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

The incidence of sarcomas of the gastrointestinal tract has remained the same, but gastrointestinal lymphomas are gradually contributing a larger percentage of malignant gastrointestinal neoplasms. The authors have examined their more recent experience with these relatively rare lesions. Twenty-eight patients (13 with lymphoma, 15 with sarcoma) have been treated at the Vanderbilt University and the Metropolitan Nashville General Hospital since 1976. There were eight men in the group with lymphoma and six in the group with sarcoma. The average age for patients with lymphoma was 66 years; the average age was 57 years in the patients with sarcoma. Seven patients with lymphoma and eight patients with sarcoma had been treated for 6 months to 3 years for presumed peptic ulcer disease. Eight of these 15 patients were found to have perforated tumors at the time of surgical exploration. Three patients (all in the group with sarcoma) had metastatic liver disease or peritoneal implants at the time of diagnosis. Treatment for most patients included resection of the tumor, followed by chemotherapy or radiation in cases of tumor perforation or metastatic disease. The survival rate for patients with lymphoma has averaged 5.5 years, with a 55% 5-year survival rate. Patients with cleaved cell tumors survived longer than those with other types of lymphoma. In the group with sarcoma, the survival rate has been 3.1 years on the average, with a 21% 5-year survival rate.
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PMID:Gastrointestinal lymphoma and sarcoma. A case for aggressive search and destroy. 359 4

In 185 consecutive, surgical patients with suspected or proven gastrointestinal cancer a preoperative liver scintigraphy was performed; liver metastases were bioptically verified in 28 patients. A seven-class descriptive system was used for blind classification of the scintigraphies according to conferential consensus. Two years later (with the knowledge of the verified incidence of metastatic liver disease) the scintigraphies were reclassified. Considering the verified state of the patients, the latter classification was substantially improved. Probability for metastatic disease increased with more abnormal class label. At best, reliability for a twice interpreted scintigraphy as a binary test to denote the true state of the liver was 92 percent. The best cut-off level for diagnostic purposes yields a probability of 1.00 for an abnormal scintigraphy to denote liver metastases, accepting that 54 percent of patients with liver metastases were not found. For screening purposes, at best, a probability of 0.98 for a normal scintigraphy to denote no liver metastases was noted; thus, 83 percent of patients with normal liver state were missed. In conclusion, we find the liver scintigraphy classification system useful to find or exclude metastases in the test population and we think the procedure applied could be useful as a vehicle to report test results for any imaging modality.
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PMID:Reliability for an imaging test: evaluation of scintigraphy to reveal liver state in gastrointestinal cancer. 374 37

All 72 resections for colorectal liver secondaries during the period 1971-1984 were analysed retrospectively. Liver tumours were single in 35 (49 per cent), unilateral in 55 (76 per cent) and associated with extrahepatic disease in 12 (18 per cent) patients. Operative mortality was 5.6 per cent. With respect to the disease in the liver, the presence or absence of four or more metastases was the predominant prognostic determinant with a 5 year survival rate of 20 per cent in patients with less than four liver tumours, and no 3 year survivor among patients with four or more tumours. When the number of liver tumours was less than four, the prognosis in patients with unilateral disease was not significantly better than in patients with bilateral disease (P = 0.19). No other liver disease variable seemed to play any role in the prognosis. Extrahepatic disease was associated with a poor prognosis and no 5 year survivor. The length of the tumour-free resection margin was the only treatment variable that varied with the outcome: a resection margin of less than 10 mm was followed by a poor survival. Variables that did not influence survival included uni- or bilateral disease, liver tumour volume, tumour size, type of liver resection, Dukes' classification, differentiation of the primary tumour and synchronous or metachronous disease. It is concluded that resection for liver colorectal secondaries is indicated when there are less than four liver tumours, even if bilateral, no extrahepatic disease is present, and a resection margin of at least 10 mm can be obtained. It should not be performed unless all of these requirements are met.
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PMID:Determinants of survival in liver resection for colorectal secondaries. 375 36

Twenty-three patients with colo-rectal hepatic metastases were retrospectively reviewed after completing treatment with split course liver irradiation and continually infused concomitant intravenous 5-fluorouracil. Although no patient attained a complete response, an objective partial response was documented in 15 (Responders). The Responders had a median survival of 45 weeks whereas Non-responders had a median survival of 17 weeks. Patients with metastatic disease solely in the liver or those with a Karnofsky performance score (k.p.s) of over sixty, had a median survival of 49 weeks. Patients with multiple organ metastatic involvement had a median survival of 25 weeks and those with a Karnofsky with less than 60 had a median survival of 27 weeks. (p values of 0.006 and 0.03, respectively.) The overall survival of the group completing treatment was 30 weeks, and 19 patients (83%) achieved subjective palliation. The patients tolerated therapy well. There was minimal hematological toxicity; 3 patients developed a leucocyte count of less than 2000 and 1 developed a platelet count of 30,000. The palliation and prolongation of survival attained with minimal complications suggest that adjuvant liver irradiation with concomitant infusion 5-fluorouracil radiosensitization may be an option to offer patients identified to be at high risk of developing subclinical liver disease.
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PMID:Response of colo-rectal hepatic metastases to concomitant radiotherapy and intravenous infusion 5 fluorouracil. 379 53

From 1980 to 1984, 48 patients were subjected to liver resection for hepatic metastases from colorectal cancer. The disease was staged according to the original staging system proposed by the authors: stage I, single metastasis involving less than 25% of hepatic parenchyma (21 patients); stage II, multiple metastases involving less than 25% of hepatic parenchyma or single metastasis involving between 25-50% (9 patients); and stage III, multiple metastases involving between 25-50% or more than 50% of hepatic parenchyma, irrespective of the number of metastases (18 patients). The extent of hepatic resection was generally related to that of liver disease; a typical lobectomy was performed in 28 patients and segmentectomies in 20. One patient died after operation (mortality, 2.1%), and major complications occurred in seven patients (morbidity, 14.9%). Morbidity was related to operatory blood loss: 45% of patients with blood replacement of more than 2000 cc developed major complications versus 5.4% with blood replacement of less than 2000 cc (p less than 0.05). The actuarial 3-year survival for stages I, II, and III was 73%, 60%, and 29%, respectively (p less than 0.05). Twenty-two patients (45%) have had recurrences, all stage III patients within 2 years of resection versus 28% of stage I patients (30 months disease-free survival, 49%). The liver only was the site of recurrence in 10 patients, distant sites in seven, and both liver and distant in five. Analysis of the different features of the primary tumor, the interval between bowel resection and detection of hepatic metastases, and the number and extent of liver secondaries demonstrated that prognosis after surgery was mainly related to the latter; they are considered in the staging system adopted in this study. It is a simple system and shows a good prognostic correlation. The results reported here are in agreement with those of the literature; the low mortality and morbidity and the survival benefit support the growing acceptance of surgery in treatment of hepatic metastases from colorectal cancer, in particular stage I patients. For the other stages, surgery should represent, when applicable, only the first step of a multimodality treatment.
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PMID:Surgical treatment of hepatic metastases from colorectal cancer. 394 21

An electrophoretic fraction of plasma alkaline phosphatase, which migrates more slowly than the main fraction, was present in one fifth of normal subjects, and in some patients with parenchymal liver disease. It was absent in patients with bone disease, uncomplicated biliary obstruction, and hepatic metastases. The electrophoretic and inhibition properties of this slow band were similar to those of intestinal phosphatase, and its significance is discussed. In a patient with hypophosphatasia this fraction was apparently not decreased.
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PMID:A distinctive fraction of alkaline phosphatase in health and disease. 591 63

The non-invasive diagnostic technique of whole-body nuclear magnetic resonance (NMR) imaging was evaluated in 30 patients with established liver disease and 20 patients without liver disease. Comparison with diagnostic ultrasound and radionuclide liver scan shows that NMR easily differentiates malignant tumours from benign cystic lesions and provides useful information in patients with cirrhosis and metastatic deposits. In the demonstration of space-occupying lesions in the liver, NMR is as sensitive as ultrasound and more so than radionuclide liver scans when the metastases are less than 1.5 cm in diameter. In the demonstration of cirrhosis it is more sensitive than both ultrasound and radionuclide liver scan. The specificity of NMR is superior to both ultrasound and radionuclide liver scan, both of which only demonstrate the presence of lesions, whereas NMR tomographic imaging based on the proton spin-lattice time (T1) of tissue accurately indicates the nature of the lesion.
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PMID:Nuclear magnetic resonance tomographic imaging in liver disease. 611 85

Statistical analyses have been made by the Liver Cancer Study Group of Japan of 4031 cases of primary liver cancers diagnosed at 155 institutes during the period of Jan. 1, 1968-Dec. 31, 1977, based on the questionnaire in the form of individual file. They comprised 2411 cases of hepatocellular carcinoma, 268 of cholangiocellular carcinoma, 58 of the mixed type, 69 of hepatoblastoma, 23 of others, and 1202 cases with only clinical diagnosis. The survey and analyses mostly based on the histology-proven cases included gross anatomical and histological features of tumors, grades of anaplasia and growth patterns of tumor cells, pathology of noncancerous liver portion, frequency of accompanying cirrhosis or fibrosis, distant metastases, past history, frequency of hepatitis in the past history, frequency of positive HBsAg and anti-HBs, familial clustering of positive HBsAg tests, age distribution, subjective symptoms, objective signs, serum alpha-fetoprotein, celiac angiography findings, number of operations performed, kinds of surgical approaches made, extents of hepatic resection, prognosis in terms of survival in relation to various surgical treatments, chemotherapeutic agents used and routes of administration, prognosis as related to the accompanying parenchymal liver disease, and overall survival.
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PMID:Primary liver cancers in Japan. 615 97

The records of 126 patients with adenocarcinoma of the colon and rectum who presented with liver involvement were reviewed. Prognosis was determined by the amount of metastases to the liver, which was usually extensive of ascites or a raised alkaline phosphatase level was present. The longest survival period was achieved with resection of the primary tumor along with hepatic lesions confined to a single lobe, especially those due to direct tumor infiltration. If liver deposits were found bilaterally, palliative resection of the primary lesion relieved intestinal symptoms. This may also prolong the survival time, because a fixed primary tumor appeared to diminish the outlook among patients with comparable liver disease. Palliative resection in the presence of ascites resulted in a high mortality, and the survival rate was no better than that after diversion procedures. We recommend resection without anastomosis for carcinoma of the rectosigmoid in patients with ascites and unresectable secondary lesions of the liver.
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PMID:Carcinoma of the colon and rectum with liver involvement. 617 Oct 42

Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), alkaline phosphatase (ALP) and gamma-glutamyltranspeptidase (GT) were determined in three groups of patients: 21 with primary liver carcinoma (PLC), 106 with metastatic liver disease, and 110 with various degrees of alcoholic liver diseases. AFP was elevated in 12 out of 14 with hepatocellular carcinoma but in none of 7 with cholangiocarcinoma. CEA was elevated in 8 of 14 with hepatocellular carcinoma and in 5 of 7 with cholangiocarcinoma. In metastatic liver disease, 83% had elevated CEA greater than or equal to 5.0 micrograms/l, 50% having CEA levels greater than 20 micrograms/l. AFP was moderately elevated in 26% of the patients, the values being less than 100 micrograms/l in all but one. In patients with alcoholic liver disease, 31% had elevated CEA levels greater than or equal to 5.0 micrograms/l; one of these had an extremely high value of 245 micrograms/l. AFP was moderately elevated to less than 100 micrograms/l in only 9%. CEA is a sensitive indicator of metastases: a value above 20 micrograms/l is almost always associated with malignancy. However, the presence of alcoholic liver diseases must be considered in evaluating patients with increased CEA levels. AFP and CEA seemed to be of value in differentiation between primary and secondary liver carcinoma. ALP and GT are also relatively sensitive indicators of malignant liver disease, but they are more unspecific than AFP and CEA.
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PMID:Alpha-fetoprotein and carcinoembryonic antigen in patients with primary liver carcinoma, metastatic liver disease, and alcoholic liver disease. 618 10


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