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)

To evaluate the clinical significance of elevated CEA titers in primary breast cancer post-mastectomy 942 patients were followed up by means of clinical methods and CEA analysis according to a routine schedule. In 282 patients CEA in serum was found to be elevated (greater than or equal to 5 ng/ml) on at least one occasion. Recurrent disease became clinically evident in 255 patients (27%). CEA-positive patients had a significantly higher recurrence rate than CEA-negative patients (52% versus 16%, p less than 0.001). The mean lead time from first elevation of CEA to clinical diagnosis of recurrence was 5 months. The frequency of recurrent disease depended on the height of the CEA titer and the further course of CEA. With titers above 30 ng/ml 91% of patients developed recurrent disease, with constantly elevated or further increasing titers 74% and 100%, respectively. Regarding CEA and the type of metastases, no clear correlation was demonstrable. However, patients with soft tissue metastases exhibited a higher frequency of normal or low (less than 30 ng/ml) CEA titers as compared to patients with visceral or bone metastases. With respect to the criteria mentioned above, CEA is a valuable laboratory tool for early diagnosis of recurrence in breast cancer patients. However, the simple criterion much greater than CEA elevation much less than (5 ng/ml threshold) is of low prognostic significance. Despite intensive clinical searches for metastases and a mean observation time of 20 months, no recurrence became clinically evident in 48% of CEA-positive patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical significance of elevated CEA values in the follow-up management of patients with breast cancer]. 407 51

The treatment protocols of 30 patients with osteosarcoma of the maxilla and mandible presenting to M.D. Anderson Hospital and Tumor Institute over a 30 year period were reviewed. Of the patients who received definitive treatment at this institution, 50 percent of those with maxillary and 71 percent of those with mandibular osteosarcomas survived 5 years. Local recurrences were the major problems, whereas distant metastases occurred less frequently. All patients who died from the cancer did so within 3 years of initial treatment. Primary treatment should consist of aggressive surgical resection. Preoperative radiation therapy is used for mandibular tumors. Postoperative radiation is occasionally used for maxillary cancer. Recurrent disease should be treated by surgery, radiation or chemotherapy as indicated.
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PMID:Management of osteosarcoma of the maxilla and mandible. 693 21

Ninety-nine patients with Stage I or II lung carcinoma that was other than the small cell type and who survived for more than 30 days after a "curative" resection were followed for five years or until death if it occurred prior to the five-year anniversary. Recurrent disease developed in 44 patients. Clinical data and data from postmortem examination were reviewed in these 44 patients in an attempt to classify each recurrence as either initially local or distinct metastatic disease. The site of the first documented recurrence was local in 18 patients and distance metastases in 26. When the patients with recurrence were separated into TNM categories, it was apparent that in those patients without lymph nodes metastases demonstrated in the resected specimen (N0), the initial recurrence tended to be a distant metastases, whereas in those with such involvement (N1), the initial occurrence was more often local. In light of these data, selection of appropriate initial adjuvant therapeutic modalities may be different for each type of patient.
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PMID:Site of recurrence in patients with stages I and II carcinoma of the lung resected for cure. 724 57

Insulinoma in patients with multiple endocrine neoplasia (MEN) is a rare condition that because of its usual multicentricity presents difficulties not encountered in sporadic patients. In contrast to gastrinoma, which is the most common pancreatic neoplasm associated with MEN I, malignancy and duodenal tumors are much less common for patients with insulinomas, and excellent palliative medication is not available. Accordingly, there is a much greater reliance on surgical therapy for this group of patients. Between 1970 and 1991 a total of 19 patients had surgical treatment of MEN I-related insulinoma. Each patient had hyperinsulinemic hypoglycemia. One patient, with extensive metastases, had unresectable disease. Of the remaining 18, there were 16 (89%) multiple pancreatic tumors. Tumors were located in the neck, body, or tail in 17 cases, 10 of whom also had tumors in the head. Pancreatic resections performed were 1 total, 12 subtotal (7 also had enucleation of tumors from the pancreatic head), and 5 limited distal resections and/or enucleation (conservative resection). There was no operative mortality. One patient developed pancreatitis, fistula, and diabetes following subtotal resection and enucleation. Postoperative cure was achieved in 17 of 18 cases. Recurrent disease occurred in 2 of 5 conservative resections compared to 0 of 12 subtotal resections, with median follow-up times of 10.4 and 10.3 years, respectively. During the follow-up period, four patients died, possibly all due to MEN I-related conditions. Hyperinsulinism in MEN I is associated with the occurrence of multiple, usually benign, pancreatic islet cell tumors, and surgery is an effective treatment modality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical management of insulinoma associated with multiple endocrine neoplasia type I. 772 33

Colonic adenocarcinoma is an uncommon but aggressive neoplasm in patients under the age of 40. The goals of this study were to evaluate the utility of computed tomography (CT) in preoperative staging and detection of postoperative recurrences in young patients with colon cancer and to evaluate the pattern of recurrent disease. We reviewed 51 cases of adenocarcinoma in patients aged 40 years and younger. CT preoperatively staged 21 (72%) of 29 patients correctly and had a 100% positive predictive value for metastatic disease. Recurrent disease occurred in 23 (76%) of 30 nonstage D patients with at least 2 years of disease-free follow-up. CT accurately detected 21 (91%) of 23 cases of recurrent disease. Local recurrences were detected in 20 (87%) of 23 patients. Isolated local disease was the most frequent pattern of recurrence, seen in 17 (74%) of 23 patients. Hepatic metastases were rare and occurred in nine (13%) of 51 patients. Young patients with colon cancer have an increased prevalence of isolated local recurrences and decreased rate of hepatic metastases than the older population. In order to detect early, and therefore resectable recurrent disease, CT examinations should be obtained early and often in the postoperative period.
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PMID:Colorectal carcinoma in young patients: CT detection of an atypical pattern of recurrence. 795 Aug 23

We report herein three cases of patients with adrenal metastases from colorectal carcinoma. Recurrent disease was suspected following markedly elevated levels of serum carcinoembryonic antigen (CEA), and adrenal metastases were confirmed by computed tomography (CT) scanning in all three patients. The adrenal metastasis was solitary in one patient and this patient is still alive and free from disease 1 year after undergoing complete removal of the adrenal metastasis. On the other hand, metastatic disease was not limited to the adrenal gland in the other two patients and both died of recurrent disease, 33 months and 4 months after undergoing removal of the adrenal metastases, respectively. Thus, although the prognosis of adrenal metastasis from colorectal cancer is usually poor, we believe that patients with a solitary adrenal metastasis will benefit from complete removal of the metastasis.
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PMID:Adrenal metastasis from carcinoma of the colon and rectum: a report of three cases. 832 38

Recurrent disease after curative resection occurred in 37-44% of patients. The common sites of recurrent disease are at the anastomotic site, in the liver, in the lymph nodes, and in the peritoneal linings. Computed tomography (CT), barium enema, and endoscopy detected local recurrent disease in 61-88% of the patients, whereas magnetic resonance imaging (MRI) detected 80-88% of the cases reported in some Phase 1 studies. CT and MRI are equally effective in the detection of hepatic metastases when lesions are larger than 2 cm, with detectability rate of 95-100%. They are fair (50-60% detectability rate) when tumors are between 1 and 2 cm and poor (less than 40%) when tumors are smaller than 1 cm. For recurrent nodal metastases and peritoneal deposits, CT is the modality of choice.
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PMID:New imaging modalities for follow-up of colorectal carcinoma. 850 85

Between 1980 and 1995, 91 (13.7%) out of 666 patients were determined by pathologic staging to have a superficial squamous-cell esophageal carcinoma of the thoracic esophagus. The male to female ratio was 3.3:1, and the mean age 60 years. Postoperative mortality was 4.3%. The median follow-up was 48 months (range 3-179). Survival was significantly decreased with increased depth of tumour invasion and presence of nodal metastases (P=0.03). Recurrent disease was prevalent in patients with submucosal tumours compared to those with mucosal tumours (P < 0.05). Only intra-epithelial and intramucosal carcinomas deserve the definition of 'early' tumours. Given the relative inaccuracy of current staging modalities and the low morbidity and mortality rates associated with surgical resection, surgery appears to be the mainstay of treatment of superficial squamous-cell esophageal cancer.
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PMID:Prognosis of early squamous cell carcinoma of the esophagus after surgical therapy. 928 73

One hundred fifty-eight procedures were performed on 136 patients with unresectable hepatic metastases using hepatic cryotherapy to ablate the tumors. The median age was 62 years. Patients included 90 males and 46 females. Fifty-eight patients had synchronous metastases, 55 had bilobar lesions, and 90 had precryo chemotherapy. Median preoperative carcinoembryonic antigen (CEA) level was 14.4 ng/dl. The numbers of lesions treated, frozen, and resected were two and one. Median survival of all patients was 30 months. Survival for 39 patients was 37 months. Patients with a CEA level > 100 ng/dl had a statistically worse survival rate than those with a level < 100 ng/dl (P < .001). Twenty patients underwent recryotherapy with median survival of 34 months. Recurrent disease developed in 78% of patients--82% of the patients developed liver recurrence. Complication rates were comparable to liver resection. Operative mortality was 3.7%. Hepatic cryotherapy is effective and safe in treating colorectal hepatic metastases under ultrasound guidance.
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PMID:Treatment of colorectal liver metastases by cryotherapy. 949 86

Between November 1987 and January 1996 pelvic exenteration for primary rectal cancer was carried out in 11 male patients. Two underwent a primary resection with subtotal cystectomy. In the remaining nine patients, the treatment commenced with a staging laparotomy and the fashioning of an end colostomy of the descending colon, followed by preoperative radiotherapy (50-56 Gy in 5 weeks). Total exenteration with uretero-ileo-cutaneostomy was carried out 4-6 weeks later. In two patients, the exenteration was performed despite the detection of hepatic metastases during the second laparotomy. The pathological staging was T4 in six and T3 in five patients. The immediate postoperative course was uneventful in eight patients and their hospital stay averaged 20 days. Serious postoperative complications prolonged the hospital stay of three patients. Three died during the first 6 months. Recurrent disease caused the death of three of the eight remaining patients: one locoregional (7.5 years after surgery), one from pre-existing hepatic metastases (18 months after surgery) and one from the combination of locoregional and distant recurrence (15 months after surgery). Four patients are on follow-up without evidence of disease, 96, 43, 23 and 22 months after surgery. One patient is alive 20 months after exenteration, with two pulmonary metastases having been recently excised. We conclude that, notwithstanding the morbidity rate, total pelvic exenteration is an acceptable option for advanced primary rectal cancer in male patients. Preoperative radiotherapy should be administered for cancers seated in the lower two-thirds of the rectum and perioperative chemotherapy should be considered seriously.
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PMID:Pelvic exenteration for advanced primary rectal cancer in male patients. 984 33


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