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

Anal cancer is a rare neoplasm: 1 anal cancer for 100 colorectal cancers. The development of anal cancer is associated with infection by human papillomavirus, which is usually sexually transmitted. Determination of tumour stage is important for planning optimal therapy and for predicting prognosis accurately. Initial work-up is primarily clinical with additional information from abdominal and transanorectal ultrasonography, and chest radiography. A classification mixing TNM (Tumour, Nodes, Metastasis) and ultrasonographic examination of the extension in depth allows to make a therapeutic decision and to follow it up. Conservative treatment is almost always possible. Concomitant external beam radiation therapy and chemotherapy are the standard to combination treatment. Surgical treatment remains indicated in rare cases.
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PMID:[Epidermoid cancer of the anus]. 1123 92

The coregistration of planning CT and 18F-fluoro-deoxy-2-glucose (FDG) positron emission tomography (PET) with patient in the same treatment position is the principally well-established tool for improving the target coverage defined and the target planning volume to treat the metabolic target volume. Most of the interest in the coresgistred CT/PET images on volume delineation has focused on conformal radiation therapy of non-small cell lung cancer. In spite of technical difficulties related to the target volume displacements, and the sensitivity and the specificity of FDG-PET images < 100%, the target volume delineation is significantly changed by the coregistration of FDG-PET images and planning CT by either reduction of the radiation volume (excluding atelectasis or mediastinal lymph node) or the increasing of mediastinal lymph node involvement. Image fusion technique reduces the interobserver variability in target volume delineation. Furthermore, after induction chemotherapy image fusion leads to improve the patient management by detecting locoregional progression disease or the presence of metastatic disease. Other anatomic tumor sites are going to investigate such as: head-and-neck cancer, gynecologic cancer, oesophageal cancer, anal cancer, Hodgkin's disease, and non-Hodgkin's lymphoma. The impact on treatment outcome remains to be demonstrated.
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PMID:[The impact of integrating images of positron emission tomography with computed tomography simulation on radiation therapy planning]. 1567 44

The prospective study was concerned with definition of the clinical and therapeutic factors behind poor response of anal cancer to radio- (RT) or chemoradiotherapy (CRT). Out of 64 female and 8 male patients at the mean age of 57 (33-81), thirty six had split-course of 60-65 Gy (RT), twenty--60-65 Gy, 5-FU and mitomycin C (CRT) and eighteen--up to 55-65 Gy (1.5 Gy--session 1, 1.0 Gy--session 2) (hyper-fractionated RT) plus 5-FU, for squamous cell anal carcinoma. There was no endorectal ultrasound evidence of perirectal lymph node involvement (uN0): T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin or endorectal ultrasound: T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin metastases) were detected in 7 patients: T1-2uN1-2M0 (n=7), T3-4N1-3M0 (n=10). Endorectal ultrasound staging (ERUS) used a linear 7.5 MHz transducer. The uTNM system was devised on the basis of tumor invasion parameters. There were no tumors confined to the subendothelial layer of the anal canal (uT1); 24 (32.4%) tumors were confined to the internal anal sphincter (uT2); 19 (25.7%) invaded the external anal sphincter (uT3) and 31 (41.9%)--levator ani (uT4). All carcinomas T4 (n=9) corresponded to the uT4 category. Only T-stage and tumor invasion (uT) proved significant prognostic variables. Complete response of T1-2 was 79.2%, T3-4--33.3% (p=0.0003); uT2--95.8%, uT3--68.4%, and uT4--41.9% (except T4) (p=0.0001). In multivariate logistic analysis, uT alone appeared an independent variable (p=0.015). ERUS uTNM staging is more effective in prognosis for RT and CRT and, therefore, should be recommended for preliminary management of epidermoid anal carcinoma.
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PMID:[Prognosis of epidermoid anal carcinoma regression after conservative treatment]. 1575 59

Anal cancer is a rare neoplasm, representing 1-2% of all large bowel cancers. Surgical excision by abdominoperineal resection has been the standard treatment. In the 1920s and 1930s inguinal node dissection was included in the surgical management of these patients. In the 1950s it was evident that the morbidity associated with lymphnode dissection was much greater than any survival benefit and this procedure was abandoned. Since 1974 "multimodality treatment" with a combination of radiation and chemotherapy has become the standard treatment. Synchronous inguinal lymph node metastases occur in 10-25% of patients and metachronous metastases have been reported in 5-25% of cases. Inguinal lymph node metastases are an independent prognostic factor for local failure and overall mortality by a multivariate analysis of EORTC. In order to assess inguinal lymph node status we applied the sentinel node technique to patients affected by anal cancer. Fifteen patients were studied with a lymphoscintigraphy after peritumoral injection of 37 MBq of Tc-99m colloid. A surgical biopsy of sentinel node was performed in all patients with a detection rate of 100%. Inguinal metastases occurred in 4 patients (26.6%), and in 2 cases metastases were located bilaterally. Twelve patients (80%) were treated in local anesthesia and they were dismissed the same day of surgical procedure. No major complication occurred. Considering the strong correlation between prognosis and node involvement, we consider this technique an important and simple method for evaluating the lymph node status and for an adequate pre-treatment staging of anal carcinoma. fundamental in the choice of radiation plane. In particular inguinal radiotherapy could be reserved for N1 patients only. avoiding the morbidity related to this procedure in N0 patients. Further studies are required to confirm these results and a consistent follow-up will be necessary to evaluate long-term results particularly in those patients (N0) who have not been treated with prophylactic inguinal radiotherapy.
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PMID:[The technique of sentinel lymph nodes in patients with anus neoplasm]. 1643 86

Accurate staging of rectal and anal carcinoma is crucial for planning surgery and indicating adjuvant therapy. Although, computed tomography and magnetic resonance imaging are very sensitive in detecting metastatic disease, the local staging of rectal cancer with these techniques has been disappointing. Endorectal ultrasound (ERUS) and anal endosonography (AE) remain the most accurate methods for staging rectal and anal cancer. Anal endosonography is also of value in evaluating perianal sepsis: it can assist the surgeon in planning the surgical strategy by delineating the anatomy of fistula tracts, and can aid in puncturing abscesses in the operating room. Continued research and development has made the instrumentation for ERUS and AE more accurate and user-friendly. New techniques that have contributed significantly to the evolution of ERUS include three-dimensional ERUS, high-frequency miniprobes, transrectal ultrasound-guided biopsy techniques and hydrogen peroxide-enhanced endosonography. Further improvements can be expected from contrast enhancement with microbubbles and colour Doppler imaging. In this new millennium, new developments in ERUS and anal endosonography, such as tri-dimensional ERUS and anal endosonography and radial electronic probing, widen the role of ERUS in the staging of rectal and anal carcinoma, as well as for perianal inflammatory conditions.
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PMID:Anorectal ultrasound for neoplastic and inflammatory lesions. 1647 4

Because of the high cure rate of localized anal cancers from combined modality treatment, there is little that is known for the treatment of patients who progress to have metastatic disease. Treatments currently used are based on activity demonstrated in other cancers with similar histology. Cetuximab, a molecular-targeted therapy, is an antibody directed against epidermal growth factor receptor that has demonstrated anticancer activity in several cancers. We report a female patient with refractory anal cancer who achieved an excellent response to the combination of cetuximab and irinotecan after having failed single-agent irinotecan.
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PMID:Evidence of clinical activity for cetuximab combined with irinotecan in a patient with refractory anal canal squamous-cell carcinoma: report of a case. 1725 87

Distant extrapelvic metastases appear in approximately in 10% of the patients with squamous cell anal cancer (SCAC) and survival depends on the treatment strategy. Exact staging leads to optimal planning of multimodality therapy and the adequate evaluation of treatment response can improve the prognosis of the disease. Diagnosis and staging of SCAC are commonly performed using contrast-enhanced computerized tomography(CT) and interpretation of the findings for tumor biological behavior. F18-fluoro-2 deoxy-D glucose positron emission tomography((18)F-FDG PET) reveals aspects of tumor function and allows metabolic measurements. Combined PET/CT scans permit exact localization with anatomical criteria of the hypermetabolic (18)F-FDG avid malignant lesions. We present a patient with SCAC in whom, according to PET/CT findings, the initial stage was changed from II (T2N0M0) to III A (T2N2M0). Radiation therapy (RT) and chemotherapy achieved a good therapeutic response but early follow up revealed new paraaortic lymph node (LN) metastases, as well as an uncommon left supraclavicular LN metastasis from the same primary carcinoma. The disease was restaged as stage IV (T2N2M1) and radiation therapy was substituted by chemotherapy.
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PMID:Impact of PET/CT on initial staging, restaging and treatment management of anal cancer: a clinical case with literature review. 1730 88

We report a case of anal cancer with iris metastasis and summarize the iris metastasis literature. A 69 years old woman with a history of anal cancer presented with a visual field loss. Slit lamp examination showed a pink ovular mass on the iris of the left eye which was typical of iris metastasis. Because of worse prognosis of metastatic cancer and any ocular complications, the patient was treated by radiotherapy which allowed a clinical improvement. A review of medical records was performed to assess the clinical presentation, diagnosis and treatment. Anal carcinoma can metastasize to the iris. Radiotherapy allows a good local control of tumour but the prognosis depends on systemic disease which is generally bad.
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PMID:Unusual iris metastasis from anal cancer: a case report. 1829 34

Anal squamous cell carcinoma and its precursor lesions are increasing in incidence in the United States and Europe. This trend predates human immunodeficiency virus/acquired immune deficiency syndrome and has been associated with persistent high-risk human papilloma virus (HPV) genotype infection, previous lower genital tract dysplasia/carcinoma, high frequency anoreceptive intercourse, heavy cigarette smoking, immunosuppression in solid organ transplant and immune disorders, and human immunodeficiency virus seropositivity. Screening protocols for at-risk patients are under active investigation and pathologists are often asked to assess anal canal and perianal biopsies for the presence of dysplasia and/or invasive carcinoma. Because underdiagnosis and overdiagnosis of anal cancer and precancer may lead to inappropriate treatment, it is important for the pathologist to be aware of current screening strategies, specific risk lesions, and the role of pathology in initial diagnosis and evaluation of anal biopsy and/or resection specimens. Standardized histologic criteria and uniform terminology should be used for reporting all anal canal and perianal squamous intraepithelial lesions. HPV subtyping, anal cytology, and recently identified biomarkers, such as p16 and Becton Dickinson ProEx C may provide additional information in problematic cases, but it is important to be aware of the limitations of these assays. HPV has been linked to all the major histologic subtypes of anal carcinoma (eg, basaloid, cloacogenic, transitional, etc.) and this association is strongest for anal canal lesions. With the possible exception of the microcystic pattern, histologic subtype does not seem to predict prognosis; and anal squamous cell carcinomas should be classified as either keratinizing or nonkeratinizing. Poorly differentiated squamous cell carcinomas have a worse prognosis and should be distinguished from poorly differentiated adenocarcinoma, melanoma, and neuroendocrine tumors. Very well differentiated squamous cell carcinoma with pushing margins (so-called giant condyloma of Buschke and Lowenstein) should be classified as verrucous carcinoma; this tumor shows aggressive local infiltration but does not metastasize. As all anal condylomata may harbor foci of high-grade dysplasia or invasive carcinoma, careful sectioning and complete histologic examination is required.
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PMID:Diagnostic problems in anal pathology. 1872

Metastasis to the regional lymph nodes is an important prognostic factor in colorectal cancer, and nodal evaluation is essential for accurate staging. In colorectal cancer, the aim of evaluating sentinel lymph nodes (SLNs) is the selection of patients for adjuvant therapy and the detection of aberrant lymphatic drainage patterns, leading to modification of the initial therapeutic plan. In a review of the literature, tracer, technique, tumor-related factors (location and size of tumor, T stage, status of lymph node metastasis), neoadjuvant chemoradiation therapy, and body mass index were important factors in the accurate diagnosis of SLNs in colorectal cancer. In recent multicenter SLN trials, ultrastaging has been possible in 10-38% of NO colon cancer patients. Most recently, the trial conducted by Bilchik et al., which investigated the prognostic significance of micrometastases in SLNs in colon cancer patients, found that all NO colon cancer patients with recurrence had positive SLN findings after reverse transcriptase-polymerase chain reaction (RT-PCR)-ultrastaging, whereas none of those with negative SLN findings in immunohistologic staining had recurrence, and there was only a significant correlation between recurrence and molecular markers in RT-PCR. However, further prospective multicenter trials are warranted to evaluate the ultimate clinical relevance of SLN diagnosis in colorectal cancer including anal cancer.
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PMID:[Current status of sentinel lymph node-based nodal ultrastaging in colorectal cancer]. 1934 97


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