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)

A 58-year-old fish dealer presented with epigastric pain. Radiographic and endoscopic studies showed a Borrmann type I gastric carcinoma on the anterior surface of the body of the stomach near the greater curvature, and a metastatic work-up demonstrated two masses in the right lobe of the liver (segment 6 and 8). The preoperative diagnosis was gastric carcinoma with liver metastasis (stage IV). At laparotomy no tumors were found in the left lobe of the liver or the peritoneum, and subtotal gastrectomy, D2 lymph node dissection, and segment 6 and 8 partial resection was performed. Ligation of the right portal vein and intraoperative common hepatic artery chemotherapy (one shot) was performed to destroy any non-visible metastatic tumors in the right lobe of the liver. Histologically, both the gastric and the hepatic lesions were adenocarcinoma. An aneurysm of the common hepatic artery developed after another shot of chemotherapy through the celiac artery one month after the operation. The aneurysm ruptured, and a small fistula formed between the aneurysm and the duodenum. The aneurysm was successfully treated by aneurysmectomy, and the perforated duodenal wall was managed by catheter duodenostomy. The patient is alive and pursuing his previous occupation with no evidence of tumor recurrence. He has been attending the outpatient clinic for follow-up every 6 months for 17 years since the operation. Removal of the primary and metastatic lesions with portal vein ligation and intra-arterial chemotherapy is therefore effective as an active measure to prolong the survival time of gastric carcinoma patients with metastases limited to a single lobe of the liver.
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PMID:Long-term survival after treatment of gastric carcinoma with liver metastases. A case report. 1469 18

Unresectable cancer of the pancreas was treated with the combination of weekly paclitaxel and external beam irradiation in an effort to improve palliation and extend life expectancy. One hundred twenty-two patients were entered in a multicentered protocol. Thirteen patients were either ineligible, cancelled, or had delinquent data, thus providing 109 for analysis. Unresectable cancer was based on imaging studies (computed tomography or magnetic resonance imaging), all had histologic proof of adenocarcinoma, and none had evidence of metastatic disease or peritoneal seeding. Image-guided radiotherapy treatment consisted of 50.4 Gy in 28 fractions over 5.5 weeks with coplanar anterior/posterior and lateral ports. An initial dose of 45 Gy was given to fields covering the primary tumor plus the regional peripancreatic, celiac, and porta hepatis lymph nodes. A cone down field was used for the last three fractions to encompass the gross tumor volume with a 1- to 1.5-cm margin. Paclitaxel was administered weekly with irradiation in a dosage of 50 mg/m2 as a 3-hour infusion. The median age was 63 and 53% were female. The Karnofsky performance status was greater than or equal to 80 in 81%. Eighty percent were classified T3 or 4; 20% had N1 disease. The primary tumor was located in the pancreatic head in 65%. Eighty-five percent received all six cycles of paclitaxel per protocol, whereas 93% received irradiation with acceptable protocol variation. Field placement, total dose, fractionation, and overall treatment time were given per protocol in greater than or equal to 90%. Acute toxicity (worst per patient) occurred in 39% with grade III (35% of these were asymptomatic neutropenia), 5% with grade IV, and one patient died of infection during the fourth cycle of chemotherapy (grade V). The median follow-up time for alive patients is 20.6 months (range 5-30). The median survival is 11.2 months (95% CI 10.1, 12.3) with estimated 1- and 2-year survivals of 43% and 13%, respectively. External irradiation plus concurrent weekly paclitaxel is well tolerated when given with large-field radiotherapy. The median survival is better than historical results achieved with irradiation and fluoropyrimidines. These data provide the basis for a new Radiation Therapy Oncology Group trial using paclitaxel and irradiation combined with a second radiation sensitizer, gemcitabine, now under way.
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PMID:Phase II study of external irradiation and weekly paclitaxel for nonmetastatic, unresectable pancreatic cancer: RTOG-98-12. 1475 34

The patient was a 73-year-old man with unresectable advanced gastric cancer and celiac and supraclavicular lymph node metastases. Neoadjuvant chemotherapy consisting of paclitaxel (TXL) and CDDP was administered. TXL (80 mg/m2) and CDDP (25 mg/m2) was administered weekly on day 1, 8 and 15 as 1 cycle. After 4 cycles of TXL/CDDP administration, the lymph node metastases and gastric tumor had decreased almost completely in size and distal partial gastrectomy was performed. After surgery, the patient was treated with 4 courses of TXL/CDDP and has survived without recurrence to the present. TXL/CDDP is associated with few adverse events in hospital visits, and is thought to be an effective chemotherapy against advanced gastric cancer.
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PMID:[A case of advanced gastric cancer effectively treated by combined chemotherapy of paclitaxel (TXL) and CDDP]. 1511 4

A 51-year-old male patient with esophageal cancer and cervical, thoracic and celiac artery lymph node metastases was treated by combination chemotherapy of TS-1 and cisplatin. TS-1 (80 mg/m2/day) was administered for 14 days followed by 14 days rest as 1 course. Cisplatin (70 mg/m2/day) was administered in 24-hour continuous intravenous infusion at day 8 after the start of TS-1. Before treatment, the tumor marker, CEA showed 27,060 ng/ml. After 5 courses of chemotherapy, endoscopy revealed that the primary tumor had disappeared and no cancer cells were detected by endoscopic biopsy. Chest and abdominal CT scan also showed almost total disappearance of the lymph nodes metastases. CEA decreased to 710 ng/ml. No high-grade toxicities (WHO grade 3 or 4) were seen during the chemotherapy. He is now very well. This TS-1/cisplatin chemotherapy regimen might be a useful treatment for metastatic esophageal cancer.
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PMID:[A case of metastatic esophageal cancer responding remarkably to combination chemotherapy of TS-1 and cisplatin]. 1517 Sep 87

A 61-year-old female patient is described who presented with weight loss, steatorrhoea and enlargement of the pancreatic head. Surgical exploration for suspected pancreatic cancer revealed multiple peritoneal white spots, initially suggestive for peritoneal metastases or tuberculosis but finally identified as peritoneal sarcoidosis. Pancreatic insufficiency could not be proven in further studies. We found pancreas divisum as an additional cause for the pancreatic head mass, and steatorrhoea was due to late-onset oligosymptomatic coeliac disease. This case demonstrates diagnostic pitfalls when several rare disorders are manifest in a single patient. Coeliac disease and sarcoidosis might be sequels of similar immune responses to certain antigens.
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PMID:Malnutrition, steatorrhoea and pancreatic head tumour. 1520 87

Gemcitabine (GEM) is currently considered a standard drug for advanced pancreatic cancer and widely used for patients with this carcinoma. We report on 2 patients with unresectable pancreatic cancer who were able to survive for more than 2 years after GEM treatments. Case 1 was a 82-year-old woman with invasion to celiac artery and who was inoperable. During GEM administration, she had no symptoms and the tumor did not progress. However, because of the toxicities of heart failure, GEM administration was stopped after she took a total of 16,800 mg. After GEM administration was stopped, symptoms appeared and the tumor progressed. Case 2 was a 39-year-old man with obstructive jaundice with liver and lymph node metastases. He was treated with metallic stent in order to reduce cholestasis. During GEM administration, he had no symptoms and the tumor did not progress. As an adverse event, rash occurred after he took a total of 51,800 mg. GEM administration was then stopped. This patient sometimes developed cholestasis due to tumor ingrowths and sludge and was treated successful by endoscopy. GEM has shown to improve survival and show a clinically beneficial response in patients with advanced pancreatic cancer. However, toxic events can be expected to occur with long term GEM administration. We consider that management of complications such as obstructive jaundice is very important in the treatment of pancreatic cancer.
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PMID:[Two cases of advanced pancreatic cancer responding to gemcitabine with long survival of 2 years]. 1522 20

The study objective was to determine the incidence of laparoscopically detected metastasis in patients with radiographically staged locally advanced adenocarcinoma of the pancreas. Patients with locally advanced pancreatic cancer are considered candidates for novel treatment protocols. Stratification of patients into locally advanced disease versus metastatic disease is imperative to accurately evaluate treatment outcome. Between 1994 and 2000, 100 consecutive patients undergoing staging laparoscopy with radiologic evidence of unresectable locally advanced pancreatic cancer were identified from a prospective database. All patients had preoperative contrast-enhanced, thin-cut computed tomography scanning or magnetic resonance imaging and had no evidence of detectable metastatic disease. There were 53 men and 47 women, with a median age of 64 years. The disease site was the pancreatic head in 69 cases and the body or tail in 31. Radiographic assessment of nonresectability was due to encasement of the celiac or hepatic artery in 37 patients, of the portal vein and superior mesenteric vessels in 56, and extrapancreatic extension in 7. Laparoscopy identified metastatic disease in 37% of patients, not seen on preoperative imaging. Peritoneal disease was noted in 12 cases and liver metastasis in 18 cases, and 7 patients had both. Neither the primary tumor size nor location influenced the incidence of metastatic disease. Standard imaging modalities failed to detect metastatic disease in 37% of patients who were considered to have locally advanced pancreatic cancer. Patients considered for treatment protocols for locally unresectable pancreatic cancer should be staged laparoscopically before initiation of therapy.
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PMID:Is there a role for staging laparoscopy in patients with locally advanced, unresectable pancreatic adenocarcinoma? 1558 95

The lymph node metastases of esophageal cancer occur over a wide area. It is essential for radical surgery of such metastases to aim at en bloc dissection. Otherwise, it can easily become a combination of blunt esophagectomy and lymph node sampling through a right thoracotomy. In the intrathoracic procedure, all the nodes to be dissected can be harvested while attached to the esophagus together with the surrounding connective tissue, except for the pretracheal nodes in front of the cardiac branches of the right vagus nerve and the subaortic arch nodes. It is important to dissect the left paratracheal nodes en bloc, preserving the left recurrent laryngeal nerve. In the abdomen, nodes around the celiac axis and nodes on the common hepatic artery and proximal part of the splenic artery are all removed en bloc with the perigastric nodes in the left gastric arterial basin. The cervical paratracheal and paraesophageal nodes are removed separately from the resected esophagus, but the continuity of dissection can be ensured when the dissection from the neck meets the empty space made by the dissection along the bilateral recurrent laryngeal nerves through the thoracotomy. We believe that such en bloc dissection is the key to improving the long-term results of esophageal cancer surgery.
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PMID:[Operative technique aiming at en bloc dissection in esophageal surgery]. 1585 37

We describe our experience with a patient who had undifferentiated gastric carcinoma with extensive lymph node metastasis, including para-aortic lymph-node metastasis, and had a complete response to induction therapy with methotrexate plus 5-fluorouracil (sequential therapy with MTX, 5-FU, and Leucovorin) and secondary treatment with oral TS-1. The patient was a 71-year-old woman with a massive gastric tumor (signet ring cell carcinoma), occupying most of the stomach. A computed tomographic (CT) scan revealed para-aortic, celiac, and common hepatic lymph-node metastases. Stage IV disease was diagnosed. Palliative total gastrectomy was performed to control bleeding and to improve oral intake of food. Two courses of induction therapy with MTX, 5-FU, and Leucovorin were started 3 weeks after surgery. A CT scan revealed residual lymph node metastasis. The response was assessed to be no change, but the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 improved from 7,028 ng/ml and 726 U/ml 3 weeks after surgery to 2,832 ng/ml and 281 U/ml, respectively. Secondary treatment with oral TS-1 was begun, and a CT scan showed distinct shrinkage of lymph-node metastases. There was no serious toxicity. The levels of CEA and CA19-9 decreased markedly to 2.9 ng/ml and 16 U/ml, respectively, about 6 months after surgery and remained at 3.7 ng/ml and 16 U/ml, respectively, about 1 year after surgery.
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PMID:[Stage IV gastric cancer patient who underwent palliative gastrectomy showing complete response to induction therapy with methotrexate plus 5-fluorouracil and secondary treatment with oral TS-1]. 1612 21

Advanced disease, defined as vascular invasion or invasion into adjacent organs, in pancreatic ductal adenocarcinoma still remains a major diagnostic and therapeutic challenge. In most cases, only exploratory laparotomy will ultimately ensure surgical resectibility. A physician is ill-advised to make any decision regarding palliation relying on CT-scan, MRI, ultrasonography or angiography, since vascular invasion is difficult to diagnose because of peritumoral pancreatitis mimicking vascular invasion. Only in the case of complete vascular encasement of the mesenterico-portal axis or celiac trunk is a laparotomy unnecessary. If a T3 lesion is present, the patient will benefit greatly from R0 surgical resection, even if this includes en bloc resections of the transverse colon, or the portal vein, which can be reconstructed without vascular grafting in most cases. In the presence of distant metastases only palliative treatment is useful. If liver metastases are identified pre-operatively, palliation should include endoscopic common bile duct stenting in the presence of icterus, or endoscopic duodenal stenting in the case of percutaneous endoscopic gastrostomy. If metastases are found during exploratory laparotomy, surgical palliation should be considered (bilio-digestive anastomosis or gastro-enterostomy), since these procedures do not lead to a significantly longer hospital stay and are not associated with significant morbidity or mortality. Pain control can be ensured using morphine analogs, CT-guided sympathectomy or thoracoscopic sympathectomy. Currently, there is no answer as to which option offers the best pain control and quality of life. There is also an ongoing debate on the palliative Whipple's procedure, even in the event of single liver metastases, since this procedure is associated with limited mortality (well below 5% in high-volume centers) and ensures excellent pain control. This needs an individual assessment of risk and, furthermore, a detailed discussion with the patient. There are no studies in which resection has been performed as a standard procedure for palliation. This question should be answered in a multicenter randomized trial, otherwise the palliative Whipple's operation should still be considered experimental, since it is not likely to significantly prolong survival.
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PMID:Surgery for advanced and metastatic pancreatic cancer--current state and perspectives. 1673 38


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