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)

Radiotherapy is an indispensable modality in the palliation of cancer. All palliative care programs should be acquainted with its indications and have a close working relationship with a radiation oncology department. The technical aspects of the subject may be intimidating to many staff and patients, and departments need to improve their outreach and education. The main indications are: pain relief (particularly bone pain), control of hemorrhage, fungation and ulceration, dyspnea, blockage of hollow viscera, and the shrinkage of any tumors causing problems by virtue of space occupancy. In addition, it has an important role in the palliation of three oncological emergencies: superior vena caval obstruction, spinal cord compression, and raised intracranial pressure due to cerebral metastases. More pragmatic fractionation schedules are being developed that are compatible with good results in terms of palliative end points, giving shorter courses with fewer hospital attendances for patient and family comfort and convenience. More clinical research and evaluation of palliative radiotherapy are required.
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PMID:The role of radiotherapy in palliative care. 171 70

Dural sinus thrombosis can be a difficult diagnosis to establish because it may present with nonspecific signs of raised intracranial pressure. Diagnosis by CT is well documented but signs may be subtle. Angiography is the "gold standard" but is invasive and requires a very high index of clinical suspicion to request. Magnetic resonance offers a method of demonstrating the dural sinuses in multiple planes and, furthermore, flow within the sinuses may be depicted by MR angiography. We report on three cases where the diagnosis of superior sagittal sinus thrombosis due to calvarial metastases was missed by CT, primarily due to their site over the convexity, but was demonstrated accurately using MR with MR angiography.
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PMID:Dural sinus occlusion due to calvarial metastases: A CT blind spot. 172 3

Breast carcinoma has a high predisposition to metastasize to the brain parenchyma or spinal epidural space with development of progressive neurological symptoms and signs and frequently death of the patient. We report 8 patients with known breast cancer who developed neurological symptoms attributable to an intracranial meningioma and 1 patient who developed spinal cord dysfunction resulting from a thoracic meningioma. The removal of the meningiomas resulted in return of normal neurological function in all patients. At follow-up, all our patients are alive without evidence of meningioma or breast carcinoma recurrence, except 1 patient who died of a metastatic malignant melanoma. This clinical association requires repeated emphasis because of the potential benefit in management of patients with suspected metastatic disease. We have reviewed and summarized the reported literature and added our 8 cases. The mean age of presentation before the second tumor was 6 years. Breast carcinoma was diagnosed first in 85% of cases. The clinical symptoms of the meningiomas were focal neurological signs in 50% of the patients, raised intracranial pressure in 40%, and a seizure in 10%.
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PMID:Intracranial and spinal meningiomas in patients with breast carcinoma: case reports. 266 77

Twenty-two cases of optic nerve sheath meningioma were reviewed. The clinical features included slowly progressive visual loss in every case. Orbital signs of limited ocular movements and mild proptosis were present in only a third of cases; gaze-evoked amaurosis occurred in 3 cases. The disc was abnormal in every case, usually swollen if vision was 6/12 or better, atrophic if the vision worse than 6/12. Optociliary shunt vessels occurred in 5 patients and were of diagnostic significance. The diagnosis was made by a high-resolution CT scan of the orbits showing tubular expansion of the optic nerve sheath. Calcification of the optic nerve was present in 12 cases. Tubular expansion of the optic nerve sheath may occur in raised intracranial pressure, optic nerve glioma, granuloma, lymphoma or metastatic disease. In the absence of calcification these alternative diagnoses must be considered. Surgery, undertaken for the intracranial component of the tumour, did not halt progressive visual loss.
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PMID:Optic nerve sheath meningioma: diagnostic features and therapeutic alternatives. 344 40

Two cases of primary intracranial choriocarcinoma are reported. One patient died with raised intracranial pressure and pulmonary metastases whereas the second patient, who was diagnosed early, has remained well a year after chemotherapy. Human chorionic gonadotrophin level estimation in serum and cerebrospinal fluid is a useful marker in suspected cases, and chemotherapy following biopsy appears to be the treatment of choice.
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PMID:Primary intracranial choriocarcinoma. 375 75

In this third article in the series, the management of patients with symptoms arising as a consequence of metastatic disease involving peripheral nerves, the spinal cord and the brain are discussed. In particular, pain, spinal cord compression and symptoms due to either raised intracranial pressure or specific neurological deficits may substantially impair the quality of life in patients with advanced cancer. Pain control, using both medical and surgical treatments, are discussed. The principles underlying the diagnosis and treatment of metastases to the vertebral column and spinal cord, as well as intracranial deposits, are outlined.
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PMID:The management of patients with advanced cancer (III). 931 69

Three cases are reported of hydrocephalus associated with spinal tumours. In two cases symptoms and signs of raised intracranial pressure and their spinal tumours developed in co-existence, in the third case hydrocephalus and multiple cerebral metastases developed ten years after removal of a thoraco-lumbal ependymoma. Pathophysiological aspects of concerted action of this rare entity and consequences of misdiagnosis are discussed, and the relevant literature is reviewed.
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PMID:The spinal tumour related hydrocephalus. 944 19

We report the case of a 70-year-old man reporting with headache and visual disturbances who was being treated for prostate cancer. Investigations showed him to have intracranial hypertension caused by venous sinus obstruction. Patients with metastatic disease and raised intracranial pressure in the absence of focal signs should be considered as possible cases of venous outflow obstruction.
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PMID:Extrinsic cerebral venous sinus obstruction resulting in intracranial hypertension. 1061 91

Stereotactic radiosurgery is being increasingly advocated as the primary modality for treatment of vestibular schwannomas (VS). This modality has been shown to arrest tumor growth, with few associated short-term morbidities, and with possibly better hearing and facial nerve preservation rates than microsurgery. Radiation-induced oncogenesis has long been recognized, although stereotactic radiosurgery de novo induction of a secondary tumor has never been clearly described. The authors report on a patient with a VS who did not have neurofibromatosis Type 2 and who underwent gamma knife surgery (GKS). This patient required microsurgical removal of the VS within 8 months because of development of a tumor cyst with associated brainstem compression and progressive hydrocephalus. The operation resulted in clinical stabilization and freedom from tumor recurrence. Seven and a half years after undergoing GKS, the patient presented with symptoms of raised intracranial pressure. Magnetic resonance imaging demonstrated a new ring-enhancing lesion in the inferior temporal lobe adjacent to the area of radiosurgery, which on craniotomy was confirmed to be a glioblastoma multiforme (GBM). Despite additional conventional external-beam radiation to the temporal lobe, the GBM has progressed. Whereas this first reported case of a GBM within the scatter field of GKS does not conclusively prove a direct causal link, it does fulfill all of Cahan's criteria for radiation-induced neoplasia, and demands increased vigilance for the potential long-term complications of stereotactic radiosurgery, and reporting of any similar cases.
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PMID:Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. 1135 16

Von Hippel-Lindau (VHL) disease is an autosomal, dominant inherited tumour syndrome with an estimated prevalence of 2-3 per 100,000 persons. A germline mutation in the VHL gene predisposes carriers to tumours in multiple organs. These tumours may include haemangioblastoma in the retina and central nervous system (CNS), renal cell carcinoma, phaeochromocytoma, islet cell tumours of the pancreas, and endolymphatic sac tumours, as well as cysts and cystadenoma in the kidney, pancreas, epididymis and broad ligament. Penetrance of VHL disease is high, most carriers of a VHL germline mutation develop one or more tumours by the age of 60 years. The most common symptoms include: loss of vision, raised intracranial pressure, neurological deficits, paroxysmal raised blood pressure and local pain. At present, metastases from renal cell carcinoma and neurological complications from cerebellar haemangioblastoma are the most common causes of death. However, it is anticipated that intensive radiological and clinical monitoring, and advanced operation techniques will reduce both morbidity and mortality in patients with VHL disease.
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PMID:Clinical management of Von Hippel-Lindau (VHL) disease. 1170 42


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