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Query: UMLS:C0024623 (gastric cancer)
 36,219 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastric and pancreatic carcinomas are important worldwide health problems, typically diagnosed late in the disease process when symptoms of pain and weight loss signify the presence of locally advanced or metastatic tumor. During the past decade, new regimens of combination chemotherapy have, in general, produced increased response rates for patients with advanced gastric cancer, with evidence of improved survival in several controlled trials. For patients with locally advanced gastric cancer, combined-modality therapy has resulted in long-term survival for approximately 15% of cases. The role of adjuvant therapy is now being defined in several randomized control trials of doxorubicin-based chemotherapy regimens. The position of combination chemotherapy for advanced pancreatic carcinoma is less well defined, but present data favor a regimen of streptozotocin, mitomycin-C, and 5-fluorouracil. Combined-modality therapy has resulted in modest improvements in disease-free survival for patients with locally advanced and resected tumors. The search for more effective drugs for gastrointestinal cancer represents the highest priority in the development of treatment strategies for this important group of tumors.
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PMID:The role of chemotherapy in the management of gastric and pancreatic carcinomas. 393 82

In the period from 1971 to 1980 we studied 11 650 patients undergoing endoscopy of the stomach. We found in 427 patients a gastric cancer. In 63 patients we found an early cancer, according to 14% of all gastric cancers. The main symptoms were pain and loss of appetite. In 34% of the patients the duration of complaints was more than 1/2 year. In more than 50% the early cancer was located in the distal part of stomach. In 52% we observed the ulcerative lesion of the gastric mucosa. The histological findings were in 52% the intestinal type and in 72% the diffuse type of early gastric cancer. The precise diagnosis of an early cancer based on the histological examination of the gastric wall after gastric resection, with the exception of loopectomy and polypectomy with well-defined diagnosis of an early cancer. By the aid of preventive examination of patients with so-called precancerous condition of the gastric mucosa we see a possibility to increase the detection of early gastric cancer.
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PMID:[Early stomach cancer in our clinical sample]. 408 86

Twenty-three patients with bone metastasis from gastric cancer which was resected during the ten years from 1970 through 1979 were investigated. The incidence was 1.2 per cent (23/1,945) and was higher in the younger patients. The main symptom was local bone pain. Change on the X-ray appeared a few months after complaints of pain. Consequently, the confirmation was delayed in most cases. All of the laboratory findings were not specific to bone metastasis. Referring to findings at the primary surgery for gastric cancer, this form of metastasis occurred in cases of a high involvement of regional lymph nodes and of a scirrhous type. The results of histological examination showed a high degree of lymphatic permeation in the submucosal layer. Poorly differentiated adenocarcinoma was readily identified. The lumbar and thoracic vertebra were the areas of frequent metastases. The metastasis occurred within two years after the gastric surgery, in most cases. Chemotherapy was ineffective and radiotherapy was effective for palliation of the bone pain. Prognosis was very poor and all but one patient died within a few months after confirmation of the metastasis.
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PMID:Bone metastasis of gastric cancer. 663 89

Dyspepsia is a common problem in ambulatory care. While many authorities recommend ordering upper gastrointestinal x-ray series (UGI) before therapy, there is evidence that clinicians frequently treat dyspepsia without diagnostic procedures. Decision analysis was performed to select optimal management based on probabilities and outcome values from the published literature. The choices evaluated were Symptomatic Therapy (low dose antacids or anticholinergics), Ulcer Therapy (high dose antacids or cimetidine), or UGI followed by further tests or therapy. Our model indicates that mortality is minimized if UGI is performed prior to selection of therapy, and if endoscopy is performed when the x ray shows gastric ulcer. Weeks of pain are minimized if Ulcer Therapy is begun immediately, but direct health care costs are minimized by beginning with Symptomatic Therapy. The marginal cost per additional life saved by performing a UGI rather than beginning with Ulcer Therapy was +1.6 million to +2.3 million, depending on whether endoscopy followed the finding of gastric ulcer. Mortality advantages of the strategies beginning with UGI were sensitive to assumptions regarding the incidence of gastric cancer and the benefits of early diagnosis. With slight reductions in these base case values, the Ulcer Therapy strategy appeared to minimize all outcomes except dollar cost.
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PMID:Diagnosis and treatment of dyspepsia. A cost-effectiveness analysis. 682 Jun 78

A 54-yr-old man was admitted to Hokkaido University Hospital, complaining of fever, multiple arthralgia, edematous erythema and face and muscular weakness of extremities during the last 2 months. He was diagnosed as dermatomyositis by acceleration of ESR, elevation of GOT, GPT, CPK, aldolase, moderate increases of collagen fibers in biopsy specimen of skin and his clinical signs. Although stools were positive for occult blood, the routine radiographic examination failed to detect the bleeding site in the upper GI. tract. However, in the double contrast picture of the stomach, a very fine abnormal linear shadow was observed at the upper corpus of the lesser curvature. This linear shadow was a margin of the tumor, retrospectively. About 4 months later, abnormal pain occurred and a mass was palpable in the left lumbar region, suggesting a pancreatic tumor. He was operated on excising the tumor, but was performed only exploratory laparotomy because of the presence of intra-abdominal metastases. Death occurred 40 days after the operation and necropsy was done. The gross anatomical findings of the abdomen showed a stomach tumor as large as an infant's head and its metastases to pancreas, lymph nodes, and greater and lesser omentum. Esophageal mucosa including esophagocardiac junction was intact. Histological examination of the intragastric tumor revealed a typical squamous cell carcinoma with keratinization. According to the absence of the components of adenocarcinoma and squamous metaplastic gastric mucosa of non-cancerous areas in the stomach, it seemed likely to be a heterotopic squamous cell carcinoma. It was unknown about the precedence between the stomach cancer and dermatomyositis. There have been 11 cases of primary pure squamous cell carcinoma in the world literature since 1968, but this is the first case report of coexistence of these two diseases.
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PMID:[A case report of a primary pure squamous cell carcinoma of the stomach associated with dermatomyositis (author's transl)]. 726 22

During a 6 year period, 38 patients with gastric cancer presented with synchronous liver metastases and 25 underwent gastric resection. Forty per cent of the operated patients presented with complications, whereas most of the non-operated patients presented with pain or an abdominal mass. Eight patients (32%) developed postoperative morbidity, five of whom died (20%). The median duration of hospital stay for those surviving surgery was 33 days. In the non-operated group 61% died while in hospital and the median duration of hospital stay was 28 days. The respective median survival time and duration of home stay were 13 and 9 weeks for the operated patients and 6 and 3 weeks for the non-operated patients. The difference of the duration of home stay between the two groups of patients was statistically insignificant. There was also no significant relief of pain after surgery. Univariate analyses of the influence on survival time of operation among 13 other factors showed that only bilirubin was significant. We conclude that gastrectomy neither prolongs life nor improves the quality of survival in patients with gastric cancer and discontiguous liver metastases. However, gastrectomy may be beneficial in selected patients presenting with potentially lethal complications such as bleeding and obstruction.
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PMID:Gastric carcinoma with synchronous liver metastases: palliative gastrectomy or not? 748 11

A phase III randomised study, comparing treatment with fluorouracil, epidoxorubicin and methotrexate (FEMTX) with the best supportive care, was conducted in patients with unresectable or metastatic gastric cancer. During the period from July 1986 to June 1992, 41 patients were randomised to receive FEMTX or best supportive care. MTX was given in a dose of 1500 mg m-2 intravenously (i.v.) followed after 1 h by 5-FU 1500 mg m-2 i.v. on day 1; leucovorin rescue was started after 24 h (30 mg orally every 6 h for 48 h) and epidoxorubicin 60 mg m-2 i.v. was administered on day 15. In addition both groups received tablets containing vitamins A and E. Response rates for FEMTX were as follows: complete response (CR), 19% (4/21); partial response (PR), 10% (2/21); no change (NC), 33% (7/21); and progressive disease (PD), 24% (5/21). Response rates in the control group were: NC, 20% (4/20); and PD, 80% (16/20). Increased pain was observed in one patient in the treated group and in 11 patients in the control group within the first 2 months. WHO grade III/IV toxicity in the chemotherapy group was as follows: nausea/vomiting 40%, diarrhoea 10%, stomatitis 15%, leucopenia 50% and thrombocytopenia 10%. One possible treatment-related death was due to sepsis. The median time to progression in the FEMTX group was 5.4 months [95% confidence interval (CI) 3.1-11.7 months], but only 1.7 months in the control group (95% CI 1.2-2.7 months) (P = 0.0013). Similarly, the FEMTX group displayed significantly (P = 0.0006) prolonged survival compared with the control group, i.e. median survival 12.3 months (95% CI 7.1-15.6 months) vs 3.1 months (95% CI 1.6-4.6 months). In conclusion, FEMTX combined with vitamin A and E is a fairly well-tolerated treatment, giving a response rate of 29% in patients with advanced gastric cancer, and also prolonging patients' survival. It can be used as a reference treatment in testing new investigational combinations.
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PMID:Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. 753 17

Pain management at home for a terminal gastric cancer patient unable to take medications orally was made possible by a combination of serial morphine drip infusion and epidural anesthesia with morphine on a continuing basis using a disposal syringe. Before the patient was discharged, a conference was held to prepare for home care. Besides the patient and family, it was attended by the primary care doctor, ward nurse, home nurse, pharmacy staff, pain clinic doctor and hospital office personnel. The patient was duly informed of the disease by name and, thanks to fine cooperation from the medical staff, had achieved a good understanding, and spent his remaining time meaningfully. Morphine dosages upon discharge were 80 mg/day by drip infusion and 90 mg/day epidurally. For times of increased pain, the patient was instructed in how to self-administer 0.5% Mepivacaine (5 ml/time) with a syringe using an epidural catheter equipped with a 3-way stopcock. When this proved insufficient to control the pain, the patient was instructed to come for outpatient treatment on an emergency basis. With one visit per week to the hospital and home visits by a nurse once or twice a week, the patient managed at home for 82 days before increased pain resulted in rehospitalization. After the pain was brought under control and the patient was discharged, he was again hospitalized 5 days later. The pain control up until the time of death was by drip infusion of up to 1,200 mg/day morphine.
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PMID:[Home terminal care for terminal gastric cancer patients--case of epidural morphine injection]. 780 56

The factors related to admission of patients with terminal cancer who had been referred to a reputable home care service were examined in 415 patients referred in a two-year period and in a prospective study of a randomized one in three sample of the 232 adults still alive one week after referral, who were able to converse and be at home with caring relatives. The reasons given by staff for intermediate admissions were mostly to improve symptom control or provide respite; for final admissions the reasons were symptom control, patients' deteriorated state and relatives needing relief. Independent weekly assessments usually concurred in showing increasing problems or distress preceding final admission, particularly patients' weakness, pain, depression and anxiety, and relatives' fatigue, anxiety or depression. Examination of selected demographic and illness factors indicated that few patients living alone or with unfit relatives stayed at home; breast cancer led to more deaths as an inpatient, whereas stomach cancer favoured deaths at home. The proportion of patients admitted steadily increased as care lengthened. Assessments of psychological factors showed that initial attitudes of denial, conscious fighting of disease, and optimism were linked with increased late admissions; earlier awareness of dying in patients and stoicism in relatives favoured home deaths. A growing preference for inpatient care usually preceded or accompanied admission. Recognition of both immediate and underlying causes of admission can indicate where further treatment or assistance is needed and also improve understanding so that patients and relatives may be suitably supported or helped to adjust.
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PMID:Which patients with terminal cancer are admitted from home care? 795 70

The authors report a rare case of acute cervical epidural hematoma caused by the hemorrhage from extradural arterio-venous malformation. The patient was a 74-year-old Japanese man with a past history of total gastrectomy after being diagnosed as having gastric cancer 12 years before. Six hours prior to admission, the patient had experienced a sudden episode of severe nuchal pain radiating to both scapular areas, followed by rapid development of left-side Brown-Sequard Syndrome below the C4 cord level, and urinary incontinence. Plain cervical X-ray films did not show any destructive lesion suggesting a metastatic tumor. T1 and T2 weighted images of MRI demonstrated a high intensity mass lesion, suggesting an acute epidural hematoma, extending from C3 to C6 and compressing severely the left side spinal cord posteriorly. Twelve hours after the onset of symptoms, emergency laminectomy from C3 to C6 was performed and a fresh epidural clot with small vascular tissue was totally removed. Histological examination of the small vascular tissue in the hematoma revealed arterio-venous malformation. The postoperative recovery of the patient was dramatic. He regained full muscle strength and there was complete disappearance of sensory deficits 2 weeks after the operation. Although acute spinal epidural hematoma caused by extradural arterio-venous malformation is a rare clinical entity, MRI is the most helpful diagnostic tool for this condition. It should be stressed that accurate neuroradiological diagnosis and prompt surgical decompression of the spinal cord are essential to obtain an excellent surgical outcome.
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PMID:[A case of acute cervical spinal epidural hematoma caused by extradural arterio-venous malformation]. 809 Feb 67


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