Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

The traditional approach to immunotherapy for metastatic renal cell cancer, to first reduce the tumor burden by nephrectomy and then offer systemic therapy, has been challenged recently. There is mounting evidence that objective responses in the metastatic disease can be achieved without prior nephrectomy, although responses in the primary tumor are much less frequent. We describe our experience that some patients may, in fact, have significant responses in extensive local disease and become surgical candidates after systemic immunotherapy. A 46-year-old patient who presented with a large renal primary tumor and pulmonary metastases was treated with high-dose interleukin 2 therapy. A complete response in the lung and partial response in the primary tumor was achieved. The patient then underwent resection of his primary tumor, and on histological evaluation only minimal residual cancer was present. He has no evidence of disease at 14 months. This case demonstrates that immunotherapy can achieve not only objective responses at metastatic sites but also in the primary tumor.
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PMID:Immunotherapy for metastatic renal cell cancer: effect on the primary tumor. 831 98

In order to evaluate the local residual cancer following breast conservation therapy (BCT) with lumpectomy, we investigated the relationships between residual cancer and age, tumor location, tumor diameter (T), mammography findings, nipple discharge findings, histopathological type, lymphatic and/or vascular invasion by tumor cells, histological grading, histological lymph node metastases (n), and estrogen receptor (ER) status, in 1494 patients with breast cancer that involved diagnostic excisional biopsy. Residual cancers were found in 581 of 1448 (40%) mastectomy specimens, after 46 (3.1%) with multicentricity had been excluded. No correlation was observed between residual cancer and age, histological grading, and ER. However, residual cancer rates were significantly higher in patients with: (1) tumor diameters of 3.1 cm or larger; (2) tumors beneath or in the vicinity of the nipple-areola; (3) malignant calcifications noted in mammography findings; (4) serous or bloody nipple discharge, particularly with positive cytologic findings; (5) papillotubular carcinoma diagnosed by biopsy, (6) lymphatic invasion by tumor cells; or (7) a high degree (n > or = 4) of lymph node metastases. The above seven clinicopathologic factors are thus considered useful prognostic indicators for local recurrence in BCT with lumpectomy.
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PMID:Prognostic factors for local recurrence in breast conservation therapy: residual cancers after lumpectomy. 832 33

From January 1987 to December 1990, 14 consecutive patients with resectable metastases from renal cell carcinoma, underwent 3 cycles of preoperative alpha-2a Interferon (INF), 18 MUI s.c. 3 times a week, and Vinblastine (VLB), 0.15 mg/kg on day 1, every 21, days. Out of the 13 patients who completed the treatment, 4 (30.7%) achieved a clinical response (1 CR and 3 PR). Nine (69.3%) patients were submitted to surgery: all, including the CRer, had residual cancer and only 4 were radically resected. The latter were further submitted to 3 INF and VLB cycles: 2 relapsed after 7 and respectively 30 months, whilst 2 (15.4%) are alive disease-free at 12 and 52 months respectively.
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PMID:[Interferon and vinblastine in presumably operable metastases of renal carcinoma]. 833 64

The examinations were performed on thirty patients with biopsy-confirmed squamous cell carcinoma of the oral cavity in clinical stage T2-3No-2M0. The aim of the present study was to perform a histological evaluation of the effect of preoperative intra-arterial treatment of surgically removed tumours and to analyse the correlations with the survival of the patients. The tumour regression (R) was evaluated quantitatively on a scale ranging between 1 and 4 points. The evaluation yielded a value of R1 in 8/30 cases (residual tumour was not found histologically). A tumour of microscopic size (R2) was found in 5/30 cases. Partial regression (R3) was established in 12/30 cases, and a slight response (R4) in 5/30 patients. The histologic picture was evaluated qualitatively on the basis of three arbitrarily chosen parameters. Examinations were made on the morphological picture of the residual cancer (C), the inflammatory reaction of the stroma (S) and the demarcation tendency of the tumour (D) and the sum of these values (A). The higher this point score, the poorer the tumour in question responds. Tumours with a score of A3-5 proved to have a very favourable prognosis in contrast with those with a score of A8-9. For the borderline scores of A6-7 the subsequent fate of the patient was decided by the extent of the original tumour and by the occurrence or not metastases. It is noteworthy that, with a comparatively small number of patients, a significant correlation was demonstrated between the survival and the total qualitative point count (A), the S value and the D value.
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PMID:[Correlation between tumor regression and survival time after chemotherapy in cancer of the oral cavity]. 835 Nov 45

A 63-year-old woman complaining of a non-productive cough was referred to our hospital. A chest X-ray film and computed tomographic scan showed a large mass in the S9 region of the right lung, and many intrapulmonary nodules with thin-walled cavities. A transbronchial biopsy specimen revealed moderately differentiated adenocarcinoma of bronchial gland origin. By the end of four cycles of chemotherapy with vindesine, ifosfamide, and cisplatin, the primary mass had markedly regressed, the many metastases had disappeared, and a few bullous lesions remained. On the second admission, many intrapulmonary metastases and cavities were seen again. Although some of the cavities may have been associated with regrowth of residual cancer cells around the remaining bullae, some nodules showed newly-developed thin-walled cavities, and in others bullous lesions developed again. These observations indicate that a check valve mechanism may operate in the formation of the thin-walled cavities.
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PMID:[Moderately differentiated adenocarcinoma of the lung presenting as multiple intrapulmonary metastases with thin-walled cavities]. 871

The incidence of local relapse after complete (R0) resection of solid tumors is largely determined by the skill of the surgeon, whereas metastatic relapse in distant organs is caused by pre- or perioperative systemic dissemination of tumor cells. The presence of individual disseminated tumor cells--e.g., in bone marrow as indicator organ--can be detected by sensitive immunocytochemical and molecular methods and is increasingly considered as a clinically relevant prognostic indicator. In contrast to solid metastases, isolated micrometastatic tumor cells are appropriate targets for intravenously applied anti-cancer therapeutics because they are easily accessible to macromolecules and immunologic effector cells. The majority of these tumor cells appear to be nonproliferating (i.e., in the G0 phase of the cell cycle), which may explain the failure of adjuvant chemotherapy. Adjuvant therapeutic strategies aimed at quiescent tumor cells are therefore of increasing interest. This therapeutic rationale has been tested and confirmed in a randomized clinical trial using antibody 17-1A in patients with non-metastatic colorectal carcinoma (UICC stage III). The antibody therapy kills also quiescent tumor cells ("dormant cells") and is independent from a potential chemotherapy resistance of the tumor cells. As treatment for minimal residual cancer, the clinical use of antibody therapy could be envisaged in conjunction with chemotherapy, applied either in parallel or sequentially. The aim of this review is to present and discuss the current state of research in the field of diagnosis and therapy of minimal residual cancer.
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PMID:[Disseminated tumor cells: diagnosis, prognostic relevance, phenotyping and therapeutic strategies]. 948 47

In this study the combination of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) is shown to be effective for detecting early prostate cancer in a urological out-patient setting. PSA provides the means to detect cancer in men with normal DRE that may otherwise present as so-called incidental cancer at transurethral resection of the prostate (TURP) for apparently benign disease or later in the course of its natural history as locally advanced or metastatic disease. PSA progression in men with incidental cancer has been previously demonstrated to be predicted more reliably by residual cancer on needle biopsy after TURP than by tumour in the resected specimen and, therefore re-staging such patients is worthwhile when further treatment would be considered. Among men selected for radical prostatectomy, non-palpable tumours detected with PSA more predictable in pathological extent than incidental cancer and their particular pathological characteristics suggest they include clinically significant tumours that would progress if untreated to palpable and eventually metastatic disease. In view of this progressive behaviour, cancer detected by PSA should be considered clinically significant particularly in men with a life expectancy of at least 10 years. Therefore screening should be offered for such individuals, to detect and treat tumours at a curable stage and thereby eliminate the high mortality and often protracted morbidity commonly associated with metastatic disease.
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PMID:Does screening for prostate cancer identify clinically important disease? 1036 58

Metastatic relapse in patients with solid tumors is caused by systemic preoperative or perioperative dissemination of tumor cells. The presence of individual tumor cells in bone marrow and in peripheral blood can be detected by immunologic or molecular methods and is being regarded increasingly as a clinically relevant prognostic factor. Because the goal of adjuvant therapy is the eradication of occult micrometastatic tumor cells before metastatic disease becomes clinically evident, the early detection of micrometastases could identify the patients who are most (and least) likely to benefit from adjuvant therapy. In addition, more sensitive methods for detecting such cells should increase knowledge about the biologic mechanisms of metastasis and improve the diagnosis and treatment of micrometastatic disease. In contrast to solid metastatic tumors, micrometastatic tumor cells are appropriate targets for intravenously applied agents because macromolecules and immunocompetent effector cells should have access to the tumor cells. Because the majority of micrometastatic tumor cells may be nonproliferative (G0 phase), standard cytotoxic chemotherapies aimed at proliferating cells may be less effective, which might explain, in part, the failure of chemotherapy. Thus, adjuvant therapies that are aimed at dividing and quiescent cells, such as antibody-based therapies, are of considerable interest. From a literature search that used the databases MEDLINE(R), CANCERLIT(R), Biosis(R), Embase(R), and SciSearch(R), we discuss the current state of research on minimal residual cancer in patients with epithelial tumors and the diagnostic and clinical implications of these findings.
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PMID:Detection and clinical importance of micrometastatic disease. 1039 19

With the advent of new therapeutic modalities, the treatment options for oncologists can vary greatly depending upon the aggressiveness of the patient's cancer. Patients may receive no therapy, adjuvant therapy, aggressive adjuvant therapy (taxane based), monoclonal antibody therapy (e.g. Herceptin) or bone marrow transplantation. It is now mandatory to determine accurate prognostic patient profiles at diagnosis and during therapy to determine who would benefit most from a particular therapeutic regimen or to determine who should be shifted into more aggressive therapy. We now have ultra-sensitive methods of tumor cell detection that can determine the presence of minimal residual cancer (MRC) in marrow, stem cell product (SCP) and lymph node to help create these prognostic profiles. The author has conducted a critical review of the literature regarding the type of testing used to detect MRC, the incidence of MRC in marrow, SCP, and lymph node, and the clinical significance of MRC at diagnosis and during therapy. To date it is now clear that immunohistochemistry is a very useful diagnostic tool with adequate sensitivity to detect MRC. The presence of MRC at diagnosis in marrow and/or lymph node is associated with a poor prognosis for a number of disorders including breast cancer, neuroblastoma, gastrointestinal tumors, and lung cancer. In addition, the presence of MRC during therapy in marrow and/or SCP is associated with a very poor prognosis for patients with breast cancer. The use of testing for MRC in the patient provides prognostic information that may be of use to the oncologist.
Cancer Metastasis Rev 1999
PMID:Clinical relevance of minimal residual cancer in patients with solid malignancies. 1050 48

Improvements in surgery and radiotherapy techniques have led to only a modest increase in the 5-year survival rate for patients with head and neck cancer. This is because the pattern of clinical disease is changing, such that locoregional recurrence now accounts for fewer treatment failures, but more patients develop a second primary cancer or distant metastatic disease. In this study, we have used the p53 phage plaque assay, immunocytochemistry, and mutational analysis to assess the contribution of minimal residual cancer and genetic aberrations in clinically normal upper aerodigestive tract mucosa to treatment failure. Eighteen consecutive patients with oral tumors, with conventional clear margins, have been followed for a minimum of 36 months. Molecular assessment identified tumor-positive surgical margins for 6 of 11 assessable patients and additional tumor-positive lymph nodes for three cases. Disseminated malignant cells were detected in the hematopoietic cell compartment for six cases, and one patient had molecular evidence of field cancerization. Locoregional recurrence developed in five patients with tumors harboring a p53 gene mutation; four of these were associated with tumor-positive surgical margins, and one was associated with molecular evidence of field cancerization. Radiotherapy to the primary site did not prevent development of local recurrence when the residual tumor harbored a p53 gene mutation. Three of six cases with a tumor-positive bone marrow aspirate developed distant metastases. These findings reveal that molecular and immunocytochemical detection of minimal residual cancer and field cancerization can help identify patients who may develop locoregional or distant recurrence and justify further studies to evaluate the contribution of these remaining malignant cells to treatment failure.
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PMID:Detection of minimal residual cancer to investigate why oral tumors recur despite seemingly adequate treatment. 1091 16


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