Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malignant carcinoid tumors are remarkably varied in their biologic behavior. The disease may be indolent for years with minimal or no symptoms. On the other hand, an acute carcinoid crisis with severe diarrhea, dehydration, and hypotension may develop in the patient. Patients with flushing and/or diarrhea, not responsive to standard symptomatic measures, may benefit from chemotherapy or hormonal therapy. Chemotherapy with single agents or combination chemotherapy may be associated with response rates ranging from 20 to 40 percent. Hepatic de-arterialization by ligation or occlusion is an effective means of inducing rapid tumor shrinkage for patients who have carcinoid tumors and hepatic dominant metastases. The addition of chemotherapy after induction of a partial remission with hepatic de-arterialization may prolong the duration of response, but this remains to be proven in prospective clinical trials. Hormonal therapy with the antiestrogen tamoxifen has been unsuccessful, but treatment of the carcinoid syndrome with a long-acting analogue of somatostatin has been strikingly effective.
 ...
PMID:Metastatic carcinoid tumors and the carcinoid syndrome. A selective review of chemotherapy and hormonal therapy. 243 81

In a prospective study of 103 patients with carcinoid tumors consecutively referred for medical treatment, the most common sites of the primary tumors were the ileum (73%), bronchi (7%), and jejunum (4%). All patients had local metastases, and 96 (93%) also had liver metastases. The most common initial symptoms were diarrhea (32%), ileus (25%), and flush (23%). The overall frequency of diarrhea was 84% and of flush was 75%. Heart insufficiency caused by cardiac valve disease was seen in 33% of the patients. The carcinoid syndrome, including flush, diarrhea, and elevated urinary 5-hydroxyindole acetic acid (5-HIAA) concentrations, was manifested by 69 patients (67%), 64 of whom (93%) had carcinoid tumors of mid-gut origin. Elevated urinary 5-HIAA was found in 91 patients (88%), of which 89 displayed liver metastases. The plasma concentration of the tachykinin neuropeptide K (NPK) was elevated in 67 patients (66%), 63 of whom had tumors of the mid-gut region. Serum pancreatic polypeptide (PP) and human chorionic gonadotrophin alpha levels were elevated in 43% and 28% of the patients, respectively, and the highest levels were found in patients with metastatic bronchial carcinoid tumors. Thirty-nine of the 103 patients are now dead; 18 died of tumor progression, whereas 14 patients died of heart failure secondary to a carcinoid tricuspidal valve insufficiency. The estimated median survival from the time of histologic diagnosis was 14 years, and from the time of carcinoid syndrome was 8 years.
 ...
PMID:Malignant carcinoid tumors. An analysis of 103 patients with regard to tumor localization, hormone production, and survival. 244 Mar 90

We retrospectively studied 112 patients treated for gastrointestinal carcinoid tumors between 1942 and 1986. The three most common sites were jejunum-ileum (27%), rectum (27%), and appendix (21%), followed by colon (12%), duodenum (9%), and stomach (4%). Seventy-five percent of patients had localized disease, primarily in the rectum and appendix. Colon and small bowel tumors were often manifested with metastatic disease. Complete surgical excision of all localized disease was curative in 94% of patients. Corrected five- and ten-year survival rates were 90% and 58%, respectively, in cases of localized disease, whereas in stage III disease, the rates were 46% and less than 30%, respectively. All patients with liver metastasis died within 25 months. A second malignancy, most often adenocarcinoma of the colon, occurred in 25% of patients. Carcinoid syndrome was found in 6% of patients. The best survival rates were noted for appendiceal and rectal carcinoids, and the worst for colon and stomach carcinoids.
 ...
PMID:Carcinoid tumors of the gastrointestinal tract: a 44-year experience. 259 19

We present our experience with 18 bronchial carcinoids, two of those being of atypical histology. Mean age is 44 years, without sex preponderance. Clinical symptoms are poorly specific, with persistent cough and recurrent pneumonia as most frequent features. Carcinoid syndrome was seen in one patient. In 4 patients, the carcinoid tumor was an incidental finding on routine chest X-Ray film. Lack of pathognomonic clinical signs explains the considerable delay in diagnosis, with a mean of 10 months of clinical evAluation. Radiographic patterns are atelectatic lobe consolidation, a solitary coin lesion or a transparent lung field. All patients were submitted to bronchoscopic evaluation and only two endoscopic explorations remained negative, because of their peripheral localizations. In all other cases, there was a typical appearance of "cherry red adenoma". Mediastinal extension was present in 2 cases, while extrathoracic metastases were never found. Whenever possible, surgical resection was performed (16 cases). Two patients got endoscopic extirpation of their tumor. There is one postoperative hospital death. This study was done to gain a better understanding of clinical, diagnostic and pathologic features of bronchial carcinoid tumors, and their implications in terms of therapy and prognosis. The authors discuss clinical, diagnostic and therapeutic aspects of bronchial carcinoids as well as their microscopic appearance and relationship with oat cell carcinoma.
 ...
PMID:[Carcinoid tumors of the bronchi. Our experience of these during the last 10 years, with a review of the literature]. 267 50

The radiological diagnosis and interventional management of neuroendocrine tumours of the gastrointestinal tract and pancreas are challenging, demanding the complete gamut of available resources. Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequently reveals vascular encasement and distortion from the mesenteric desmoplastic reaction. Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma. Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is more revealing. Computed tomography with the catheter in the superior mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases. Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87% while 79% of islet cell tumour hepatic metastases have responded. Contraindications to HAE includes a combination of all of the following: (i) replacement of more than 50% of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100 mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.
 ...
PMID:Gastrointestinal and pancreatic endocrine tumours. 267 21

A consecutive series of gastrointestinal carcinoid tumours presenting over a 3-year period at a district general hospital is reported. None were diagnosed at autopsy. Sites of origin from fore-, mid- and hind-gut were all represented. Sixty-three per cent of patients had tumour-related symptoms at presentation. Of these 90% had nodal metastases and 60% had liver metastases. Carcinoid syndrome developed in most patients with liver metastases. The presentation and management of carcinoid tumours is discussed.
 ...
PMID:Gastrointestinal carcinoid tumours in a district general hospital. Review of a three-year consecutive series. 272 19

Ileal carcinoid is an infrequent pathology that may present clinically in a highly varied way. It may be completely asymptomatic and present acutely with occlusion or haemorrhage, or it may present with an unmistakable symptomatology of carcinoid syndrome. Clinical aspects are discussed together with possibilities of treating the primary lesions and metastases. Five cases observed in the past 7 years are reported.
 ...
PMID:[Carcinoid of the ileum. Presentation of 5 cases]. 272 29

Primary hepatic apudoma associated with serotonin syndrome was recorded in a man of 55 followed up for 6 years. Clinically, there was a progressive enlargement of the liver with varicosis of venae subcutaneae abdominis and venae esophageae. There were also weak signs of carcinoid syndrome. The patient died of acute venous esophageal hemorrhage. The tumor, represented by white dense cystic tissue, was nearly encapsulated and involved almost the whole liver. Histologically, there were monomorphic cells with clear empty or eosinophilic cytoplasm, small central nuclei which developed into solid streaks and alveoli. Glandular formations and pseudorosettes occurred locally. Grimelius staining revealed argyrophil granules in the tumor cells cytoplasm. Metastases of the tumor were found in portal lymph nodes.
 ...
PMID:[Primary hepatic apudoma with serotonin syndrome]. 274 32

During the last 5-year period aggressive surgical debulking was performed in 19 of 21 consecutive patients with the midgut carcinoid syndrome. Two patients were excluded due to severe cardiac disease. Fourteen of the patients had hepatic metastases. Carcinoid symptoms can occur also in patients without proven liver disease with sole lymph node metastases or retroperitoneal tumours. In 4 patients all metastatic tumour tissue could be removed resulting in biochemical cure and no symptoms. In patients with multifocal hepatic metastases surgical debulking was followed by transarterial embolisations of the hepatic arteries. All patients had good symptomatic relief of the combined surgical and radiological treatment. Five patients had currently stable disease anatomically and biochemically, 2 slowly progressive disease and one patient has a more rapid progression. Three patients have just undergone debulking and are waiting for further treatment. During the observation period 4 patients have died. Of these deaths one was related to the surgical procedures. After the introduction of somatostatin analogues major surgery can be performed safely in these patients with little risk of carcinoid crises. The role of additional drug therapy in these rare patients must be evaluated critically in randomized multicenter trials using a common surgical primary treatment.
 ...
PMID:Surgical treatment of patients with the carcinoid syndrome. 274 79

SMS 201-995 (Sandostatin) was studied using low doses (50 to 100 micrograms) administered subcutaneously every 12 hours. A single 50-micrograms dose of SMS 201-995 effectively controlled gastric acid and blood gastrin levels for 12 hours in three patients with benign gastrinomas and was useful in their perioperative management. Higher doses of the agent (500 to 800 micrograms per day) had no effect on metastases in one of two patients with metastatic gastrinoma. In the other patient, one tumor shrank but the other continued to grow after three months of treatment while serum gastrin levels did not change. Cultured metastatic tumor tissue from this patient released different forms of gastrin; growth rates varied, independent of uptake of SMS 201-995, and gastrin release increased. A neonate with nesidioblastosis maintained normal blood glucose levels while receiving SMS 201-995 therapy following a 95 percent pancreatic resection. In two elderly patients with organic hypoglycemia--one with a single benign adenoma and one with multiple adenomatosis--the somatostatin analogue did not prolong the hypoglycemia-free interval. In nine patients with carcinoid syndrome, flushing was uniformly controlled with 50 micrograms of SMS 201-995 administered every eight to 12 hours. One of the nine required exocrine pancreatic replacement. After six months of treatment, three of the nine had no change in tumor size and one had remission of symptoms and stopped treatment. In two patients with vipoma, SMS 201-995 controlled diarrhea and reduced levels of vasoactive intestinal peptide; tumor necrosis occurred in one patient. In a patient with diabetic diarrhea unresponsive to all treatments, SMS 201-995 therapy controlled the diarrhea but did not interfere with control of the diabetes.
 ...
PMID:Somatostatin analogue (SMS 201-995) in the management of gastroenteropancreatic tumors and diarrhea syndromes. 287 47


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>