Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007097 (carcinoma)
 152,788 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our experience with 40 patients receiving complete androgen blockade with luteinizing hormone-releasing hormone agonist and flutamide, prior to radical surgery, has shown a definitive decrease in prostate volume of 40-50%. This significant reduction in volume, induced by the neoadjuvant therapy, seems to facilitate the dissection of the prostate from closely vulnerable structures, with a reduction in blood loss (average 400 ml) and in time of surgery (average 135 min). Clinical downstaging was observed in one third of the patients, but the final pathological staging clearly showed that it is difficult to confirm this issue. Downgrading was not observed, but this is difficult to assess since the biopsies are not representative of the entire heterogeneous tumor. Prostate-specific antigen (PSA) dropped to undetectable levels in 59% of the patients 3 months after hormone suppression. Among these, 80% had pT2 and only 13% had pT3 tumors while there was 1 pT0 patient. Patients who still had a PSA of > 4 ng/ml after neoadjuvant therapy all had stage PT3-PT4 disease. Histological changes were observed in both the non-neoplastic tissue and the prostatic carcinoma, with effects being more marked in the latter. PSA, after 3 months of neoadjuvant hormone treatment, might have a useful predictive value in patient selection for radical surgery, since 86% of patients with undetectable PSA had tumors confined to the gland (pT2-B2). Large, prospective, randomized studies, comparing radical prostatectomy against radical prostatectomy with neoadjuvant complete androgen deprivation in locally advanced (T2-T3N0M0) prostatic carcinoma, are needed to assess the true influence of the combined approach on local control, time to progression and overall survival.
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PMID:Neoadjuvant hormonal deprivation before radical prostatectomy. 750 31

In a prospective study, 288 consecutive patients without evidence for prostatic carcinoma at digital rectal examination (DRE) and scheduled for prostatectomy because of benign prostatic hyperplasia (BPH) were examined by transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) measurement prior to surgery. 46 patients were found to have a carcinoma at histological examination of the surgical specimens. 14 carcinomas were detected preoperatively by TRUS and biopsy (10 pT1, 3 pT2, 1 pT3) of 32 patients with suspicious, i.e., hypoechoic, lesions at TRUS. Among the remaining 256 patients with normal findings at TRUS, another 32 carcinomas were found at histological examination of the surgical specimen. Of the 14 carcinomas detected by TRUS, 13 were found within a group of 57 patients with PSA levels > 7 ng/ml corresponding to a cancer detection rate of 22.8% in this group. In 231 patients with PSA < 7 ng/ml, the use of TRUS was successful in detecting only 1 carcinoma (cancer detection rate 0.4%). These results suggest that the use of TRUS is dispensible in 80% of palpably normal patients without affecting the cancer detection rate.
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PMID:Is transrectal ultrasonography needed to rule out prostatic cancer with normal findings at digital rectal examination and normal serum prostate-specific antigen? 750 47

The general term "carcinoma of the gastric cardia" includes three different types of adenocarcinomas. Carcinoma of the distal oesophagus (Type I), true carcinoma of the cardia (Type II) and subcardial gastric carcinoma (Type III). The preoperative classification of these carcinomas of the gastro-oesophageal junction is primarily based on radiologic and endoscopic examination. The most accurate method for preoperative staging is endosonography; if this shows that complete tumour resection is not possible, preoperative chemotherapy for downstaging of the tumour is suggested. As the serosal cover on the back wall of the cardia and the gastric fundus is lacking, the Union Internationale Contre le Cancer (UICC) pT2 classification includes wall penetrating tumours which would be equivalent to pT3 in other parts of the stomach. For prognostic reasons these advanced carcinomas should be classified as pT2b in contradistinction to tumours limited to the muscularis propria (pT2a). The results of surgical resection of 445 carcinomas of the gastric cardia are presented (Type I 38%, Type II 28%, Type III 34%). The overall 30-day and 90-day mortality rates were 4.9% and 10.4%, respectively. Long term survival after resection of carcinoma of the gastric cardia was mainly associated with complete tumour removal, limited wall penetration and absence of lymph node metastases. Patients with Type I cancers showed a tendency for a better outcome compared to Type II and III because of a higher percentage of early cancers and a higher rate of complete tumour resection.
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PMID:Carcinoma of the gastric cardia. 757 79

Presentation of clinico-pathological correlation in a series of patients with bladder carcinoma. All of them had a complete pathological and clinical staging following TNM guidelines (UICC 1987). Clinical evaluation consisted of a clinical examination, urography and/or ultrasound, cystoscopy, bimanual palpation under anaesthesia and biopsy. As an option, pelvic CAT, MRI and a bone scan were performed. In all cases a reliable pathological staging was obtained, either from cystectomy or complete TUR. Overall, there is a 66% clinico-pathological correlation (60% for Ta category, 78% for T1, 25% for T2, 57% for T3, and 74% for T4). There is a global error of 34% (40% of cases clinically considered Ta were invasive, 16% T1 were pT2 or more, 42% T2 were pT3 or more, and 10% T3 were pT4; while 6% of those considered T1 were pTa, 33% of T2 were pTa or pT1, 33% of T3 were pT2 or less, and 26% of T4 were pT3 or less). We therefore conclude that when T is lower the risk of being clinically understaged is greater, while higher T values increase the risk of clinical overstaging. From a practical point of view, the most severe errors are in the understaging of T2 and T3 (pT3-pT4) tumours and the overstaging of T2 (pT1) tumours. When cystectomy is performed, the risk of understaging is greater for tumours interpreted as T2-T3 while the risk of overstaging T4 tumours is lower. We conclude that, even when adequate staging of bladder cancer is attempted, pre-treatment tumour classification using the diagnostic methods currently available is far from satisfactory.
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PMID:[Staging error in bladder carcinoma: anatomo-clinical correlation]. 771 56

Between June, 1987 and December, 1993, ten patients with solitary kidney after total nephroureterectomy for advanced upper urothelial transitional cell carcinoma were treated with chemotherapy (M-VAC or modified M-VAC). This series comprised 6 males and 4 females between 27 and 81 years of age (mean age: 58.5 years). The site of primary lesions was the renal pelvis in one case, ureter in 5 and renal pelvis and ureter in 4. Histologically, these extripated tumors were all identified as transitional cell carcinoma, the stage being pT3 and pT4 in 9 and grade being G3 in 8 of the 10 patients. Among the 13 cases including the 3 cases of recurrence after first line chemotherapy, 7 had lesions suitable for the evaluation. Two of the 7 cases achieved complete response and four achieved partial response, resulting in an 86% response rate. Of the 10 patients, 4 died of metastasis of carcinoma and the others are still alive. The average period after operation among 10 patients was 25 months. Side effects related to this chemotherapy were as follows: general fatigue, nausea or vomiting and alopecia 100%, leucocytepenia (< or = 1,000/mm3) 23%, anemia (RBC < or = 250 x 10(4)/mm3) 62%, thrombocytopenia (< or = 5 x 10(4)/mm3) 46%. However, nephrotoxicity in spite of solitary kidney was not noticed in any patients. From our experience, we suggest that M-VAC or modified M-VAC chemotherapy are safe against patients with a solitary kidney after nephroureterectomy for advanced transitional cell carcinoma of the upper urinary tract.
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PMID:[Clinical studies of chemotherapy for patients with a solitary kidney after nephroureterectomy for advanced upper urothelial transitional cell carcinoma]. 774 Oct 70

Cathepsin D is a widely expressed aspartyl lysosomal protease. Clinical studies in several tumor types have shown a strong correlation between cathepsin D expression and tumor progression. In breast carcinoma, its expression is an independent prognostic factor associated with an increased risk of death. However, there have been no studies evaluating cathepsin D in bladder tumors. Therefore, the aim of this study was to determine the pattern of expression of cathepsin D in a large series of bladder carcinomas and assess its role as a prognostic factor against established variables. The tumors from 105 patients (median age 73) (median follow-up 26 months) with transitional cell carcinoma of bladder were examined. Forty-nine patients had superficial tumors (16 pTa; 33 pT1), 56 had invasive tumors (14 pT2; 42 pT3); there were 35 grade 1/2 tumors and 70 grade 3 tumors. These were stained by a standard immunohistochemical technique with an anti-cathepsin D monoclonal antibody. All 4 normal bladder specimens were positive for cathepsin D. Fifty-four tumors (51%) were positive for cathepsin D and 51 (49%) were negative. Chi square analysis showed a significant positive relationship between negative cathepsin D expression and stage (p < 0.0005), grade (p < 0.0001) and tumor morphology (p = 0.001). There was no relationship between cathepsin D expression and tumor ploidy (p > 0.1) or patient age (p = 0.09). Univariate analysis of disease-free and overall survival showed that negative cathepsin D expression (p = 0.01 and p = 0.0003 respectively), stage (p = 0.004 and p < 0.005 respectively) and grade (p = 0.02 and p = 0.0007 respectively) were associated with significantly worse prognosis. However, in a multivariate analysis of age, stage, grade and cathepsin D expression, only stage remained significant for overall survival (p < 0.005). The observed result for cathepsin D in the univariate analysis is probably due to its strong association with grade and stage. Nevertheless, cathepsin D status was able to provide additional prognostic information for overall survival in invasive tumors when stratifying for grade (p = 0.047), which suggests that it might provide additional prognostic data within particular tumor stages.
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PMID:An immunohistochemical and prognostic evaluation of cathepsin D expression in 105 bladder carcinomas. 777 37

To evaluate significant postoperative prognostic factors for esophageal carcinoma, clinicopathological findings and several markers for biological malignant potential were studied, including cell nuclear DNA contents, EGF receptor, p53 protein, MMP-2, Ki-67 positive cell rate, and tumors infiltrating Leu 7 cells. The subjects of this study were 96 patients with thoracic esophageal carcinoma, who underwent radical surgery with extended lymphadenectomy. In the pathological findings, the postoperative survival rate significantly correlated with depth of invasion (pT1(-2) vs. pT3, p = 0.003), lymph node involvement (pNo vs. pN1, p = 0.0002), vascular invasion (-vs. +, p = 0.0003), stage (pSt. 1-2A vs. 3, p = 0.0018), and the number of node involvements (1-3 vs. more than 4, p = 0.025). Analyzing the markers for the malignancy, a significant difference in postoperative mortality due to the relapse was recognized with p value of 0.0009 between Ki-67 positive (under 1%) and Ki-67 negative (over 1%) tumor. Ki-67 positive tumor significantly correlated with the mortality in both cases with pNo (p = 0.024) and pN1 (p = 0.020). Low-grade tumor infiltrating Leu 7 cells significantly correlated with the mortality (Grade 1+ vs. 2+, p = 0.013; Grade 1+ vs. 3+, p = 0.008). These results suggest that Ki-67 study is a useful prognostic factor after radical surgery for thoracic esophageal carcinoma.
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PMID:[Postoperative prognostic factors for carcinoma of the thoracic esophagus]. 788 53

In a retrospective review of 242 cystectomy specimens performed for bladder carcinoma, ureteral carcinoma in situ was found in 14 patients (5.7%), unilateral in 12 and bilateral in 2. Pathology of the bladder specimen was pT4 (6 cases), pT3 (3 cases), pT2 (1 case), pT1 (3 cases), and pT0 (1 case). In the cystectomy specimen and in previous biopsies, they all had grade 3 tumor, and 85% had bladder CIS. Two patients were lost during follow-up. Seven patients (58.4%) died of metastatic disease without evidence of upper tract recurrence (UTR). Their average survival was 15.8 months (range 4-60). Five patients (41.6%) are alive after an average follow-up of 33.6 months (range 18-72 months). In one case an UTR appeared 53 months after cystectomy. In patients with ureteral CIS and long-term survival, a careful follow-up is advisable. The incidence of UTR is increased in this subgroup (8% global and 20% of survivors) but mortality is due to progressive bladder disease.
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PMID:Significance of ureteral carcinoma in situ in specimens of cystectomy. 805 23

Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5-year survival rate was 44.8%. The 5-year survival rate of patients with curative resection (R0 and R1) was 49.5%, whereas patients with palliative resection (R2) did not survive more than 3 years. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node-positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Esophageal squamous cell carcinoma: pathology and prognosis. 858 2

A 24-year-old male Egyptian complained of cramp-like upper abdominal discomfort and weight loss (3 kg) over 4 weeks. Physical examination merely gave evidence of the weight loss and of a slightly prominent gas-filled abdomen, mild diffuse abdominal tenderness and considerable borborygmus. Radiology of the intestines revealed chronic subileus of the small intestine caused by stenosis of the ileocaecal valve, which was impassable by coloscope. Biopsy suggested schistosomiasis of the ileocaecal valve. Examination of the resected ileocaecum showed a typical signet-ring carcinoma of the ileocaecal valve which had infiltrated all layers but had not metastasised to the regional lymph nodes (pT3, N0, M0). Typical eggs of Schistosoma haematobium were present in the mucosa of the tumour segment and of the neighbouring tissues. It is possible that chronic intestinal schistosomiasis is a potentially precancerous condition, similar to schistosomiasis of the urinary bladder.
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PMID:[Schistosomiasis and signet ring cell carcinoma of the ileocecal valve]. 805 Mar 48


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