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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A biopsy of normal-looking mucosa showed mucosal abnormalities in 48.9% of patients with transitional cell carcinoma of the bladder. The presence of dysplasia or carcinoma in situ was significantly associated with grade but not with tumour category. In 100 patients who completed a course of radical megavoltage X-ray therapy, the result of mucosal biopsy gave no significant prognostic information about tumour regression, durable local control, survival or the risk of subsequent metastases.
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PMID:Do normal mucosal biopsies predict prognosis in patients with transitional cell carcinoma of bladder treated by radical radiotherapy? 356 86

The subject of management of patients after endoscopic removal of cancerous adenomas is controversial. A retrospective review of 126 lesions in 121 patients who had had colonoscopic polypectomy of malignant lesions between 1971 and 1985 was used to determine the criteria for colon resection. Invasive cancer was identified in 80 patients, while 41 patients had carcinoma in situ. A synchronous colon cancer was found in five of the 121 patients. The patients who had carcinoma in situ had no evidence of residual tumor or metastatic disease on subsequent follow-up (colon resection in three patients and endoscopic surveillance in 38 patients). Of the 80 patients with invasive cancer, 44 had subsequent colon resection, and 34 of these had no evidence of tumor in the resected bowel or mesenteric lymph nodes. Ten patients had residual tumor, metastatic cancer to regional lymph nodes, or both. Each of the 10 had at least one of the following indications of inadequate resection or dissemination of disease to local lymph nodes (the first indication is a macroscopic evaluation, while the remaining four are all microscopic): incomplete excision, poorly differentiated tumor, invasion of the line of resection, invasion of the polyp stalk, and invasion of venous or lymphatic channels. Present recommendations for patient management after endoscopic removal of an invasive malignant adenoma should include colon resection with regional lymphadenectomy for patients with one or more of these five criteria. Patients without any of these risk factors should have early repeat endoscopic examination 3 months after initial polypectomy to evaluate the polypectomy site. Total colonoscopic examination is repeated at 1 year to ensure the surveillance program is begun with a colon without neoplasms.
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PMID:Patient management after endoscopic removal of the cancerous colon adenoma. 359 9

The International Staging System for Lung Cancer provides for classification of six levels of disease extent in five stage groups that relate to patient management and prognosis. Stage 0 is reserved for patients with carcinoma in situ. The Stage I and II definitions provide for classification of two levels of disease extent completely contained within the lung that have different prognostic and therapeutic implications. Definitive resection is the first choice of therapy for patients with non-small cell lung cancer in these stage groups. The Stage II category takes into account the erosion of survival expectations in the optimum group of T1 and T2 patients as a consequence of intrapulmonary lymph node involvement. Although small cell carcinoma is infrequently encountered as Stage I and Stage II disease, these classifications may be useful in the structure of investigational programs involving adjuvant surgery. The exclusion of distant metastases and the division of Stage III into two levels of extrapulmonary disease allow for selection of patients for specific treatment plans. Patients with non-small cell tumors with Stage IIIa disease usually are candidates for definitive surgical treatment. The specificity of the T and N definitions in the Stage IIIa and IIIb categories identifies patients for whom particular radiotherapy treatment plans are structured and protocol assignments are made. It is consistent with patient management concepts that all those with distant metastases are classified as having Stage IV disease. Implications of the system for selection of surgical, radiotherapeutic, and chemotherapeutic regimens are rational for all cell types. The classification meets the requirement for simplicity and can be readily applied in a broad spectrum of clinical and teaching environments. It is, however, sufficiently specific to be useful for reporting results of investigational therapies. Prospective use of the classification should encourage precision in clinical evaluations that exploit full use of refinements in imaging technologies. The cooperative efforts of the Task Force on Lung of the AJCC and the TNM Committees of the UICC to bring this classification system to fruition and international acceptance have been described. It has been adopted by these groups and others, including the International Association for the Study of Lung Cancer, the Japanese Cancer Committee, and the Spanish Society of Respiratory Disease, as their official recommendation for staging lung cancer.
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PMID:The new International Staging System for Lung Cancer. 362 29

We treated 52 patients with carcinoma in situ by transurethral resection, thiotepa and other intravesical chemotherapeutic agents. All patients underwent standard initial and subsequent evaluative procedures and the average followup was 62 months. Half of the patients had a history of stage Ta and/or T1 transitional cell carcinoma. The remainder had carcinoma in situ when first diagnosed (10 had carcinoma in situ only). Of 12 patients treated by transurethral resection alone 1 reached 60 months without radical cystectomy or disease progression. There were 18 patients who had a complete response following chemotherapy, 11 had a partial response (positive cytology) and 11 failed (persistent carcinoma in situ). Patients with a history of transitional cell carcinoma had a statistically significantly greater probability of achieving a complete response. Despite other types of treatments only 2 of 22 patients (partial response and failure) achieved a lasting complete response. Persistent partial response and failure resulted in progressive transitional cell carcinoma (stage T2 or greater, prostatic involvement and metastases) and only 1 of these survived for more than 5 years without cystectomy. None of our patients received bacillus Calmette-Guerin because it was not available during the time most of the patients were treated. While the lives and bladders in some patients may be spared by its use, failure to achieve a complete response indicates impending disaster and cystectomy should be considered seriously.
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PMID:The outcome of conservative treatment of carcinoma in situ of the bladder. 365 29

Sixty-four cases of stage I vulvar squamous cell carcinoma were analyzed histologically to define a patient subset at minimum risk for recurrence or nodal metastases. Three patterns of invasion were predefined: carcinoma in situ with early stromal invasion (33%), pushing (8%), and infiltrative (59%). Infiltrative pattern and invasion deeper than 1.5 mm equally predicted nodal metastases (P = .045), although depth measurement in biopsy specimens was subject to sampling error. Confluence and absence of carcinoma in situ each predicted extranodal recurrence (P = .011). Local recurrence appeared more related to inadequate surgical margins than failure to perform radical vulvectomy. Carcinoma in situ with early stromal invasion represents a group at zero risk for nodal metastases. We recommend wide local excision for all stage I lesions. In general, omission of lymphadenectomy should be reserved for cases of carcinoma in situ with early stromal invasion.
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PMID:Histologic prognosticators in stage I squamous cell carcinoma of the vulva. 365 90

Intra-arterial infusion chemotherapy with adriamycin (ADM) was carried out in 32 patients with bladder cancer prior to total cystectomy. An oblique incision approximately 12 cm long was made in the gluteal region to expose either the superior or inferior gluteal artery, into which a Teflon catheter was inserted and fixed. The distal end of the catheter was taken out from under the skin in the precordial region. Via this catheter, a single dose of 10 mg ADM was injected twice a week. Superior-gluteal-artery infusion chemotherapy was performed in 7 patients; the 5-year survival rate was 14.3%, which was not as high as expected. Inferior-gluteal-artery infusion chemotherapy was performed in 25 patients. Cisplatin (CDDP) was used with ADM in 8 patients. Radiation and/or hyperthermia were used in 11 patients. The 5-year survival rate in these 25 patients was 58.4%, which was considered to be satisfactory. Of these 25 patients, 5 were stage-T4 cases; for these, the treatment was ineffective, and all 5 died within 2 years. Of the 6 patients at stage T2, 1 died, as did 1 patient with carcinoma in situ (CIS). Of the 13 patients with bladder cancer at stage T3, 3 died; lymph-node metastases were found in all 3 of these cases. Of the 25 patients who received inferior-gluteal-artery infusion chemotherapy, 9 died of cancer; all 9 died within 2 years due to distant metastases. There was no evidence of recurrence in any patient who survived for 2 years or more after total cystectomy. Therefore, inferior-gluteal-artery infusion chemotherapy may be effective as a preoperative adjuvant therapy with no serious side effects.
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PMID:Intra-arterial chemotherapy for bladder cancer. 366 45

A total of 85 cases treated by intravesical administration of adriamycin (ADM) at Okayama University and other cooperating institutions were examined. Instillation of 50 mg adriamycin dissolved in 30 ml physiological saline was performed in two courses of 3 consecutive days, with a 4-day interval between the courses. The response rate was 70.6%. Following instillation therapy transurethral resection (TUR) was carried out in 69 cases (80%), segmental cystectomy in 7, and total cystectomy in 3. The follow-up period averaged 42 months, during which the recurrence rate was 57%; recurrence occurred within 18 months in 80% of these cases. Since the recurrence per patient-month x 100 was 3.348, the precise effect of intravesical chemotherapy in the prevention of recurrence was unclear. There were 9 cases of advanced disease (11% of the total, 18% of cases with recurrence). One patient with CIS (flat invasive tumor) seemingly achieved CR, but died 43 months after treatment due to metastatic disease. While this method is not always indicated in cases of CIS (flat invasive tumor), in cases in which it is indicated a drug causing only limited stimulation of the bladder mucosa should be used and long-term follow-up is essential.
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PMID:Intravesical chemotherapy. 366 46

Between May 1979 and July 1983, 217 consecutive patients with documented primary bladder tumors invading muscle were evaluated to determine the fate of patients with conservatively treated muscle-infiltrating bladder cancer. The disease was re-staged by urine cytology, bimanual examination with the patient under anesthesia and transurethral biopsy or resection. Of the 217 patients 172 underwent total or partial cystectomy and 45 (21 per cent, 37 with stage T2, 7 with stage T3a and 1 with stage T4 disease) did not because re-staging showed no residual tumor (stage T0) in 20, carcinoma in situ in 17, stage T1 tumor in 4 and local stage T2 cancer in 4. The median followup was 5.1 years (range 3 to 7 years). Of the 45 patients 30 (65 per cent) are free of tumor or have required transurethral resection and intravesical therapy for recurrent tumors but cystectomy has not been necessary. Of the 15 failures 11 underwent cystectomy 9 to 30 months after re-staging (7 are alive and 4 died of disease) and 4 are alive with metastatic disease (2 with negative bladder biopsies). Re-staging in the 4 patients who died showed stage T0 disease in 2, carcinoma in situ in 1 and stage T2 tumor in 1. The over-all survival rate was 82 per cent (37 of 45) and it was 67 per cent (30 of 45) for patients with a functioning bladder. The data suggest that endoscopic re-staging may identify a subset of patients with limited muscle-infiltrating bladder tumors that can be managed conservatively without immediate cystectomy.
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PMID:Conservative management of muscle-infiltrating bladder cancer: prospective experience. 366 60

In 1982, a total of 250 breasts were removed for cancer in the surgical departments of the Oslo City Health Department, comprising 81% of all new breast cancers reported in Oslo in 1982. Invasive ductal carcinoma (68%) and invasive lobular carcinoma (12.4%) were the predominant types. Special attention was given to the presence of occult in situ or invasive carcinomas more than 1 cm from the periphery of the main carcinoma. In 24.8% of the specimens, carcinoma in situ was found in such locations, and an additional 6.9% showed a second, occult invasive carcinoma. Carcinoma in situ was equally common in invasive ductal and invasive lobular carcinoma. Occult invasive carcinoma was predominantly found in specimens with invasive lobular carcinoma. There was a significantly increased number of lymph node metastases in patients with carcinoma in situ or second, occult primary carcinoma more than 1 cm from the periphery of the main carcinoma.
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PMID:On the occurrence of focal, occult in situ and invasive carcinoma in 250 mastectomy specimens. 370 15

A variety of diagnostic techniques has enhanced our ability to detect and accurately stage urothelial carcinoma. Urine cytology is a sensitive method for detecting occult high-stage tumors in both the upper and lower tracts. Rigid ureteroscopy has extended direct visualization from the bladder (with cystoscopy) to the renal pelvis. The evaluation of metastatic disease has been improved by CT and MRI. However, caution must be applied in interpreting bladder masses demonstrated by these studies after transurethral resections. The mainstay of local therapy continues to be transurethral resection. This established technique has been aided by intravesical chemotherapy and immunotherapy. Intravesical instillation of chemotherapeutic drugs or BCG may help preserve some bladders that would otherwise be sacrificed. The appropriate role of laser therapy as a primary form of treatment remains to be defined. Photodynamic therapy appears to be a powerful new treatment modality for carcinoma in situ. However, photodynamic therapy should still be considered a clinical experiment at this time. Patients with more advanced local disease will require either cystectomy or definitive radiation therapy. The survival results with primary surgical therapy appear to be slightly better than radiation therapy, particularly when younger individuals are being treated. Persons with metastatic disease are best treated with chemotherapy. Combination cisplatin-based regimens appear to be particularly promising and offer a high incidence of objective remissions with good duration of response. Although the five-year survival of patients with bladder carcinoma has steadily improved, there is still room for additional progress. The basis for any such improvement rests in accurate diagnosis and treatment and careful surveillance for recurrent disease.
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PMID:Diagnosis and treatment of bladder carcinoma. 374 97


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