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)

Anal bleeding and pain were the symptoms in half of 53 patients with carcinoma within and around the area of the anus treated from 1950 to 1974. Twenty-seven carcinomas were exclusively located in the anal canal and six, in the perianal skin. Vaginal invasion was present in 13 of the women. There were 39 squamous cell carcinomas and nine basaloid cell carcinomas. More than 37 of the patients had an abdominoperineal resection as part of the treatment. The resection margins were positive for carcinomas in 11 patients. Radiation as the primary treatment was used only once. Palpably enlarged inguinal lymph nodes were treated by subsequent radical groin dissection. The crude over-all survival rate was 42 per cent; the adjusted five year survival rate was 38 per cent. Significant correlates of death were symptoms for longer than six months' duration bleeding, inguinal adenopathy and presence of hemorrhoids. In general, abdominoperineal resection is the operation of choice for carcinoma of the anal verge or anal canal. Inguinal lymphadenectomy at a later time should be reserved for patients with signs of metastases to the inguinal nodes.
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PMID:Appraisal of the treatment of carcinoma of the anus and anal canal. 92 54

Twenty-four patients with primary anorectal melanoma diagnosed since 1974 have been retrospectively studied. The most common presenting symptom was rectal bleeding, typically misdiagnosed as hemorrhoids. Progressive disease most commonly presented as a large pelvic mass, diffuse bilateral pulmonary nodules, or diffuse liver metastases. Twenty-one patients (88%) died of their disease; none survived more than 6 years. Among the patients who have died of their disease, mean survival was 2.2 years. Among assessable stage I patients initially managed with abdominoperineal resection (APR), 50% developed recurrent local regional disease (mean disease-free interval = 23 months), compared with 100% of those managed with more limited surgery (mean disease-free interval = 16 months). Even after APR, however, distant metastases were common, and there was no prolongation of survival for patients treated with APR. Primary melanoma of the anorectum has a high metastatic potential and carries a grave prognosis. APR appears to have some effect in controlling local and regional disease, but prolongation of survival will depend both on earlier diagnosis and on development of more successful therapeutic approaches.
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PMID:Anorectal melanoma: clinical characteristics and the role of abdominoperineal resection. 164 15

Twenty-four patients with primary anorectal melanoma diagnosed since 1974 have been studied retrospectively. There was a predominance of women (2.4:1): Mean age was 64 years. The most common initial symptom was rectal bleeding, typically misdiagnosed as hemorrhoids. Seventeen patients had stage I cancer when first seen, four had stage II, and three had distant disease. Progressive disease most commonly started as a large pelvic mass, diffuse bilateral pulmonary nodules, or diffuse liver metastases. Twenty patients (83%) died of the disease; none survived more than 6 years. Among the patients who died of the disease, median survival was 1.9 years. Median survival for patients with stage I disease (29 months) was longer than that for patients with stage II disease (11 months; p less than 0.05) or stage III disease (9 months). Twelve patients were treated initially with abdominoperineal resection (APR), and three additional patients underwent APR to manage recurrent local or regional disease that developed later in the clinical course. Among evaluable patients with stage I disease initially managed with APR, 50% developed recurrent local-regional disease (mean disease-free interval, 23 months), compared with 100% of those who underwent more limited surgery (mean disease-free interval, 16 months). Even after APR, however, distant metastases were common, and there was no prolongation of survival for patients treated with APR. Primary melanoma of the anorectum has a high metastatic potential and carries a grave prognosis. APR appears to have some effect in controlling local and regional disease, but prolongation of survival will depend on both earlier diagnosis and development of more successful therapeutic approaches.
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PMID:Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients. 229 48

The records of 21 patients treated for adenocarcinoma of the anal ducts between 1943 and 1982 were reviewed. The patients were followed until death or current status in April 1987. The median follow-up period was eight months (range, 3 to 144 months). Fifteen patients had an erroneous diagnosis made at first physician visit resulting in a median doctor's delay of 14 months (range, 3 to 24 months) before correct treatment was carried out. Nine of the tumors were localized perianally (ischiorectal space), seven anally, and five in a fistula-in-ano. Tumors localized anally were significantly smaller and had a significantly shorter history than perianally or fistula-in-ano localized tumors (P less than .05 for each localization). Three patients with anal tumors had their diagnosis made accidentally by routine histologic examination of an excised hemorrhoid. First examination revealed distant metastases in 13 patients and follow-up examination revealed regional or distant metastases in seven patients. Modes of treatment were wide local excision (N = 3), abdominoperineal resection (N = 3), colostomy (N = 9), and radiotherapy (N = 2). Twenty of the 21 patients died within 18 months due to the cancer. One long-term survivor was observed; the patient was alive 12 years after local excision of the tumor without evidence of recurrent disease. The crude five- and 10-year survival was only 4.8 percent.
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PMID:Adenocarcinoma of the anal ducts. A series of 21 cases. 335 95

J.W. is a 68-year-old white female who noted an "anal growth" 1 year prior to admission. She also complained of bleeding from her rectum when she was constipated. She attributed these symptoms to hemorrhoids. She noted increasing pain and more bleeding 1 month prior to admission. Locally applied hemorrhoid remedies gave her no relief. She was then admitted to a hospital where a biopsy of the anal mass was performed, and then referred to Rush-Presbyterian-St. Luke's Medical Center. On physical examination the patient was noted to be obese. There was no inguinal lymphadenopathy. There were no abdominal masses or hepatosplenomegaly. Rectal examination revealed a 3 X 4 cm mass protruding from the anus. Examination and protoscopy done under anesthesia revealed this mass to be approximately 4 X 5 cm and arising from the proximal anal canal. The mass was freely moveable and bled spontaneously when manipulated. Pelvic examination revealed a normal uterus and adnexa with no obvious tumor involvement of the vagina. Proctoscopic examination revealed no tumor proximal to the lesion described. Further evaluation included a liver-spleen scan that was negative for metastatic disease and intravenous pyelogram that showed no lesions. A barium enema revealed only diverticula. A gallium scan showed marked uptake at the area of the anal tumor but no other lesions. The chest x-ray was within normal limits. A CT scan of the abdomen and pelvis revealed no masses or lymphadenopathy. The CEA was 1.3 ng/ml. The patient underwent concomitant radiation therapy and chemotherapy. Over a 4-week period the patient received 5000 rads to the anal region. In addition, during the first week of radiation therapy and the fourth week of radiation therapy, the patient received 5-fluorouracil, 800 mg/m2 by continuous infusion for 5 days. In addition, the patient received mitomycin C, 15 mg/m2 on the first day of the first week of chemotherapy and the first day of the last week of chemotherapy. During the treatment period, the patient had mild diarrhea, perineal desquamation, and mild ulceration at the site of the anal tumor. During the third week of treatment, the patient had a white blood cell count nadir of 2800 and a platelet count of 86,000 per cubic millimeter. Her symptoms were managed with local emolients and antidiarrheal medications.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Carcinoma of the anal canal. 663 29

Anal melanoma is a devastating malignancy easily confused with benign hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion can lead to delays in diagnosis and therapy. Four cases of anal melanoma, all initially mistaken for hemorrhoids, have been documented in the past 4 years at our institution. Despite surgical intervention and chemoimmunotherapy, each patient succumbed to widely metastatic disease. Average survival was 15.2 months. The clinical, pathologic, surgical, and oncologic features of anal melanoma are reviewed to enhance physician recognition of this unusual anorectal disorder.
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PMID:Anal melanoma: an aggressive malignancy masquerading as hemorrhoids. 1159 45

Merkel cell tumors are rare neuroendocrine tumors typically found on sun-exposed areas such as extremities. We describe the case of a 42-year-old female with a Merkel cell tumor arising in the anal canal. The tumor was initially thought to represent a hemorrhoid arising during pregnancy and was excised locally after confirmation of extensive metastatic disease. The patient died 13 months after diagnosis with extensive metastatic disease involving the liver. In our search of the world literature there are several reports of neuroendocrine tumors in the rectum; however, no cases of documented Merkel cell tumors arising in the anal canal have been reported. These tumors seem to behave in a very aggressive manner when found in other atypical areas. The presentation symptoms were perianal discomfort and bleeding. Local excision may be the only surgical treatment necessary to control symptoms, given the propensity to early metastases and short life expectancy.
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PMID:Merkel cell (neuroendocrine) carcinoma of the anal canal: report of a case. 1504 1

The work of coloproctological center of Vishnevsky Central Military Clinical Hospital for he last 10 years is analyzed. The increased number of treated patients and surgical interventions is noted. The greatest group includes the oncological patients and 90% of them are operated radically. Among the peculiarities of treatment tactics the introduction of laparoscopic operations, interoperation intraperitoneal hyperthermal chemotherapy for relapses and metastases, Lango operation for haemorrhoids are noted. 72 casualties with colon injuries were treated in the center.
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PMID:[Development of liver surgery at the Vishnevsky Central Military Clinical Hospital]. 1296 67

Anorectal melanoma is an uncommon disease. Histologically, the tumor may mimic adenocarcinomas, small cell carcinomas, and sarcomas; grossly, the lesion often mimics hemorrhoids. We report 3 cases of anorectal melanoma: a 40-year-old woman with anorectal melanoma with local recurrence after an abdominoperineal resection (APR); a 30-year-old woman with anorectal melanoma and multiple liver metastases returning with multiple masses in the rectum and 2 nodules above and below the left clavicle after receiving chemotherapy; and a 62-year-old woman with inguinal node metastases. The histologic findings in all 3 cases revealed malignant tumor composed of atypical melanocytes diagnosed as malignant melanoma of the rectum. In the first case, APR with pararectal lymphadenectomy was performed. Histopathology revealed nodal metastasis. The patient was noncompliant with chemotherapy and died after several months. In the second case, chemotherapeutic treatment was begun. Seven months after receiving chemotherapy, the patient returned with multiple metastases. The final case was lost to follow-up after referral to an oncologist. Anorectal melanoma is highly aggressive and unresponsive to both radical surgery and local control. Although supplemental therapy may improve quality of life and prolong survival, the 5-year survival rate is 10% with a mean survival time of 15 to 25 months. In the 3 cases presented, metastatic disease was present at the time of diagnosis. At this stage, APR with lymphadenectomy followed by some form of adjuvant therapy is our recommended treatment.
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PMID:Anorectal melanoma--3 case reports and a review of the literature. 1522 86

Malignant melanoma (MM) of the anal region is an uncommon disease. In many cases, the disease is undetected or mistaken for a benign polyp or haemorrhoids until it reaches an advanced state. Owing to delayed diagnosis and early metastases, the prognosis is often poor. In contrast to melanomas of the skin, a history of sun exposure does not seem to have an impact in development of MM in this region. Anorectal melanomas (AM) are most common in the rectum, followed by the anal canal and anal verge. Ras mutations, especially in codon 61 of the N-ras oncogene, are common in CM and rare in melanomas of the vulva and anorectum. The diagnosis of an AM is usually made using a biopsy. Histopathological examinations show spindle-shaped and pleomorphic cells. Adjuvant immunohistological markers are the calcium-binding protein S-100, the melanoma antigen HMB-45, the melanoma-expressed protein Melan A, and microphthalmia-associated transcription factor (MiTF). To date, there are few published guidelines for the correct management of AM, and surgery remains the mainstay of treatment. We report on a 39-year old man who presented with a 5-week history of recurrent prolapse of an anal tumour. The tumour was histologically confirmed to be malignant melanoma.
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PMID:Malignant melanoma of the anal region. 1737 15


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