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 prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs.
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PMID:Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study. 147 99

Peritoneal effusion recurrence is one of the most important problem in the palliative management of patients with gastrointestinal malignancies and ovarian cancer. Ten patients with recurrent malignant ascites (three with ovarian cancer, two with pancreas cancer, two with gastric adenocarcinoma and one affected by colon cancer, one patient with peritoneal carcinomatosis, one subject with pleural mesothelioma surgically treated that after three years showed a peritoneal metastases and ascites), were treated with intraperitoneal beta interferon. In all patients a Tenckoff's catheter for peritoneal dialysis was introduced and peritoneal effusion extracted and measured. Three millions of beta interferon in saline solution was infused in peritoneal cavity every three days for nine days. Successively twenty millions every three days for nine days. In the 50% of patients a significant reduction of peritoneal effusion was observed. The locoregional therapy with beta interferon is proposed in palliative management of malignant ascites.
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PMID:[The locoregional treatment of neoplastic ascites with interferon-beta]. 150 25

Gastric cancer sometimes spread to peritoneal surfaces in the absence of lymphatic or hematogenous metastases. For the treatment of peritoneal carcinomatosis, we applied large volume intraperitoneal chemotherapy (L.V.I.C.). In L.V.I.C., drugs were administered with large volume of saline through the reservoir buried in the subcutaneous tissue of the abdominal wall. We used mitomycin C (MMC), 5-fluorouracil (5-FU) and CDDP and examined the pharmacokinetics of these drugs when they were administered by this method to the patients of peritoneal carcinomatosis. A marked pharmacokinetic advantage was observed when 5-FU and CDDP were administered. AUC of these drugs were much larger than that of MMC. In vitro sensitivity test (SDI test) was useful for the selection of adequate drugs for each patient. On this method, drugs were distributed widely in the abdominal cavity and the patients could be taken this treatment repeatedly as out-patient. L.V.I.C. seems to fulfill the need for a safe, effective and acceptable delivery system of intraperitoneal chemotherapy.
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PMID:[Large volume intraperitoneal chemotherapy as treatment for the peritoneal carcinomatosis from gastric cancer]. 155 95

Sixty-six consecutive patients who underwent curative resection for rectal cancer were studied prospectively to evaluate the roles of sequential carcinoembryonic antigen (CEA), tissue plasminogen activator (TPA), and carcinomatous antigen 19-9 (Ca 19-9) determinations in the early diagnosis of resectable recurrences. Thirty-three recurrences were detected between 6 and 42 months. CEA, TPA, and Ca 19-9 showed a sensitivity of 72.7 percent, 78.8 percent, and 60.1 percent, respectively, and a specificity of 60.6 percent, 60.6 percent, and 87.9 percent, respectively. In 23 cases the rise in the value of CEA and/or TPA and/or Ca 19-9 was the first sign of recurrences, and the diagnosis was established later by clinical methods. In this group, the lead time was two months for liver metastases and four months for disseminated metastases. As far as the relationship between localization of recurrence and marker level increase is concerned, of 16 hepatic metastases CEA, TPA, and Ca 19-9 showed a sensitivity of 94 percent (P less than 0.05), 69 percent, and 62 percent, respectively. Of six patients with local recurrences, CEA, TPA, and Ca 19-9 showed a sensitivity of 50 percent, 100 percent (P less than 0.05), and 83.3 percent, respectively. Of three patients with peritoneal carcinomatosis, CEA, TPA (P less than 0.05), and Ca 19-9 showed a sensitivity of 0 percent, 100 percent, and 0 percent, respectively. No significant differences were reported among the three markers according to multiple metastases and metachronous polyps. Fourteen patients (42.4 percent) underwent surgical treatment for recurrent disease, and eight of them (57 percent) showed a resectable disease, for a total resectability rate of 24.2 percent. The findings of our study indicate that a follow-up program based on CEA, TPA, and Ca 19-9 assays is related to an early diagnosis and a good resectability rate for both local and metastatic recurrences from rectal cancer.
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PMID:Role of CEA, TPA, and Ca 19-9 in the early detection of localized and diffuse recurrent rectal cancer. 156 99

From January 1974 to December 1989, 16 patients with locally recurrent rectal adenocarcinoma and hydronephrosis underwent exploratory celiotomy with curative intent. There were eight males and eight females. The median age was 61 years. Primary rectal adenocarcinomas were treated with abdominoperineal resection in 12 patients and low anterior resection in 4 patients. Four patients underwent adjuvant radiotherapy, one patient adjuvant chemotherapy, and one patient combination therapy. The median disease-free interval between resection of the primary tumor and recurrence was 18 months. Hydronephrosis was unilateral in seven patients (44%), and bilateral in nine patients (56%). Preoperative evaluation indicated that all 16 patients had local pelvic-perineal recurrence or pelvic recurrence alone. Resection was not possible in any of these 16 patients for the following reasons: 5 patients (31%) had pelvic sidewall involvement and carcinomatosis; 3 patients (19%) pelvic sidewall involvement alone; 2 patients (13%) pelvic sidewall involvement and sacral fixation; and 2 patients (13%) had sacral fixation alone. In the remaining four patients, there was pelvic sidewall involvement by tumor and/or synchronous hepatic metastases, carcinomatosis, or sacral fixation. The median survival after exploratory celiotomy was 8 months in the 16 patients who died of their disease. Unilateral and bilateral hydronephrosis appears to be a contraindication for potentially curative surgical resection in recurrent rectal adenocarcinoma.
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PMID:Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis. 162 1

In the management of the patient with intra-abdominal recurrence of colorectal carcinoma, surgery remains the primary mode of therapy when cure or significant palliation is anticipated. Appreciation of the importance of close follow-up after primary resection coupled with improved diagnostic modalities has allowed the surgeon not only to detect earlier recurrence but also to select the patients most likely to benefit from resection of recurrent disease. Improved surgical techniques with resultant decreases in the rates of morbidity and mortality have allowed safe hepatic resection of metastatic disease. In selected patients, this procedure produces 5-year survival rates approaching 50%. Although a clear consensus has not been reached, most studies agree that positive prognostic indicators include absence of extrahepatic disease, a small number of intrahepatic lesions, a low CEA level, and a better Dukes stage of the primary. Likewise, in the patient with recurrent disease locally, surgery provides the only means of cure and also plays a significant role in palliation. Aggressive resection with generous surgical margins in patients with contained disease may yield 5-year survival rates approaching 35%. In patients with unresectable disease and even in those with carcinomatosis, palliation can be obtained by surgical therapy. Judgment is necessary in treating these patients both preoperatively and intraoperatively. Surgical intervention for obstruction, perforation, or other anatomic or physiological compromise is often indicated and can improve the quality of life of the patient with intra-abdominal recurrence.
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PMID:Reoperation for colorectal carcinoma. 170 30

We report a case of an extragonadal germ cell tumor in the retrovesical region. The patient complained of a perineal and micturition pain. Urethrography, CT and MRI showed a retrovesical tumor protruding into the bladder. Alfa-fetoprotein was increased to 12,170 ng/ml. Bilateral testes did not contain any palpable mass by careful palpation. No tumor was detected by ultrasonography, either. Clinically, he was diagnosed as having a retrovesical extragonadal germ cell tumor associated with paraaortic lymph-nodes and bilateral pulmonary metastases. Although he was treated by combination chemotherapy (PVB and VAB-6 regimen) and irradiation, he died of carcinomatosis about 6 months after the admission. There was no evidence of tumor in bilateral testes on autopsy. This case was a second case of extragonadal germ cell tumor originating from the retrovesical lesion in the literature.
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PMID:[A case of retrovesical embryonal cell carcinoma]. 171 80

The general biologic behaviour of exocrine pancreatic cancer was examined retrospectively in a total of 840 autopsies (382 males, aged 31-86 [average 66.5] and 458 females, aged 2-90 [average 72]). 95 % of autopsies showed definable tumours (caput 64%, corpus 17%, cauda 14%), in 5% the gland was diffusely permeated by cancer tissue. 19.5% had no metastases, whereas in 80.5% carcinomatosis was diagnosed. In 7% only locoregional metastases of the lymph nodes could be found. Tumour sizes were observed in the range of 0.3 to 14 cm. All carcinomas below the size of 1 cm were free of metastases. In tumours larger than 2 cm, the formation of metastases increased sharply. In sizes more than 3 cm complications were important for the prognosis. Carcinomatosis proceeds cascade-fashion with high first rate metastatic spread into the liver. 6% of liver metastases were solitary ones, 94% were multiple. In 171 cases malignancy grading was performed. Free of metastases were 50% of the decreased with grade-I-carcinomas, 21% with grade-II-carcinomas and 7% with grade-III-carcinomas. These data comment on the possibilities and limitations of curative cancer resection from a morphological view.
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PMID:[The biological behavior of exocrine pancreatic carcinoma from a pathological-anatomical viewpoint. A contribution to the problems of surgical therapy]. 177 73

This study was performed in 65 patients with cytologically proved malignant ascites to describe and classify direct and indirect sonographic signs of peritoneal carcinomatosis. Abdominal sonography revealed tumour-associated abnormalities which account for malignant ascites in 60 cases (92%). This includes visualisation of peritoneal metastases (n = 16, 25%); matting together of bowel loops (17, 26%); distribution of fluid (19, 29%); echoes within the fluid space (3, 5%); omental matting (8, 12%); associated masses (21, 32%); lymphoadenopathy (31, 48%); and hepatic metastases (26, 40%). Sonography enables the physician to demonstrate direct and indirect signs of peritoneal carcinomatosis in almost all tumour patients with ascites and is therefore useful in determining whether the cause of ascites is malignant or benign disease.
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PMID:Malignant ascites: sonographic signs of peritoneal carcinomatosis. 182 11

Last month, the author discussed epidural spinal cord compression. This month he describes the incidence, clinical presentation, and management of CNS complications from intradural, extramedullary metastases; leptomeningeal carcinomatosis; intramedullary spinal cord metastasis; paraneoplastic myelopathies; radiation myelopathy, and chemo-induced myelopathy.
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PMID:Myelopathies in the cancer patient: incidence, presentation, diagnosis and management. 183 75


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