. We therefore investigated the incidence of preoperative anemia in colorectal cancer and assessed risk factors for anemia. Prospective data were collected on 311 patients diagnosed with colorectal cancer over a 6-year period from 1994 through 1999. Patients were stratified by age, gender, presenting complaint, preoperative hematocrit, American Joint Committee on Cancer (AJCC) stage, and TNM classification. Discrete variables were compared using Pearson's Chi-square analysis. Continuous variables were compared using Student's t test. Differences were considered significant when P < 0.05. The mean age of the study cohort was 67 +/- 9.2 with 98 per cent of the study population being male. The mean AJCC stage was 2.2 +/- 1.2 and the mean preoperative hematocrit was 35 +/- 7.9 with an incidence of 46.1 per cent. The most common presenting complaints were hematochezia (n = 59), anemia (n = 51), heme-occult-positive stool (n = 33), bowel obstruction (n = 26), abdominal pain (n = 21), and palpable mass (n = 13). Preoperative anemia was most common in patients with right colon cancer with an incidence of 57.6 per cent followed by left colon cancer (42.2%) and rectal cancer (29.8%). Patients with right colon cancer had significantly lower preoperative hematocrits compared with left colon cancer (33 +/- 8.5 vs 36 +/- 7.4; P < 0.01) and rectal cancer (33 +/- 8.5 vs 38 +/- 6.0; P < 0.0001). Patients with right colon cancer also had significantly increased stage at presentation compared with left colon cancer (2.3 +/- 1.3 vs 2.1 +/- 1.2; P < 0.02). Age was not a significant risk factor for preoperative anemia in colorectal cancer. We conclude that there is a high incidence of anemia in patients with colon cancer. Patients with right colon cancer had significantly lower preoperative hematocrits and higher stage of cancer at diagnosis. Complete colon evaluation with colonoscopy is warranted in patients with anemia to improve earlier diagnosis of right colon cancer. A clinical trial of preoperative treatment of anemic colorectal cancer patients with recombinant human erythropoietin is warranted.
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PMID:Preoperative anemia in colon cancer: assessment of risk factors. 1207 43

Patients with colorectal cancer continue to present with relatively advanced tumors. Delay in diagnosis is often believed to have been a contributing factor, and the validity of this hypothesis has seldom been questioned. The aim of this study was to establish whether a delay in diagnosis is related to long-term survival and if the most frequent symptoms were related to the stage or time at which the carcinoma was diagnosed. Data from 660 patients surgically treated for uncomplicated colorectal carcinoma in our institution between 1985 and 2000 were analyzed retrospectively. Age, sex, initial symptoms, duration of symptoms, neoplasm location, curative surgery, TNM stage, and survival time were the variables recorded. Patients were classified into two groups according to symptom duration: < 3 months versus >/= 3 months. Comparative statistical analysis was performed for the two groups as well as the initial symptom, TNM stage, and survival time. Also, the initial symptoms most frequently reported were compared with the TNM stage. The two groups were found to be equal with regard to distribution of age, gender, location of the neoplasm, type of surgery performed, and TNM stage. We found that symptom duration was shortened in the presence of abdominal pain ( p = 0.002) [odds ratio (OR) 0.53; 95% confidence interval (CI) 0.35-0.80] and was delayed in the presence of an anemic syndrome ( p = 0.006) (OR 2.4; 95% CI 1.27-4.56). Also, the stage of the neoplasm was related to rectal bleeding ( p < 0.001) and abdominal pain ( p = 0.008). The log-rank test indicated that duration of symptoms was not related to long-term survival ( p = 0.90). We concluded that the duration of colorectal cancer symptoms is not related to the stage or prognosis of tumors.
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PMID:Can early diagnosis of symptomatic colorectal cancer improve the prognosis? 1538 71

Mixed germ cell tumours of the ovary are rare malignant neoplasms containing combinations of two or more types of germ cell elements. The aim of the study was to review biopsy examinations, medical records, treatment strategy, follow-up and outcome of all girls treated for mixed germ cell tumour of the ovary at the Department of Pediatric Oncology, University Hospital Motol during the period 1979-2002. Archival slides of all tumours were reviewed and tumours were classified according to the WHO system. The clinical data on surgical treatment, chemotherapy and radiotherapy used and follow-up information were obtained in all girls. The staging was reviewed retrospectively on the basis of surgical and pathological findings and results of imaging investigations, and it was outlined according to the most recent FIGO criteria and TNM classification. Sixteen girls with mixed germ cell tumour of the ovary, age range 3 years 11 months to 17 years 8 months (median 12 years) were treated. All girls presented with unilateral tumour of the ovary and all underwent surgery as an initial treatment. The most common presenting symptom was abdominal pain, occurring in ten patients. The original diagnosis of mixed histology was confirmed in all cases; in five cases the tumour contained three histologic components, in eleven cases the tumour consisted of two germ cell types. All tumours contained elements of yolk sac tumour, followed by immature teratoma, embryonal carcinoma, dysgerminoma and mature teratoma. At the time of diagnosis three patients had stage I disease, four patients stage II, seven stage III and two stage IV disease. All patients were treated with chemotherapy after surgery, predominantly with platinum-based regimens (PVB, BEP). Three patients treated initially with MAC (metothrexate, dactinomycin, cyclophosphamide) were diagnosed in the early eighties. In seven girls with advanced disease treated in the early years, radiotherapy was administered to the pelvis or whole abdomen. Overall survival and event-free survival were 80% and 81.3% respectively (median follow-up time 7.6 years). Three patients have died from the disease, two progressed on treatment (MAC), one girl relapsed three months after finishing therapy, no further therapy was administered. One girl underwent resection of tumour of her remaining ovary 24 months after original diagnosis. Histology showed mixed serous and mucinous cystadenoma. The latest examinations revealed that all other patients were in good health. Microscopic examination should be extensive and careful to find out all types of malignant germ cell elements. Platinum based chemotherapy is effective in the management of children and adolescents with mixed germ cell tumors of the ovary. Chemosensitivity of these tumours allows most girls to have conservative surgery with possible preservation of reproductive function.
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PMID:[Mixed germ cell tumours of the ovary in childhood and adolescence]. 1549 15

We previously read with interest the case report by Filik et al. (International Journal of Gastrointestinal Cancer, 2003;34:55-58) on appendicular metastases from pancreatic adenocarcinoma. We would like to share our recent experience.A 64-yr-old man presented with a 2-d history of progressively increasing colicky abdominal pain and fever. His past medical history included a pneumonectomy of the left lung for locally advanced lung adenocarcinoma 9 mo previously. TNM stage of the original lung cancer was T2N2M0. On examination, his abdomen was slightly distended and he had an intermittent metallic bowel sound. Abdominal CT scan showed a low-density mass, 3 cm in diameter, in the right pelvic cavity. Endoscopic evaluation revealed no obstruction, but failed to identify mucosal abnormalities in the ileocecal region. Chest CT scan prior to surgery did not show any evidence of pulmonary recurrence or metastasis. He underwent a laparotomy, and tumor of the appendix, 3 x 3 cm in diameter, adhered to the surrounding tissue, but no perforation was seen. The mass was excised in combination with an ileocecal resection, followed by ileocolic anastomosis. Hisotologically, the neoplastic tumor cells infiltrated the submucosa, muscularis, and serosa, but mucosa of the appendix was intact, unremarkable, with no precursor lesion. The tumor was morphologically similar to the lung primary tumor. The patient had an uneventful postoperative course. He was examined at regular periodic follow-ups, but died from lung cancer 12 mo after the resection of the metastatic tumor to the appendix.
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PMID:Metastasis to appendix from lung adenocarcinoma. 1523 36

We assessed population incidence rates 1998-2002 and 5-year survival rates of 317 primary gallbladder cancer (GBC) entered in the population-based cancer registry in Valdivia. We analyzed GBC incidence (Poisson regression) and GBC survival (Cox regression). Cases were identified by histology (69.4%), clinical work-up (21.8%), or death certificate only (8.8%). Main symptoms were abdominal pain (82.8%), jaundice (53.6%) nausea (42.6%), and weight loss (38.2%); at diagnosis, 64% had Stage TNM IV. In the period, 4% of histopathological studies from presumptively benign cholecystectomies presented GBC. GBC cases were mainly females (76.0%), urban residents (70.3%), Hispanic (83.7%) of low schooling <4 years (64.0%). GBC standardized incidence rate per 100,000 (SIR) were all 17.5 (95%CI: 15.5-19.4), women 24.3, and men 8.6 (p < 0.00001); Mapuche 25.0, Hispanic 16.2 (p = 0.09). The highest SIRs were in Mapuche (269.2) and Hispanic women (199.6) with <4 years of schooling. Lowest SIRs were among Hispanic men (19.8) and women (21.9) with >8 years of schooling. Low schooling, female and urban residence were independent risk factors. By December 31, 2007, 6 (1.9%) cases were living, 280 (88.3%) died from GBC, 32 (10.1%) were lost of follow-up. Kaplan Meier Global 5-year survival was: 10.3%, 85% at stage I and 1.9% at stage IV; median survival: 3.4 months. Independent poor prognostic factors were TNM IV, jaundice and nonincidental diagnoses. Our results suggest that women of Mapuche ancestry with low schooling (>50 years) are at the highest risk of presenting and dying from GBC and should be the target for early detection programs.
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PMID:Gallbladder cancer: incidence and survival in a high-risk area of Chile. 2047 11


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