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

Eleven population-based cancer registries tabulated second cancers among 133,411 patients diagnosed with testicular cancer, ovarian cancer or Hodgkin's disease between 1945 and 1984. Overall, 3,157 second cancers were observed, as compared with 2,420 expected at least one year after the first cancer. Survivors of testicular and ovarian cancer experienced 30% and 20% more cancers respectively than the general population comparison group, and patients previously diagnosed with Hodgkin's disease had an 80% excess of cancer. No information was available either on treatment for the first cancer, or other risk factors. However, temporal patterns in the risk of specific second cancers were analysed, with particular reference to the possible role of therapy for the first cancer. Leukaemia of the acute or non-lymphatic type, which has been previously linked to alkylating agent therapy, occurred in excess following all 3 first cancers, as did non-Hodgkin's lymphoma (overall relative risks of 6.1 and 1.8 respectively, with considerably higher relative risks following Hodgkin's disease). Other cancers for which important and plausibly therapy-induced excesses occurred were lung cancer following Hodgkin's disease (relative risk 1.9), breast cancer following Hodgkin's disease (relative risk 1.4) and bladder cancer following ovarian cancer and Hodgkin's disease (relative risks 1.7 and 2.2 in women, respectively). Rarer sites at which striking excesses occurred were the salivary gland, thyroid, bone and connective tissue. There were smaller, but clear excesses for cancers of the rectum and colon following ovarian cancer and testicular cancer, skin cancer following Hodgkin's disease, and kidney cancer following ovarian cancer. Overdiagnosis, misclassification of metastases and confounding by other risk factors were all considered as explanations of observed excesses. Nonetheless, it appeared that there are clear excess risks for cancers other than acute leukaemia which must be ascribed to therapy for the first cancer, especially in view of the possible under-reporting in registry material. Case-control studies are under way to provide information on the role of specific aspects of therapy.
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PMID:Second malignancies following testicular cancer, ovarian cancer and Hodgkin's disease: an international collaborative study among cancer registries. 357 May 50

A study of 217 cases of testis cancer in Ireland revealed a longer duration of symptoms (median 2.8 months, mean 10 months) than elsewhere: 32% of patients waited at least 6 months before seeking medical advice. Delay was associated with metastases (P = 0.001), diminished prospects of cure (P = 0.001) and increased mortality (P = 0.002) but not with marker status or complexity of treatment required. Eleven per cent did not notice a detectable swelling and 25% waited at least 3 months after such a discovery. These facts and the incidence of maldescent (12%, with more than two-thirds untreated) highlight the need for better health education in this area.
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PMID:Patients' delay in the presentation of testis cancer in Ireland. 359 2

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.
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PMID:Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer. 367 73

Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.
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PMID:Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal. 394 32

The clinical, pathological and laboratory data for 60 patients with pathological stage I, 50 with stage II and 55 with stage III nonseminomatous testicular cancer were reviewed to identify prognostic factors that may be used to guide therapeutic approaches. In patients with stage I disease the presence of embryonal carcinoma (p less than 0.001) and vascular invasion in primary tumors (p less than 0.01) are significant predictors of metastases and/or recurrence after retroperitoneal lymphadenectomy. In patients with clinical stage II disease, lymph nodes greater than 2 cm. in diameter or more than 5 in number, vascular and/or lymphatic invasion and the presence of embryonal carcinoma with or without choriocarcinoma indicated an increased risk for recurrent tumor after retroperitoneal lymphadenectomy. In patients with stage III disease the involvement of 3 or more organ systems was associated with decreased survival. Patients in this group with intrathoracic metastases smaller than 2 cm., retroperitoneal metastases less than 4 cm., normal kidneys and liver, and no evidence of yolk sac tumor or choriocarcinoma had improved survival. These observations can be used to guide the type and duration of therapy selectively in patients with nonseminomatous testicular cancer.
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PMID:Prognostic factors in nonseminomatous testicular cancer. 394 93

Twenty patients with clinical Stage I nonseminomatous testicular cancer have been staged by retroperitoneal exploration and removal of landing zone lymphatics. Only two patients had microscopic metastases to these landing zone lymphatics and underwent retroperitoneal lymph node dissection. Two patients developed chest metastases in 2 to 5-year follow-up. All patients had preservation of ejaculation and their fertility status. This relatively brief surgical staging avoids the complications of a formal lymphadenectomy with 100% survival, and cost-effectiveness with excellent quality of life due to minimal complications.
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PMID:Alternative to retroperitoneal lymphadenectomy with preservation of ejaculation and fertility in stage I nonseminomatous testicular cancer. A prospective study. 403 9

The author resumes the basic progress achieved in the classification, staging and treatment of testicular cancer in the last 10 years. It is already possible to evaluate with precision the extent of non-seminomatous tumours of the testicles by using serum and intra-cellular tumoral markers (immunoperoxydase and anti-peroxydase peroxydase technique), ultrasonography and CT scan. It should be possible to selective scan the metastases with anti-alpha-foeto protein and anti HCG antibodies. Greater precision is necessary in the staging of tumors than is generally admitted. Local invasion of blood vessels and lymphatics. Invasion of the cord. The number of invaded retro-peritoneal lymphnodes (greater than or less than 5). The size of the lymphnodes (2 cm). For stage I tumours: A. Good prognosis. Wait and see without lymphnode dissection or chemiotherapy. Year 1--monthly check-ups. Year 2--quarterly check-ups. Then annual check-ups. B. Poor prognosis. Limited biopsic retroperitoneal lymphnode dissection subsequently extended following the result of the frozen section histology. For stage II tumours (with histologic proof of lymphnode invasion) the author recommends radical lymphnode dissection, except in the case of very large tumours. Subsequently: Where the excision is complete and the prognosis good (number and size of lymphnodes) no immediate chemotherapy. The author prefers to save it should the patient suffer a relapse (same follow-up as for stage 1A). Where the excision is incomplete or where it is complete but the lymphnodes are numerous (greater than 5) or large (greater than 2 cm) chemiotherapy is recommended. Where the lymphnodes are bulky. The author recommends chemiotherapy initially to be followed by retroperitoneal radical dissection. The presence of persisting tumoral tissue would imply additional chemiotherapy. In advanced tumours, a bone-marrow sampling would precede very aggressive chemiotherapy followed by surgery for residual tumoral tissue, reinjection of the bone marrow and an additional course of chemiotherapy.
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PMID:A decade of progress, current problems and future perspectives in testicular cancer. 407 52

Recently, the study of the physiological role of the essential trace elements is being emphasized. Some environmental and disease factors has been demonstrated to perturb trace element homeostasis. A number of recent studies have described alterations in serum copper levels (SCLs) and serum zinc levels (SZLs) in human cancer patients and the relationship between the magnitude of their perturbation and disease activity. This report describes SCLs, SZLs and SCL/SZL ratios in patients with malignant neoplasms of the urogenital tract at various clinical stages and the relationship of the levels of these trace elements to disease activity. According to SCLs before treatment, patients with renal cell carcinoma appeared to be separated into two groups, normal SCL group and higher SCL group. In the higher SCL group, patients generally displayed increased erythrocyte sedimentation rate, CRP, alpha 2 globulin, beta 2 microglobulin, ferritin and CEA. In this group, SCL was a useful index of disease activity. In the normal SCL group, SCLs remained within normal limit even in patients with advanced disease. In renal cell carcinoma, SZLs did not reflect disease activity. In transitional cell carcinoma of the upper urinary tract, patients with metastasis had significantly elevated SCLs and significantly decreased SZLs, compared with normal controls or patients without metastasis. In transitional cell carcinoma of the bladder, no distinct relationships were observed between these trace elements and extent of malignancy. But there was a trend toward increasing SCLs and decreasing SZLs with progressing stage and SCL/SZL ratios fairly reflect stage of disease. Patients with prostatic cancer had nearly normal SCLs and SZLs, although there were a few exceptions. Testicular cancer patients with distant metastasis had significantly elevated SCLs and initially high SCLs decreased in patients responding to therapy and increased again in relapse. SZLs and, hence, SCL/SZL ratios had no relationship to activity of testicular cancer. Currently there is no satisfactory way of following the progress of malignancies of the urogenital tract except prostatic cancer with elevated acid phosphatase and non-seminomatous testicular tumors until the secondary tumor can be detected radiographically. Our study suggests that these trace element might be a useful indicator of disease activity of some of the urogenital malignancies.
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PMID:[Serum copper and zinc levels in patients with malignant neoplasm of the urogenital tract]. 408 94

30 Patients with stage IIC and III nonseminomatous testicular cancer underwent surgery for residual tumor after induction chemotherapy (postinductive surgery). There were no operative deaths and surgical morbidity was not influenced by preoperative chemotherapy. A complete surgical remission was achieved in 9 of 15 patients with mediastinal or pulmonary deposits and in 6 of 12 patients with retroperitoneal metastases. Alphafetoprotein (AFP) levels over 10(4)ng/ml at diagnosis and persistently elevated AFP values preoperatively were associated with failure of surgery to achieve complete remission (p less than .05) and to achieve long-term survival even after surgical complete remission. Fifteen of 17 patients with radical surgery remained disease-free after a median follow-up of 33 months. Six of the 13 relapsing patients had elevated AFP levels prior to definitive surgery. In one patient a contralateral testicular cancer was diagnosed 60 months after postinductive surgery. Of the 17 disease-free survivors, 12 had no tumor, 4 had mature teratoma and only one patient had mature teratoma with malignant foci in the resected surgical specimen. We conclude that AFP levels at diagnosis, elevated AFP prior to definitive surgery, achievement of complete surgical remission and histology of residual tumor are important prognostic factors determining long-term survival in residual stage IIC and III nonseminomatous testicular cancer.
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PMID:The role of surgery in stage IIC and III nonseminomatous testicular cancer. 409 17

Surgical removal of bulky metastases of non-seminomatous germ-cell testicular cancer has been advocated as an adjuvant to chemotherapy in patients whose disease probably is too extensive to be cured by chemotherapy or surgery alone. However, in 8 of our patients, cytoreductive surgery was followed by a sudden and dramatic exacerbation of the disease. In some cases, a marked rise in the serum levels of alpha-fetoprotein and human chorionic gonadotropin was the only evidence. The cause and prevalence of such exacerbations are unknown. Cytoreductive surgery in patients with advanced testicular tumor is accepted treatment and should be advocated, but it appears that in some cases such surgery may adversely alter the course of the malignancy. This must be considered in planning treatment for patients with advanced disease.
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PMID:Acclerated growth of testicular cancer after cytoreductive surgery. 615 70


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