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

Four patients suffering spinal cord compression resulting from epidural metastases were treated with adrenocorticosteroid hormones. For 2 patients, prompt relief of symptoms followed glucocorticoid therapy alone and was associated with marked shrinkage or disappearance of the metastasis, a direct oncolytic effect of the steroids. For the other 2 patients, glucocorticoids combined with other chemotherapeutic agents caused disappearance of the extradural tumor. For 1 patient, failure to recognize the oncolytic effects of the chemotherapy led to an unnecessary surgical procedure, and for a second patient an unnecessary operation was narrowly averted. Thus, for certain patients, glucocorticoids may occasionally have a marked oncolytic effect on epidural metastatic tumors.
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PMID:"Disappearing" spinal cord compression: oncolytic effect of glucocorticoids (and other chemotherapeutic agents) on epidural metastases. 36 73

A patient with an untreated breast carcinoma and a clinically minimally symptomatic, extradural spinal cord compression secondary to metastatic disease is described. The observation of an abnormally distended urinary bladder on a bone scan led to the prompt diagnosis and successful treatment of a total spinal cord block.
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PMID:Extradural metastatic breast carcinoma detected on a bone scan. 58 66

Clinical interest in spinal compression and resultant paraplegia due to metastases has mounted in recent years. This has stimulated attention to the neuropathology of the condition. 14 cases of spinal cord compression due to vertebral metastases are compared with over 100 traumatic cases. In the traumatic lesions there is central haemorrhagic necrosis leading to cavitation and gliosis with nerve root regeneration in the late stages. In the metastatic cases, lesions are often peripheral, pie-shaped and are related to vascular factors. The neuropathology of cord necrosis due to metastatic spinal disease is therefore different from that caused by trauma. These observations have clinical importance in planning treatment.
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PMID:Vertebral metastases and spinal cord compression. 75 26

A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.
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PMID:Indications for nonoperative treatment of spinal cord compression due to breast cancer. 90 30

Examination of the cerebrospinal fluid (CSF), and myelography, were performed in most of 89 consecutive patients with X-ray evidence of vertebral metastases to test the value of these examinations in the early detection of neoplastic involvement of the epidural space. Patients were divided into 3 groups. In 7 cases (group I), the vertebral metastases were asymptomatic. Fifty-nine (group II) had symptoms or signs of radicular lesions but not of spinal cord compression. Twenty-three showed various stages of spinal cord or cauda equina compression (group III). Involvement of the epidural space was demonstrated on myelography in almost 50% of patients from groups I and II by a partial (29%) or complete (19%) arrest of the opaque medium. In addition, five patients in group II with normal myelograms had increased levels of CSF protein. Leucocyte counts were within normal limits in all patients. Neoplastic cells were found in two cases. It is suggested that in patients with only radiological evidence of neoplastic involvement of the epidural space and complete myelographic blocks, laminectomy, followed by radiation therapy, should be performed. Patients showing partial blocks should receive radiation therapy only.
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PMID:Early diagnosis of metastases in the epidural space. 118 11

Bone metastases in breast cancer are common and frequently lead to serious skeletal related morbid complications. Metastases develop in areas of metabolically active trabecular bone. It is presumed that breast cancer cells undergo the same stepwise process for metastases development as demonstrated in other tumor types. The specific factor or factors responsible for the osteotropism of breast cancer have not been identified. The morbid events associated with skeletal metastases, such as pathologic fracture, and spinal cord compression, may be assessed objectively by a variety of techniques including skeletal radiography, radionuclide scanning, computed tomographic scanning and magnetic resonance imaging. Biochemical parameters or markers of skeletal metastases are not sensitive enough to detect clinically occult disease. Therapeutic interventions for bone metastases include local and systemic therapies. Surgery and radiation therapy are most frequently used for relief of pain or impending fracture, or when bone fracture or neurologic compromise has already developed. Systemic treatment of bone metastases appears to be as effective as systemic treatment of other metastatic sites. Both hormone and chemotherapy may provide significant palliation. Clinical research suggests that the adjunctive use of bisphosphonates may significantly reduce the incidence of skeletal-related morbid events associated with osteolytic bone disease. Future research efforts directed at determining the osteotrophic factors responsible for bone metastases in breast cancer, the pathophysiology of the bone remodeling process in metastatic disease and the prophylactic use of bisphosphonates may lead to significant clinical benefit for those in whom bone metastases from breast cancer develop.
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PMID:Bone metastasis in breast cancer. 145 Apr 38

Screening chest radiographs do not reduce mortality from lung cancer. Should an incidental noncalcified pulmonary parenchymal nodule be discovered, chest CT will demonstrate one third of such patients to, in fact, have the multiple nodules of metastatic disease. CT is very helpful to guide fine needle aspiration biopsy of lung lesions and to assist in evaluation for resectability. MR can be helpful in special circumstances, including the definition of the extent of paravertebral, superior sulcus, and diaphragmatic lesions. Endorectal ultrasound is not sensitive enough to function as a screening tool for prostate cancer but is used routinely to guide biopsies. CT and MR are rarely helpful in staging this disease. Given the highly characteristic trait of bone metastasis in prostate cancer, a bone scan is mandatory in all patients. Double contrast barium enema can be used as an adjunct or alternative to sigmoidoscopy for colorectal cancer screening, in the preoperative evaluation of patients, and in postoperative surveillance. CT and MR can detect macroscopic adenopathy and liver metastases; CT is generally the preferred study. Screening mammography can have a major impact in reducing breast cancer mortality. It is recommended that a baseline study be obtained at age 35. Annual or biannual examinations should commence at age 40. Any palpable lesion, whether or not it is demonstrated mammographically, must be subjected to biopsy. Ultrasound is the most useful initial imaging study for evaluating pelvic masses. MR will, on occasion, identify the origin of a mass not determinable from ultrasound scan. MR is particularly valuable to identify parametrial spread (inoperability) of cervical cancer, and has been underused for this purpose. Surgery remains the mainstay for the staging of ovarian and endometrial cancer, although CT can be helpful to identify macroscopic relapse, ascites, or liver metastases. Bone scan and liver CT remain the standard procedures for detecting metastases in these respective organ systems. MR can be invaluable in the imaging of epidural metastasis and spinal cord compression in patients with vertebral metastatic disease. Contrast-enhanced MR is more sensitive than contrast-enhanced CT for detecting brain metastases, but the latter remains a useful tool. Chest CT can improve the detection of pulmonary metastases when this is of crucial importance.
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PMID:Diagnostic imaging in cancer. 146 83

Spinal cord compression due to epidural metastases, and malignant pleural effusions are devastating complications of advanced cancer that can destroy the quality of a life that is already limited in quantity. Neither need do so. A diagnostic algorithm has been developed for each of these complications. Early diagnosis of cord compression can be accomplished by prompt myelography or magnetic resonance imaging of the affected area of the spine. A malignant pleural effusion, even one that initially appears cytologically negative, can be promptly diagnosed. Radiation and steroids are optimal therapy for most patients with cord compression, and few require surgery. Intrapleural bleomycin appears to be the most effective agent for pleurodesis.
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PMID:Special problems in the older cancer patient: spinal cord compression and pleural effusions. 153 25

Spinal cord compression is a common neurological emergency. The causes of spinal cord compression may include primary or (more frequently) metastatic tumor, infections, trauma, and vertebral or intervertebral disc disease. In most instances the underlying etiology is known or easily ascertained. We present here three recent cases in which patients presented with spinal cord compression and lytic bone lesions suggesting metastatic cancer. In these cases, vertebral osteomyelitis was found to be the cause.
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PMID:Spinal cord compression produced by osteomyelitis mimicking spinal epidural metastasis. 155 8

Eight patients treated for histologically confirmed primary spinal epidural non-Hodgkin's lymphoma diagnosed between January 1979 and August 1989 (6.6% of all cases of intraspinal lymphoma) were studied. There were six men and two women. The median age was 70 years (range, 43-80 yr). Patients sought treatment for a prodrome of back pain (median duration, 3 mo) followed by an acute neurological deterioration (median duration, 6 d). The most common findings were a discrete sensory level in 5 patients, hyperreflexia in 5 patients, and paraparesis or paraplegia in 5 patients. Radiographically, there was an absence of bony destruction by these tumors. All patients underwent a decompressive laminectomy, subtotal tumor resection, and spinal irradiation (median dose, 3800 cGy). Two patients had low-grade lymphomas (one B cell and one T cell), and 6 patients had intermediate-grade lesions (six B cell). Two patients with B-cell lymphomas (one low-grade and one intermediate-grade) developed metastatic disease 15 and 17 months after the initial diagnosis; no evidence of lymphoma developed in the other 6 patients. The median survival was 22 months (range, 2-71 mo). Lymphoma was the cause of death in only 1 of the 4 patients who died, and the 4 younger patients are alive and well. Primary spinal epidural non-Hodgkin's lymphoma should be a diagnostic consideration in the older patient who seeks treatment for spinal cord compression manifested by a prodrome of back pain, followed by a rapid neurological deterioration, normal plain spine radiographs, and neuroimaging consistent with an extradural compressive lesion. Surgery for this diagnosis followed by spinal irradiation should result in significant neurological improvement.
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PMID:Primary spinal epidural non-Hodgkin's lymphoma: report of eight patients and review of the literature. 158 77


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