Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An alpha-feto-protein (AFP) is present in many mammals, in birds, and in sharks during development. The AFP present in different species have similar physicochemical properties and often have common antigenic determinants. Their study, both in health and disease, has provided a useful model for the understanding of other phase-specific antigens and the activation of the genes which control their synthesis. In the human fetus, the level of AFP falls with increasing maturity. The more sensitive methods of detection have disclosed that this fetal protein persists in trace amounts throughout life and its level increases in maternal blood during pregnancy. The principal sites of synthesis are the fetal liver and in some mammals, the yolk sac splanchnopleur. In humans as well as in mice and cows, it is notable that the synthesis of AFP is increased in liver cancer cells and that high levels of this protein are present in serum. Elevated values of AFP have also been detected in human subjects with undifferentiated tumours of the testis and ovary. A fall to normal levels has been noted in cases of complete remission after surgery and a return to high levels in patients who develop metastases. In some patients with hepatitis a temporary rise in the level of AFP has also been observed. In recent years, the detection of high levels of AFP in amniotic fluid has proved to be of great value for the prenatal diagnosis of neural-tube defects. Abnormal levels have also been found in the amniotic fluid or in maternal serum in cases of spontaneous abortion. Such measurements are now being assessed as a methodof monitoring abnormal pregnancy.
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PMID:Alpha-feto-protein during development and in disease. 4 25

A brief summary is given of the developments leading to the current status of treatment of gestational trophoblastic neoplasms, both nonmetastatic and metastatic. Hydatidiform mole has been identified as the precursor type of pregnancy in approximately 50% of those women developing metastatic disease. The other half developed this as consequences of either a full-term delivery or some type of abortion. Sensitive assays for human chorionic gonadotropin (HCG) are needed in the diagnosis, management, and follow-up of these patients. Current therapy is outlined: nonmetastatic disease receives single agent chemotherapy with methotrexate or actinomycin D, with approximately 100% cure and 90% retention of reproductive function; metastatic disease, "low risk", receives single agent chemotherapy with the same drugs, with an expected cure rate of 95-100%; metastatic disease, "high risk", receives initial therapy with multiple agent chemotherapy, with a cure rate of approximately 75%. Current unresolved questions are discussed briefly.
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PMID:Current status of treatment of gestational trophoblastic disease. 17 95

Three hundred and seventeen patients with gestational trophoblastic tumors were investigated and treated between 1957-1973. The risk of trophoblastic tumor was influenced by the outcome of the antecedent pregnancy (hydatidiform mole, non-mole abortion, term delivery) and the ABO blood groups of the mating couple; it was also influenced by the patient's age. The response to treatment with chemotherapy and , where appropriate, with surgery and radiotherapy, was influenced prfoundly by several factors. These included 1) the outcome of the antecedent pregnancy, 2) the total body burden of tumor at the time treatment stated as reflected by the urinary output of human chorionic gonadotrophin (CG), 3) the interval between the antecedent pregnancy and the start of chemotherapy, 4) the ABO groups of the mating couple, 5) the extent of mononuclear cell infiltration in the tumor, 6) the immunological status of the patient at the start of treatment, 7) the size of tumor masses, 8) the site of metastases and particularly the presence of intracranial metastases, and possibly by 9) the age and 10) the parity of the patient. A detailed study of the HLA antigens of the patient, her husband, and antecedent child has shown no positive effect on risk or prognosis. These data provide a basis for a scoring system that allows the prognosis to be defined at the time of diagnosis and facilitates tisk of drug resistance. Applied retrospectively to the cases from which the scoring system was generated, prognostic groups with survival rates ranging from 0-100% can be defined. Unfavorable prognostic factors combine so as to increase the probability of drug resistance.
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PMID:Risk and prognostic factors in trophoblastic neoplasia. 18 54

A case of choriocarcinoma in a 17-year-old unmarried female is presented. She attended the E.N.T. Clinic with a rapidly growing mass at the tip of the nose. Histologic report of the excised mass was reported as a secondary deposit from a choriocarcinoma. Further questioning at this stage revealed the history of an abortion two years before. Gynecological examination revealed secondary deposits in the vagina. X-rays of the chest showed evidence of metastases in the lungs. She died of profuse bleeding from the vagina.
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PMID:Choriocarcinoma of the nose. 56 10

Fifty-two cases of choriocarcinoma were recorded in the Jamaica Cancer Registry for the parishes of Kingston and St. Andrew, giving an incidence of 1:7,384 live births. This is intermediate between figures reported for Western metropolitan populations and for Far Eastern countries. Clinicopathological studies on 26 cases treated at the University Hospital in Jamaica revealed that 65% followed either normal pregnancy or abortion. Choriocarcinoma following a normal pregnancy or occurring without a previous history of pregnancy carried a poorer prognosis than those with a preceding hydatidiform mole. Many patients had primary neurological manifestations. The overall prognosis was poor due to late presentation with disseminated metastases. Of the 26 patients, 15 died of the disease within two years and only six appeared for a six-year follow-up.
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PMID:Choriocarcinoma in Jamaica. 84 72

Uterine choriocarcinoma develops fairly frequently after passage of a hydatidiform mole and very rarely after normal pregnancy or abortion. The disease is highly curable by chemotherapy, especially if detected early. Histologic examination of uterine curettings is unreliable and the principal indicator of active primary or metastatic disease is the HCG titer. The ability to visualize the tumor is helpful for a variety of reasons. In the past, this has been achieved primarily through arteriography. Our experience with 6 patients suggests that sonography is as sensitive a detector as arteriography and perhaps somewhat more specific. These facts, plus its convenience and repeatability, make ultrasound the method of choice for visualization of intrauterine malignant trophoblastic disease. Arteriography will continue to play an important role where the sonographic findings are equivocal and where local invasion or distant metastases are suspected.
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PMID:Complementary role of sonography and arteriography in management of uterine choriocarcinoma. 123 96

A case is presented of extragenital abdominal choriocarcinoma without uterine lesion in a postmenopausal woman. Nineteen years after her antecedent pregnancy, a legal abortion, and thirteen years after her menopause, the patient was admitted to the hospital because of intermittent abdominal pain. Explorative laparotomy revealed a large tumour mass in the greater omentum, mesosigmoideum, peritoneal implants and metastatic growth to the serosal lining of the uterus and the wall of the stomach. Cytoreductive surgery was performed. The histopathological report showed an extrauterine, nongonadal pure choriocarcinoma. Immunoperoxidase stain was strongly positive for hCG and a raised serum beta-hCG level preoperatively confirmed the diagnosis. A polychemotherapy regimen was administered. However, after six months the beta-hCG levels increased rapidly. Liver, lung and mediastinal metastases were diagnosed. The patient's condition rapidly deteriorated and she expired one month later. The post mortem examination showed a far advanced extragonadal pure choriocarcinoma without any obvious primary origin. The implications for a possible origin of extragonadal nongestational choriocarcinoma are briefly discussed.
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PMID:Postmenopausal extragenital choriocarcinoma. A case report and review of the literature. 191 65

Forty-seven patients were treated for primary operable carcinoma of the breast and had subsequent pregnancies. Their ages varied from 22-45 years, the median age being 35 years. Each patient with negative nodes received only a radical mastectomy, and each patient who had metastases to the lymph nodes in addition received a course of radiation therapy. None of the patients received chemotherapy. Of the 30 patients who did not have metastases to the lymph nodes, 23 survived a 10-year period (77%). Of the 16 patients who manifested metastases to the lymph nodes, nine survived a 10-year period (56%). No detrimental effect of subsequent pregnancy could be demonstrated even among patients with positive axillary nodes. It is generally agreed that most metastases show up within a 3-year period before incurring a pregnancy. In this series there was no differences between those who delayed. Abortion could not be demonstrated to improve the survival rate; in fact, patients who had abortions did worse than those who did not. We conclude, accordingly, that pregnancy need not be avoided or terminated among those patients who are apparently free of recurrences or residual cancer after undergoing treatment for carcinoma of the breast. The decision to become pregnant and the medical conduct of the pregnant female are best determined by the stage of the cancer and how the malignant potential affects prognosis. Careful consultation should be sought with all support personnel, which should include the husband, spiritual leader, psychologist, etc., to discuss the potential for the patient's surviving and supporting the child.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The prognosis of patients who become pregnant after mastectomy for breast cancer. 260 23

Seventy-three patients with metastatic high-risk gestational trophoblastic disease were treated with methotrexate, actinomycin D, and cyclophosphamide chemotherapy at the Brewer Trophoblastic Disease Center between 1968 and 1982. Forty-six patients were treated primarily with methotrexate, actinomycin D, and cyclophosphamide because of the presence of one or more high-risk factors. Twenty-seven additional patients who had not responded to initial single-agent chemotherapy with methotrexate and/or actinomycin D were subsequently treated with methotrexate, actinomycin D, and cyclophosphamide. Adjuvant surgery and radiotherapy were used in selected patients. The overall cure rate was 51% (37 of 73): 63% (29 of 46) for primary treatment and 30% (eight of 27) for secondary treatment (P less than .01). Several factors that influenced response to primary treatment with methotrexate, actinomycin D, and cyclophosphamide chemotherapy were determined: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (59 versus 100%), 2) metastases to sites other than the lung and/or vagina (44 versus 74%), 3) antecedent term gestation compared with hydatidiform mole or abortion (50 versus 75%), and 4) presence of three or more high-risk factors (27 versus 74%). There were no significant differences in cure rates during the course of the study period.
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PMID:Treatment of high-risk gestational trophoblastic disease with methotrexate, actinomycin D, and cyclophosphamide chemotherapy. 298 66

Metastatic choriocarcinoma can present in bizarre fashions. Two cases with primary neurological presentations are reviewed. Cerebral metastases in choriocarcinoma generally denote a poor prognosis. However, in solitary metastases in the brain, craniotomy and excision followed by chemotherapy may be curative as illustrated by the following two cases. The first patient was diagnosed to have brain metastases 1 1/2 years after an evacuation of her molar pregnancy while the other patient developed cerebral choriocarcinoma 5 months following a spontaneous first trimester abortion. Both presented with neurological symptoms. Both patients are alive and well now, 9 and 5 years respectively after craniotomy and chemotherapy. A brief review of current considerations in the management of cerebral metastases in gestational trophoblastic disease is presented.
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PMID:Metastatic cerebral choriocarcinoma with primary neurological presentation. 334 55


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