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)

This report is based on the observation of 109 patients with testicular cancer over a period of 6 years. At the time of orchiectomy metastases were present in 54 patients. In 13 patients with an initially nonmetastatic disease, secondaries occurred later. The aim of this study was to evaluate the role of serum levels of human chorionic gonadotropin (beta-HCG) and alpha-fetoprotein (AFP) in the prognosis for achieving a complete remission. The importance of serial serum AFP and beta-HCG determinations for the early detection of tumor metastases was also evaluated. Remission rates were lowered significantly in patients with serum AFP levels above 500 micrograms/liter (8%, P less than 0.0005) and serum beta-HCG concentrations exceeding 5,000 U/liter (27%, P less than 0.05). For an early detection of metastases the best results (efficiency 0.92) were achieved with the combination of beta-HCG with AFP and X-ray examination of the chest.
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PMID:Prognostic value of tumor marker determinations in testicular cancer patients. 243 82

The prognosis for metastatic testicular cancer has been analysed in seven reports using multivariate analysis. Serum hCG is the most important factor. Volume of metastases, serum LDH and serum AFP are also of prognostic value. Bone, liver, nodal or retroperitoneal metastases are not independent prognostic factors. The prognosis for extragonadal nonseminomas remains in dispute. Future studies should categorize poor prognosis patients using one of the several available prognostic formulas. No consensus yet exists on optimal treatment for such patients.
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PMID:Prognostic factors in metastatic testicular cancer. 243 20

Neuron-specific enolase (NSE) was evaluated as a serum marker in 105 patients with testicular cancer and compared with the established tumor markers alphafetoprotein (AFP) and human chorionic gonadotropin (HCG). Increased serum NSE activity was measured in eight of 11 (73%) patients with metastatic seminoma. Serum NSE concentrations fell to within the normal range following chemotherapy. Localization of NSE in seminoma cells was demonstrated immunohistochemically. Only six of 40 (15%) patients with metastatic nonseminomatous germ cell tumors showed elevated serum NSE levels. AFP and HCG were both positive in 70% of patients in this group, and NSE determination gave no additional information. Serum NSE concentrations were normal in 53 of 54 testicular cancer patients after orchiectomy and there was no evidence of metastatic disease; only one had borderline NSE levels, indicating the specificity of serum NSE determination. NSE is a new marker of seminoma and its measurement may be of clinical value in monitoring chemotherapy in patients with metastatic seminoma.
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PMID:Serum neuron-specific enolase. A marker for responses to therapy in seminoma. 244 May 52

Previous reports indicate that enlarged hilar and mediastinal lymph nodes due to sarcoid-like reactions may develop after curative resection of testicular cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary nodules in this setting may be related to nodular sarcoidosis. A patient developed progressive hilar and mediastinal adenopathy associated with multiple pulmonary nodules after apparent curative resection of a testicular embryonal cell cancer. Biopsy specimens from the mediastinal lymph nodes demonstrated granulomas, suggesting the diagnosis of nodular sarcoidosis. Needle aspiration of the pulmonary nodules, however, revealed metastatic testis cancer. Sarcoid-like mediastinal reactions occur after resection of testis cancer, but biopsies should be performed on coexisting pulmonary nodules to exclude pulmonary metastases.
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PMID:Sarcoid-like hilar and mediastinal lymphadenopathy in a patient with metastatic testicular cancer. 244 44

The incidence and epidemiology, pathophysiology, diagnosis and staging, and therapy of testicular cancer are reviewed. Although relatively rare, testicular cancer is an important disease because it is the first disseminated solid tumor occurring in adults for which truly effective therapy has been developed. More than 90% of testicular neoplasms are of germ-cell origin; about 40% of cases involve pure seminoma, 15%-20% are pure embryonal carcinoma, and the rest are of mixed types. Clinically, the major distinction is between pure seminoma and other types because of therapeutic differences. Most men with testicular neoplasms initially complain of a painless testicular mass. Surgical exploration follows, with orchiectomy and complete excision of the spermatic cord if a neoplasm is documented. Seminoma is a highly radiosensitive tumor, and overall cure rates now approach 95%-98%. Combination therapy with cisplatin has been effective in treating patients with extensive disease. Nonseminomatous testicular cancer patients who do not have metastases are treated with a traditional orchiectomy and retroperitoneal lymph-node dissection; about 10% of patients will relapse and must be treated with antineoplastic agents. Patients with disseminated disease require systemic treatment with cisplatin-based combination drug therapy. Reduction of toxicity and identification of patients who can be spared extensive treatment are the current thrusts of research; efficacy is excellent for several regimens. Major advances have been made over the last two decades in curing patients with testicular cancer.
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PMID:Current concepts in clinical therapeutics: testicular cancer. 244 18

An interim analysis of the current EORTC studies in advanced testicular cancer indicates that (a) for low volume metastatic disease the addition of bleomycin (B) to etoposide (E) and cisplatinum (P) may not be necessary, and (b) for high volume metastatic disease the alternating schedule of PVB/BEP is not superior to treatment with BEP. Future studies will subdivide patients into 3 groups. Those with low volume metastatic disease will receive EP using 2 dose schedules for cisplatin. Those with high volume metastases will receive either BEP or etoposide, ifosfamide and cisplatinum (VIP). Those with ultra-high volume metastases will receive BOP/VIP, possibly randomised against another intensive chemotherapy schedule.
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PMID:Potential advances in combination chemotherapy for advanced testicular cancer. 245 13

The use of computed tomography (CT) and lymphangiography in the follow-up of 50 patients with intra-abdominal metastatic testicular cancer was assessed. The pattern and time course of loss of lymphangiographic contrast medium from different node groups is described. Computed tomography was more effective than lymphangiography in assessing the presence of residual metastatic disease and showed residual disease in 21 patients when lymphangiography follow-up radiographs showed evidence of disease in only seven. In the detection of relapse, lymphangiography follow-up showed evidence of nodal enlargement in four of eight cases when CT showed evidence of relapse in all eight. Computed tomography is superior to lymphangiography in the follow-up of patients with metastatic testicular cancer both in monitoring response of known disease to treatment and in the detection of relapse.
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PMID:Computed tomography scanning and post-lymphangiogram radiography in the follow-up of patients with metastatic testicular cancer. 253 1

Of the various urogenital malignancies, preoperative chemotherapy is most effective for testicular cancer and Wilms' tumor. The most effective treatment regimens for advanced nonseminomatous testicular tumors employ vinblastine, CDDP and bleomycin and adjunctive surgery. Another effective chemotherapy regimen is combination of vinblastine, actinomycin D, bleomycin, cyclophosphamide and CDDP presented by MSKCC. Available pretreatment with 4 courses of platinum, vinblastine and bleomycin before any surgical treatment in those with massive bulk metastatic disease seems to provide the most effective cytoreduction and best survival. Donohue has shown that in a primary chemotherapy group, there is only 20% active carcinoma after primary chemotherapy, whereas in a salvage chemotherapy group there is approximately 50% active carcinoma at surgery. It must therefore be emphasized that complete remission should be obtained by primary chemotherapy and adjunctive surgery. In Wilms' tumor preoperative chemotherapy with vincristine and actinomycin D should be given.
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PMID:[Preoperative chemotherapy of testicular cancer and Wilm's tumor]. 258 12

The management of testis cancer is continually changing. Since the introduction of curative chemotherapy for metastatic disease, the entire approach to early disease (stage I and stage II) is undergoing reevaluation. Individuals with favorable prognostic features can be offered, under detailed clinical protocols, orchiectomy followed by meticulous surveillance. Likewise, individuals with retroperitoneal disease may be offered retroperitoneal lymph node dissection initially or, alternatively, chemotherapy initially. The prognosis for individuals with metastatic disease is extremely favorable, with the majority of patients being cured with 9-12 weeks of combination chemotherapy. Major efforts are still underway to identify appropriate second-line or "salvage" regimens for individuals who are not cured with first-line chemotherapy. Likewise, the use of new modalities, such as bone marrow transplantation, and new drugs must be evaluated in appropriately designed, prospective studies. Such studies will continue to increase the cure rate of individuals with metastatic disease and enhance the prognosis for such high-risk populations of patients. This paper reviews basic aspects relating to histology, clinical staging, and approach to management for all stages of germ cell cancer of the testis.
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PMID:Testicular cancer. 267 28

Serial thoracic CT scans of 50 consecutive patients with testicular cancer were reviewed. In 30 of them with metastatic disease treated according to the Einhorn Scheme changes in thymic size caused by cytostatic agents were studied. During chemotherapy 78.6 per cent of all patients examined developed thymic atrophy, followed by rebound enlargement that reached its culminating point 13 months after initiation of treatment. After that a slow (approximately 2 years) involution process began, until the initial size or somewhat smaller size was re-achieved. The other 20 patients with no evidence of metastases, and therefore not treated with chemotherapy, showed no changes in thymic size. Rebound thymic enlargement following cytostatic therapy for metastatic testicular cancer should not be mistaken for lymphadenopathy.
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PMID:Thymic atrophy and rebound enlargement following chemotherapy for testicular cancer. 273 79


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