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)

Laboratory studies have suggested that rapidly alternating chemotherapy and radiation therapy might act synergistically. We undertook this study to evaluate the toxicity and effectiveness of this approach in patients with carcinoma involving the hypopharynx or esophagus. Between 1987 and 1991, we treated 47 patients (23 with carcinoma involving the hypopharynx and 24 with carcinoma involving the esophagus) by three cycles of chemotherapy (during weeks 1, 4, and 7) rapidly alternating with twice-a-day radiation therapy (during weeks 2, 5, and 8). Chemotherapy consisted of cisplatin 100 mg/m2 and 5-fluorouracil 3-4 g/m2 given over 4 days. Radiation therapy consisted of 180-200 cGy twice each day to 2000 cGy/cycle, total 6000 cGy over 7 weeks. The histology was squamous cell carcinoma in 44 patients and adenocarcinoma in 3 patients with esophagus cancer. Median follow-up is 2 years (range 1-5 years). The observed survival rate for all 47 patients was 54% at 1 year and 38% at 2 years. Acute toxicity was considerable. Twelve patients (25%) died during therapy from toxicity, without tumor progression, leaving 35 patients (18 hypopharynx, 17 esophagus) evaluable for response. Among the hypopharyngeal patients, 83% had a complete response, 11% had a partial response, and 6% had no response. Among the esophageal patients, 94% had a complete response, and 6% had a partial response. Local control was better for the esophageal patients than the hypopharyngeal patients (98% vs. 52% at 2 years, p = 0.038). The incidence of distant metastases was 25% at 2 years and not significantly different between the two groups. A high rate of local control was achieved, particularly in esophageal cancer, by delivering chemotherapy and radiation therapy in a rapidly alternating fashion. This was achieved at a considerable cost in terms of toxicity, however. Although our response rates and local control compare favorably with those of other recently published studies of combined modality therapy in esophagus or head and neck cancer, much additional work is required to reduce the toxicity and, in hypopharyngeal cancer, to further improve the local control.
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PMID:Chemotherapy rapidly alternating with twice-a-day accelerated radiation therapy in carcinomas involving the hypopharynx or esophagus: an update. 758 5

Immunostaining of the proliferating cell nuclear antigen (PCNA) provides important information about cell kinetics and is easily performed on routinely obtained formalin-fixed, paraffin-embedded materials. We report herein the results of a retrospective study on PCNA staining in esophageal cancer undertaken to determine its significance. As this study indicated that immunoreactivity was preserved in specimens fixed within 24h, only 31 specimens from surgical patients were available for this investigation. The mean PCNA index of the patients without invasion to the adventitia (35.7 +/- 17.9) was significantly lower than that of those with invasion to the adventitia or neighboring structures (49.7 +/- 14.5), while the PCNA index did not correlate with other clinicopathologic parameters such as histologic type, lymph node metastases, or prognosis. However, when an analysis of PCNA staining was combined with an analysis of argyrophilic nucleolar organizer region (AgNOR) staining, a correlation with prognosis was found. In fact, seven patients with a high PCNA index (> or = 44) and AgNOR count (> or = 6) had a significantly poorer prognosis than the remaining 22 (P = 0.0014), and six of these seven patients died within 2 years. These results indicate that this combined evaluation may be useful for the identification of patients with a poor prognosis among those undergoing surgery for esophageal squamous cell carcinoma.
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PMID:PCNA immunostaining combined with AgNOR staining in esophageal squamous cell carcinoma to identify patients with a poor prognosis. 764 Apr 65

A secondary malignancy is a common finding in carcinoid tumor patients. Several authors saw 7 to 36% of their carcinoid tumor patients developing an other malignancy. From 1965 to 1990 we treated 144 patients with a carcinoid tumor. During the follow-up time 24 (17%) developed a secondary tumor commonly sited in the gastrointestinal tract (8 colon carcinomas, 3 rectal carcinomas, 2 gastric carcinomas, 1 small bowel carcinoma, 1 esophageal cancer). The incidence is elevated 8 times in comparison to the normal population. One may speculate that a carcinoid patient possesses an increased susceptibility to all forms of malignancy. As a consequence all the carcinoid tumor patients should be thoroughly investigated and should be followed up in short terms. Central point of interest should be the gastrointestinal tract.
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PMID:[An unusual incidence of carcinoid tumors and secondary malignancies]. 766 90

The p53 tumor suppressor gene has recently been implicated in the pathogenesis of human esophageal cancer. To assess potential clinical applications for this molecular marker, 52 patients with primary esophageal adenocarcinoma were studied prospectively. p53 protein accumulation was evaluated immunohistochemically in surgically resected esophageal tissues, and correlated with clinicopathologic findings and survival. All patients underwent total esophagectomy with reconstruction, completely resecting all gross disease. Immunopositivity was seen in 28 of 52 (54%) primary adenocarcinomas, and was associated with a trend towards reduced postoperative survival (P = 0.06; log-rank). Regional lymph node metastases were found in 30 (58%) patients. Thirteen of 30 (43%) regional lymph node metastases were immunopositive, which was the most significant predictor of overall survival by univariate (P = 0.02; log-rank) and multivariate analysis (P = 0.05; Cox regression). This study further implicates p53 in esophageal tumor development and progression. The immunohistochemical finding of p53 protein in primary esophageal adenocarcinomas and regional lymph node metastases appears to be associated with reduced overall survival for this disease. If these preliminary observations are confirmed in larger prospective studies, p53 may prove to be a clinically useful molecular marker in future clinical trials of esophageal cancer.
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PMID:Prognostic value of p53 protein in esophageal adenocarcinoma. 766 67

A critical evaluation has been made of the available evidence in man of the effects of prolonged low acid states on the structure and function of the stomach. Various human models have been examined. 1. Ageing does not affect acid output from the normal male stomach, and there may be an increase in women. With progressive atrophy of the corpus mucosa, which is more frequent and rapid in patients with gastric ulcer, there is an associated loss of secretory function. Chronic gastritis and atrophy are the most important age-related changes, which in many cultures are hypothesized to develop via a prior Helicobacter pylori-related gastritis. However, H. pylori colonization of the mucosa decreases with increasing grades of gastric atrophy probably because intestinal metaplasia provides a hostile environment. Atrophy and intestinal metaplasia are associated with precancerous lesions and gastric cancer. Apparent hyperplasia of the gastric argyrophil endocrine cells is a common and spontaneous phenomenon in patients with atrophic gastritis, which in part may be related to the preferential loss of nonendocrine cells. 2. Pernicious anemia is associated with a complete lack of acid production, marked hypergastrinemia, and endocrine cell hyperplasia in the majority of patients. ECL-cell carcinoids and gastric cancer occur with a prevalence of 3-7%, and endoscopic surveillance in routine clinical practice is not warranted. 3. Gastric ECL-cell carcinoids are rare events that have been described in association with two diseases in man, pernicious anemia and Zollinger-Ellison syndrome as part of multiple endocrine neoplasia syndrome type I, and usually relate to marked hypergastrinemia and the presence of chronic atrophic gastritis with gastric antibodies or a genetic defect rather than the presence or absence of acid. Regression or disappearance of ECL-cell carcinoids, either spontaneously or after removal of the gastrin drive, has been recorded. Lymph node, and rarely hepatic, metastases are documented but death in these cases has been anecdotal. 4. Therapy with H2 antagonists may result in up to a twofold rise in serum gastrin levels but in man no endocrine cell hyperplasia has been recorded. However, the data for H2 antagonists on these aspects are very limited. There is no drug-related risk of gastric or esophageal cancer, although the incidence of the latter may be raised. Long-term treatment with omeprazole is associated with a two- to fourfold increase in gastrin levels over baseline values in one third of patients and apparent endocrine cell hyperplasia in 7% of cases overall.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Pathophysiological effects of long-term acid suppression in man. 785 87

The records of autopsy on 43 patients underwent esophagectomy were evaluated retrospectively. Fifteen patients were performed palliative surgical treatment and 28 were curative, there were 41 men and 2 women in the series. The mean age at the first operation was 59.5 yr. The distribution of the primary lesions were 1 cervical, 40 thoracic (3 upper intra-thoracic, 28 middle intra-thoracic and 9 lower intra-thoracic) and 2 abdominal esophagus. There were 42 cases of squamous cell carcinoma (13 well differentiated types, 25 moderately differentiated types and 4 poorly differentiated types) and 1 adenosquamous cell carcinoma. Their stage classification were 0 for 2 patients, I for 1, III for 13 and IV for 27. In cases of palliative surgical treatment, the residual tumor were present on 6 cases in trachea or bronchus and 2 in aorta. Others were the rest of metastatic nodes in 3 cases, positive surgical margin in 3 and visceral metastasis and peritoneal dissemination in 1. At autopsy, 14 patients (93%) had distant organ metastases, 11 (73%) local recurrent tumor, 11 (73%) node metastases and 9 (60%) disseminations. In cases of curative surgical treatment, the first recurrent sites were as follows. Lymph node metastasis observed in 20 cases (71%), local recurrence in 9 cases (32%), distant organ metastases in 8 cases (28%) and disseminations in 5 cases (18%). While at autopsy, 24 patients (86%) had lymph node metastases, 20 (71%) distant organ metastases, 15 (54%) local recurrent tumors and 11 (39%) disseminations. On 10 cases whose first recurrent site was observed only at lymph node, 9 cases (90%) had distant organ metastases at autopsy. In both cases of palliative surgical treatment and of curative surgical treatment, the most dominant metastatic site at autopsy was distant organ metastasis. Therefore, in the future, distant organ metastasis must be an important target for esophageal cancer treatment.
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PMID:[An autopsy study of the mode of cancer metastasis on the esophagectomied patients for esophageal cancer]. 786 Oct 55

Based on own experience and on published data we report about indications and efficacy of endoscopic ultrasonography (EUS) in esophageal and gastric diseases. At the present time the following conclusions can be drawn: Submucous tumors can be clearly demonstrated and unequivocally distinguished from extramural compressions. Although the EUS aspect does not allow to differentiate benign from malignant lesions, EUS findings can give hints as to the nature of a submucous tumor (leiomyoma, lipoma, cyst). The main indication for EUS ist local tumor staging. The pT stage of esophageal carcinoma can be assessed correctly in 84% (73 to 92%) and that of gastric carcinoma in 80% (69 to 92%) of the cases by EUS. Especially in early tumor stages, EUS is superior to computed tomography. Regional lymph node metastases can be visualized in 70 to 90% of the cases. EUS is also helpful in the follow-up of patients with operative resection of esophageal cancer and in patients with gastric non-Hodgkin lymphoma during radio-/chemotherapy.
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PMID:[Endoscopic ultrasonography--indications and results in diseases of the esophagus and stomach]. 797 91

Alternating chemoradiotherapy has recently been reported to produce encouraging results in patients with advanced head and neck cancer. We have treated 17 patients with squamous cell carcinoma of the upper esophagus by alternating chemoradiotherapy and by following the patients for 2 to 5 years, or until their death. Chemotherapy (cisplatin and 5-fluorouracil) was delivered during weeks 1, 4, and 7, and radiotherapy (180 to 200 cGy twice each day to 2,000 cGy) during weeks 2, 5, and 8 (total 6,000 cGy). Three patients (18%) died of toxicity (nadir sepsis). All 14 patients who survived the treatment achieved a complete response as shown by endoscopy and biopsy specimens, with restoration of swallowing, and none experienced a local relapse. Three patients died of distant metastases (actuarial incidence 32% at 3 years). The 5-year survival rate was only 16%, however, because 8 other patients with no evidence of the cancer died of a variety of other causes: radiation pneumonitis (1), chronic neutropenia (1), esophageal actinomycosis (1), pneumonia (2), stroke (1), myocardial infarction (1), and small-cell lung cancer (1). Conceivably, some further improvement in the results might occur from cytokines, stem cells, and brachytherapy (by decreasing deaths due to toxicity), but with so many causes of comorbidity it seems unlikely, for the foreseeable future, that the 5-year survival rate could be much improved by better treatment of esophageal cancer.
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PMID:Patterns of failure in carcinoma of the upper esophagus after alternating chemoradiotherapy. 797 65

Barium swallow and endoscopy are complementary procedures in the detection of early esophageal carcinoma. CT is useful in the detection of distant metastases, and mediastinal invasion of key structures such as airway, aorta, and pericardium, but does not reliably differentiate T2 from T3 lesions or define subtle upper abdominal adenopathy. The disparity in reported results from different series published over the last 12 years can be accredited to two causes. First is the lack of uniformity in the way the studies were performed. Most authors agree that slice thickness should be 1 cm and contiguous. Lehr et al used 2-cm slices through the upper abdomen with additional slices through areas of special interest. Similarly, Markland defines his technique as "1-cm intervals from the thoracic inlet to the carina and below this at 1.5 cm intervals to the level of the adrenal glands." Such parameters are hardly optimized for the detection of 8-mm lymph nodes. The other cause of the disparity is interobserver variation in study interpretation. Goei et al staged 35 cases of esophageal cancer using CT. The CT interpretations of each of three readers were subsequently correlated with surgical and pathologic findings of 17 patients. CT pathologic correlation of the three observers showed sensitivities ranging from 50% to 57%, specificities ranging from 50% to 60%, and accuracies ranging from 46% to 71%. CT is useful as a surveillance tool in the postoperative patient. MR imaging does not have a defined role in the workup of esophageal tumors at this time.
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PMID:The radiographic evaluation of the patient with esophageal carcinoma. 804 94

Most patients with esophageal cancer present late with regional or distant metastases and have a poor prognosis. They have many debilitating physical and psychosocial problems. Proper symptom management improves quality of life. The continuity of health care in advanced disease can be best provided by hospice home care programs. Appropriate comfort measures will alleviate terminal restlessness in a dying patient and permit them to die with dignity.
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PMID:Symptom management in esophageal cancer. 805


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