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)

Transanal endoscopic microsurgery (TEM) allows minimally invasive full-thickness local excision of rectal tumors with perirectal fat dissection. Thirty-seven patients with extraperitoneal rectal carcinoma underwent full thickness TEM resection for T1 (10 patients), T2 (20 patients), and T3 (6 patients) lesions, with associated radiotherapy in the second and third group. One patient, staged as T2, underwent full-dose radiotherapy and TEM and the pathologist did not find cancer cells on the specimen (pT0). Morbidity included would dehiscence and stool incontinence in three and two patients, respectively, that resolved with medical therapy and rectovaginal fistula in one patient that required reoperation. No perioperative mortality was observed. Mean follow-up was 35 months (range 17-60 months), with two local recurrences (5.4%) that were successfully retreated. Cancer-related mortality due to systemic metastases was 8.1%. This is the first clinical study reporting on the application of TEM combined with radiotherapy for the treatment of T2 and T3 rectal cancer in selected patients. This approach is feasible, safe, and appears to be effective at the present duration of follow-up, with preservation of normal and sphincter function.
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PMID:Transanal endoscopic microsurgical excision of irradiated and nonirradiated rectal cancer. A 5-year experience. 970 94

Breast cancer is the most commonly diagnosed cancer among women in the USA and the second leading cause of cancer deaths in women. Breast cancer metastases to the bladder are unusual but have been reported occasionally in the literature. The majority of the reports describe bladder metastases presenting with symptomatology or occurring in the context of disseminated disease. We present the case of an 87-year-old woman with a history of breast cancer and negative routine work-up for metastatic disease. She was referred to the urogynecology division in our institution because of complaints of urinary incontinence and urinary urgency. A urethrocystoscopy revealed suspicious bladder mucosal lesions that were biopsied. The pathology findings, when compared to the original cancer specimens, were consistent with metastatic disease. This case suggests that in patients with a history of breast cancer, even subtle urinary symptoms should be thoroughly evaluated.
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PMID:Metastatic breast cancer diagnosed during a work-up for urinary incontinence: a case report. 1020 66

Patients with localized adenocarcinoma of the prostate gland (CaP) are frequently (approximately 50%) found at radical prostatectomy to have extracapsular disease or positive surgical margins. The management of these patients is a subject of controversy because some question the impact of this manifestation of CaP on patient survival or disease-free survival. Between 1976 and 1991, 241 patients with pathologic stage C (T3N0) were treated in this medical center. Of these 241 patients, 201 (83%) received a planned postoperative pelvic irradiation consisting of 48 Gy given to the prostatic fossa, whereas 40 (17%) patients were treated with radical prostatectomy alone. The two study urologists selected these patients not to receive postoperative irradiation based on intraoperative findings and important prognostic factors. Comparison of treatment outcomes in these two treatment groups is a subject of this report. The 201 patients treated with surgery-radiotherapy (S+RT) combination had a higher pathologic stage, greater incidence of seminal vesicle involvement, p = 0.002, and higher mean and median preoperative prostate-specific antigen level, p < 0.0001, than the 40 surgery (S) alone patients. There was no significant difference in the incidence of higher Gleason's score by the treatment group, p = 0.14. In univariate analysis, there was no significant difference in survival, disease-free survival, and time to failure between the two treatment groups. In multivariate analysis after controlling for pathologic stage and Gleason's score, the 201 adjuvant radiotherapy patients were predicted to have recurrence at 68% (95% confidence interval 39%-118%) the rate of the 40 surgery-alone patients. Local recurrence with or without metastatic disease was found in 10% of surgery-alone patients as compared to 5% in those also receiving postoperative irradiation. Treatment tolerance was very good with minor radiotherapy complications only. There was no significant difference in the incidence of incontinence between the two treatment arms. In summary: (a) The use of moderate-dose postoperative radiotherapy was of low toxicity and it did not increase the incidence of incontinence. (b) Local recurrence was 5% in S+RT and 10% in S-alone patients. (c) In multivariate analysis, S+RT patients had 68% rate of recurrence of S-alone patients. (d) Adjuvant RT probably reduces the risk of recurrence in patients with poor prognostic factors. (e) These data need to be interpreted with caution because of the nonrandomized nature of the study.
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PMID:Comparison of outcomes of radical prostatectomy with and without adjuvant pelvic irradiation in patients with pathologic stage C (T3N0) adenocarcinoma of the prostate. 1044 Jan 84

Prostate adenocarcinoma is the most common nonskin malignancy in males and the second most common cause of cancer death in the United States (Landis et al., 1998). Initial treatments of surgery or radiotherapy may cause impotence and/or incontinence from neural damage (Eastham and Scardino, 1998; Porter et al., 1998). When extraprostatic or metastatic disease develops, castration or pharmaceutical androgen ablation is utilized (Catalona, 1994). Androgen-resistant recurrence indicates a poor prognosis and justifies experimental chemotherapy (Oh and Kantoff, 1998). G207 (Mineta et al., 1995; Yazaki et al., 1995) is a multimutated herpes simplex virus 1 (HSV) vector that replicates within cancer cells, causing cellular death; however, replication is limited in normal cells, including those of the nervous system. In vitro, G207 at a low multiplicity of infection (MOI of 0.01) is oncolytic for multiple human prostate cancer cells. In athymic mice, a single intraneoplastic inoculation of G207 completely eradicates >22% of established subcutaneous human prostate cancer tumors irrespective of hormonal responsiveness. Two intraneoplastic inoculations of G207 completely eradicated two of three recurrent previously irradiated tumors and two intravenous administration of G207 induced tumor regression in distant subcutaneous tumors and completely eradicated one-fourth of the tumors.
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PMID:Local and systemic therapy of human prostate adenocarcinoma with the conditionally replicating herpes simplex virus vector G207. 1049 54

Local recurrence after any type of radiation therapy presents the clinician with a significant challenge. If there is no evidence of metastatic disease, patients can be offered a potentially curative salvage prostatectomy. To qualify for such surgery, patients should be at least 12 months from the completion of radiation and have at least a 10-year life expectancy; ideally, they will have a serum prostate specific antigen concentration <10 ng/mL and a Gleason score of 7 or less. Perioperative complications are substantial, with urinary incontinence rates of 40% to 50% and rectal injury rates of 10% to 15%. Long-term disease-free survival rates of 30% to 40% can be expected.
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PMID:Salvage radical prostatectomy after radiation therapy and brachytherapy. 1091 Jan 57

Treatment options in patients with bone metastases of differentiated thyroid carcinoma are limited and mostly aimed at palliation. Conventional treatment modalities are: radioiodine therapy, surgery or external irradiation. A lesser known option is selective embolization of tumour metastases. During selective catheterization of the arteries that feed the metastases embolization material (e.g. polyvinyl alcohol particles) is injected into the local vasculature under radiographic control. The embolization is immediately evaluated angiographically. This therapy was used in three patients with differentiated thyroid carcinoma, a 60-year-old man suffering from back ache, paresis and afterwards paralysis of the lower body parts with incontinence, and in two women aged 59 years (suffering from diplopia and a pelvic metastasis) and aged 27 years (suffering from neurological symptoms or pain of the right leg due to a pelvic metastasis). In all three the symptoms disappeared after the embolization and ensuing treatment with radioactive iodine. Due to recurrent increase in serum thyroglobulin concentration repeated re-embolization was necessary, but during a follow-up period of 3-5 years the palliation remained adequate. Selective embolization appears to be a safe and efficacious treatment, with good tolerability for the patient. Embolization alone or preferably preceded by radioiodine therapy may lead to decreased tumour progression and often gives rise to immediate relief of symptoms.
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PMID:[Embolization of skeletal metastases in patients with differentiated thyroid carcinoma]. 1092 50

The colonic J-pouch (pouch group) functions better than the straight coloanal anastomosis (straight group) immediately after ultra-low anterior resection, but there are few studies with long-term follow-up. This randomized controlled study compared functional outcome, anal manometry, and rectal barostat assessment of these two groups over a 2-year period. Forty-two consecutive patients were recruited, of which 19 of the straight group [17 men with a mean age of 62.1 +/- 2.3 (SEM) year] and 16 of the pouch group (11 men with a mean age of 61.3 +/- 3.2 year) completed the study. Four died from metastases and two emigrated; there was no surgical morbidity or local recurrence. At 6 months the Pouch patients had significantly less frequent stools (32.9 +/- 2.8 vs. 49 +/- 1.4/week; p < 0.05) and less soiling at passing flatus (38% vs. 73.7%; p < 0.05). At 2 years both groups had improved with no longer any differences in stool frequency (7.3 +/- 0.4 vs. 8 +/- 0.2/week) and soiling at passing flatus (38% vs. 53%). Defecation problems remained minimal in both groups. Anal squeeze pressures were significantly impaired in both groups up to 2 years (p < 0.05). The rectal maximum tolerable volume and compliance were not different between groups. Rectal sensory testing on the barostat phasic program showed impairment at 6 months and recovery at 2 years, suggesting that postoperative recovery of residual afferent sympathetic nerves may play a role in functional recovery. In conclusion, stool frequency and incontinence were less in the Pouch patients at 6 months; but after adaptation at 2 years the straight group patients yielded similar results. Nonetheless, this functional advantage can be given to patients with minimal added effort or complications by using the colonic J-pouch.
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PMID:Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial. 1157 27

The detection of ovarian cancer remains a major challenge for gynecologists, as the majority of cases are symptomatically silent until regional metastases or ascites have occurred. This report examines a case of early-stage ovarian adenocarcinoma presenting with irritative voiding symptoms and urge incontinence, all of which resolved fully following surgery. We also report on the frequency of lower urinary tract symptoms leading to the detection of early-stage ovarian cancer, within a cohort of 52 consecutive patients surgically treated at our institution. Lower urinary tract symptoms may trigger the diagnosis of early ovarian cancer in up to 11% of surgically managed patients at our institution. To our knowledge there are no previous reports of early ovarian cancer causing transient irritative voiding symptoms or urge incontinence. This report highlights the importance of considering ovarian neoplasm as a relatively uncommon but critically important etiology accounting for these common female urologic complaints.
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PMID:Early-stage ovarian carcinoma presenting with irritative voiding symptoms and urge incontinence. 1171 3

The surgical treatment of low rectal cancer has yet to be standardised. The aims of the study were to define the curative role of intersphincteric resection and to evaluate its indications and functional results through a retrospective clinical experience. From 1988 to 2000, out of 783 operations for primary rectal cancers (resectability rate 96%; restorative resections 83% and APR 10%) an intersphincteric resection was performed in 48 patients (31 male, 17 female, average age 62) for tumours located at a mean distance of 4.5 cm from the anal verge. Clinical stage: 27 T3 (56.3%), 12 T2, 5 T4 and 4 T1. All the operations were rated R0. TME with N-S, endo-anal distal transection and manual colo-anal anastomosis with a protective stoma were systematically performed. The mean follow-up was 46 months (range: 12-80). Functional results were evaluated with a prospective standardised questionnaire. There was no hospital mortality (30 days). The total morbidity rate was 22% with anastomotic leakage (clinical or X-ray evidence) in 12.5%. Four anal stenoses needed dilatation. Only one local recurrence six years after operation (2.1%). Nine patients died of systemic metastases within 3 years of surgery; the others are still alive and disease-free. Minor faecal incontinence with frequency and urgency occurred in 68.7% of cases at 3 months after protective stoma closure and in 37.5% after 6 months. After one year continence was good in 85.4% of survivors. Only one case required a permanent stoma for poststenotic total incontinence. The best functional results were achieved by colonic pouch reconstruction. For selected low rectal cancers (T2/T3) without voluntary sphincter infiltration, intersphincteric resection is safe and effective for oncological and functional purposes. The procedure requires accuracy in dissecting the anorectal junction. Preoperative radiotherapy may increase the indications for intersphincteric resection as well as the availability of a disease-free margin. A manual colo-anal anastomosis with colonic pouch interposition is strongly recommended.
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PMID:[Role of intersphincter resection among the surgical options for cancer of the distal rectum]. 1182 51

Radical cystectomy has emerged as the standard therapy for patients with invasive bladder cancer. Controversy is related to the indication, i.e. a low or high threshold. Meticulous pelvic lymphadenectomy can cure 20%-30% of patients with lymph node metastases, particularly those with limited node involvement. Unilateral nerve-sparing surgery is feasible in most patients without compromising oncological outcome and, besides erectile function, has an impact on the continence status after orthotopic bladder substitution. The excellent local control rates following radical cystectomy indicate that the weight of the problem in the future lies in reducing distant metastases. Orthotopic bladder substitution with a low-pressure ileal reservoir is currently the preferred method to reconstruct the lower urinary tract for both sexes following cystectomy. Long-term experience with follow-ups exceeding 10 years demonstrates a sustained favourable voiding outcome with slightly increasing incontinence rates as patients age.
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PMID:Contemporary cystectomy and urinary diversion. 1219 98


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