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)

Spontaneous regression or remission (SR) of cancers has been defined as the disappearance of the malignancies without any treatment or with obviously inadequate treatment. Four case reports are presented. These include a case of pleomorphic liposarcoma with bilateral lung metastases, a case of recurrent squamous cell carcinoma of the esophagus following esophagectomy a year earlier, a case of a squamous cell carcinoma of the scalp, and a case of a ruptured hepatocellular carcinoma with an emergency right hepatic lobectomy but with some gross cancer remaining in the left hepatic lobe. The literature of SR of cancers was reviewed and various mechanisms possibly involved in the disappearance of the cancers were discussed. Although immune modulation has been stated to be the most likely process causing SR, other mechanisms, such as genetic therapy, withdrawal of carcinogens, infection, fever and vaccine roles, apoptosis, antibody, antiangiogenesis and maturation mechanisms, withdrawal of therapy, natural killer activity, endocrine, hormonal, and pregnancy factors, and prayers or psychoneuro-religious participation were also mentioned. Induction and inhibition of malignant protein expression and repair of gene damage may prove to be the more important processes in cancer regression. It was also pointed out that the pulmonary metastases of the liposarcoma and the recurrent squamous cell carcinoma of the esophagus may be the very first cases of their kind to be described and that it is rare indeed to find 4 cases of SR's in a solo practice. Finally, it is likely that SR is rarer than previously believed and that the incidence may be one in every 140,000 cases of cancer rather the one per 60,000 to 100,000 cancer cases as earlier thought.
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PMID:Complete spontaneous regression of cancer: four case reports, review of literature, and discussion of possible mechanisms involved. 1178 63

Recent studies point out that cytokeratins (CKs) are involved in dynamic cell remodeling during cancer progression and particularly, CK expression patterns have been associated with invasion and metastasis. In oesophageal squamous cell cancer (ESCC), lymph node (LNN) metastasis is an important step in disease progression, invariably associated with an ominous prognosis. To assess whether specific CK expression patterns could represent reliable markers of tumor progression, a series of 111 ESCCs (59 lymph node-positive, 52-negative) derived from the high- incidence area of Linxian (Northern China), were subjected to immunohistochemical (IHC) analysis with an extensive panel of CK antibodies. Statistically significant differences were observed for CK18 (p=0.01), CK19 (p=0.04) and PKK1 (p=0.02) expression between the LNN-negative and LNN-positive ESCCs. Furthermore, significant correlation between specific CK distribution pattern and progressive disease (i.e., LNN metastasis) was evidenced. The results suggest that CK8, CK18 and CK19 expression and distribution pattern could be of predictive value as a marker of disease progression as defined by the appearance of lymph node metastases in oesophageal squamous cell cancer.
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PMID:Cytokeratin expression patterns as an indicator of tumour progression in oesophageal squamous cell carcinoma. 1191 18

In patients with squamous cell carcinoma of the esophagus, the preoperative clinical staging of the N category is primarily based on the lymph node size. Lymph nodes > 10 mm are considered to be tumor-infiltrated. This histopathologic study investigated the correlation of lymph node size and metastatic infiltration in esophageal carcinoma of patients with and without neoadjuvant radiochemotherapy. The specimens of 40 patients with squamous cell carcinoma of the esophagus were included in a prospective morphometric study. Half of these patients (n = 20) received preoperative radiochemotherapy. The number of resected lymph nodes were counted, and the largest diameter of each node was measured. Metastatic involvement of each node was analyzed by histologic examination. The frequency of lymph node metastases was calculated and correlated to the lymph node size. A total of 1196 lymph nodes with an average of 29.9 nodes per patient were resected and analyzed; 129 lymph nodes (10.8%) showed metastatic infiltration. The average size of 1067 tumor-free lymph nodes was 5.1 +/- 3.8 mm in maximum diameter, whereas the average size of 129 metastatic lymph nodes was 6.7 +/- 4.2 mm (p = 0.00006). Of all resected lymph nodes, 761 (63.6%) were < or = 5 mm in maximum diameter. Only 9.3% (n = 111) of all resected lymph nodes were > 10 mm in maximum diameter. There was no significant correlation between lymph node size and the frequency of nodal metastases. No difference in size could be demonstrated between patients with and without neoadjuvant radiochemotherapy. Diagnostic imaging techniques using size as the criterion of nodal infiltration cannot exactly assess the nodal status of patients with esophageal carcinoma. This is also true for patients after neoadjuvant radiochemotherapy. Therefore, evaluation of the nodal status in patients with squamous cell carcinoma of the esophagus is entirely based on pathohistologic analysis after a well defined lymphadenectomy.
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PMID:Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. 1209 49

Patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus should undergo computed tomography of the chest and abdomen and positron emission tomography to look for evidence of distant metastatic disease. In the absence of systemic metastases, locoregional staging should be performed with endoscopic ultrasonography and fine needle aspiration of accessible periesophageal lymph nodes and any detectable celiac lymph nodes. Patients found to have T3 tumors (transmural extension), T4 tumors (invasion of adjacent structures), or N1-M1a (lymph node-positive) disease do poorly when treated with surgery alone; 5-year survival is less than 20%. These patients should be considered for combined modality therapy. Patients with T4 disease are generally not deemed candidates for surgical resection; they may be considered for definitive chemoradiotherapy. Patients with T3 disease or lymph node-positive disease may be treated with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy alone. Patients considered for trimodality therapy should be fully restaged before surgery to assess their response to neoadjuvant treatment. This should include repeat endoscopic ultrasound and fine needle aspiration of lymph nodes. Patients whose lymph node metastases do not completely respond to neoadjuvant therapy are unlikely to benefit from the addition of surgery. Patients with persistently positive celiac lymph nodes have a very poor prognosis and should not undergo surgery. Patients with persistent nodal disease who have good performance status may be considered for additional chemotherapy. Patients with locally advanced esophageal cancer who have poor performance status are not good candidates for combined modality therapy. These individuals are best managed with palliative intent. Particular attention should be given to alleviating the common problem of dysphagia, which causes significant morbidity.
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PMID:Locally advanced esophageal cancer. 1239 37

Vinorelbine and docetaxel are two effective drugs in esophageal cancer; our purpose was to evaluate efficacy and toxicity of a combination of these drugs in recurrent squamous cell esophageal cancer. Twenty patients previously treated with concomitant chemoradiotherapy (n = 14), surgery alone (n = 2), surgery plus radiotherapy (n = 2), or concomitant chemoradiotherapy + surgey (n = 2) were enrolled. Thirteen patients had a local-regional recurrence, two patients had metastases, and five patients had both. The doses were 80 mg/m(2) for docetaxel and 20 mg/m(2) for vinorelbine on d 1 every 21 d for a maximum of six cycles. Twenty patients received a total of 106 cycles (median per patient, 5). Neutropenia was the most frequent and severe side effect (grade 4 in 80%; grade 3 in 20%). The overall response rate was 60%, which included 3 of 20 complete responses (15%) and 9 of 20 partial responses (45%). Median response duration was 7 mo (2-50+). Overall median survival was 10.5 mo (range, 2-55+). A dysphagia improvement was observed in 81% of patients. In conclusion, the data from this phase II study indicate that this combination is effective in recurrent heavily pretreated patients with a short-lasting manageable toxicity.
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PMID:Docetaxel and vinorelbine: an effective regimen in recurrent squamous cell esophageal carcinoma. 1266 80

Similar to squamous cell esophageal cancer, the lymph node status constitutes the major prognostic factor after complete tumor resection (R0-resection) in patients with adenocarcinoma of the distal esophagus (the so-called Barrett's cancer). Lymphatic spread in patients with Barrett's cancer, however, appears to follow certain rules. Lymphatic spread is closely correlated to the pT-category of the primary tumor, starts only after infiltration of the submucosa und is initially limited to the regional lymph nodes. Distant lymph node metastases are almost exclusively found in patients with multiple positive regional nodes, skipping of regional lymph nodes is rare. These observations set the stage for tailored lymphadenectomy-strategies based on the, sentinel-lymphadenectomy' concept.
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PMID:[Lymph node excision in invasive Barrett carcinoma]. 1270 34

Focal adhesion kinase (p125(FAK); 'FAK') is a tyrosine kinase that is localised to cellular focal adhesions and is associated with a number of other proteins, such as integrin adhesion receptors. We performed an immunohistochemical analysis of FAK protein expression to determine the relationship between FAK overexpression and clinicopathological factors in oesophageal squamous cell carcinoma (ESCC). We examined tissue specimens that had been removed from 91 patients with thoracic oesophageal cancer who had undergone surgery between 1983 and 2001. Immunohistochemical staining was performed by the standard streptavidin-biotin method. Seven human ESCC cell lines-TE-1, TE-2, TE-8, TE-13, TE-15, TT, and TTn-and one immortalized human keratinocyte cell line-HaCaT-were used in Western blot analysis. Immunostaining of FAK was seen in the cytoplasm of cancer cells, particularly in cells located in the invasive fronts of cancer nests. FAK overexpression was detected in 54 of the 91 patients (59.3%). Significant correlations were observed between FAK overexpression and cell differentiation (P=0.0057), depth of tumour invasion (P=0.0023), presence of regional lymph node metastasis (P=0.0097), number of lymph node metastases (P=0.0026), and disease stage (P=0.012). The survival rates of patients with FAK-overexpressing cancer were significantly lower than those of patients without FAK-overexpression cancer (P=0.006). The 5-year survival rate of patients without FAK overexpression was 69%, whereas that of patients with FAK overexpression was 38%. On Western blot analysis, FAK was expressed at a high level in TE-1, TE-8, TE-15, and TT cells, at a moderate level in TE-2 and TTn cells, and at a low level in TE13 and HaCaT cells. FAK phosphorylation at tyrosine 397 was demonstrated in proportion to the intensity of FAK in all cell lines except TE15 and HaCaT. In conclusion, FAK overexpression of ESCC was related to cell differentiation, tumour invasiveness, and lymph node metastasis. Consequently, patients with ESCC who had FAK overexpression had a poor prognosis.
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PMID:FAK overexpression is correlated with tumour invasiveness and lymph node metastasis in oesophageal squamous cell carcinoma. 1283 15

As in squamous cell esophageal cancer, the presence and number of lymph node metastases constitutes the major prognostic factor in patients with adenocarcinoma of the distal esophagus (the so-called Barrett's cancer) who have had complete tumor resection (R0 resection). In contrast to squamous cell esophageal cancer, however, lymphatic spread in patients with Barrett's cancer appears to follow certain rules. Lymphatic spread is closely correlated with the pT category of the primary tumor; it starts only after infiltration of the basal membrane, and initially it is limited to the regional lymph nodes. Lymph node metastases at distant locations-i.e., the upper mediastinum and the celiac axis-are found almost exclusively in patients with multiple positive regional nodes. Skipping of regional lymph node stations occurs in less than 5% of the patients. These observations set the stage for individualized and tailored lymphadenectomy strategies. The sentinel lymphadenectomy concept may be applicable to patients with early Barrett's cancer.
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PMID:Pattern of lymphatic spread of Barrett's cancer. 1291 58

Barrett's carcinoma, usually arising in the distal esophagus, must be considered a separate entity from squamous cell esophageal cancer. Epidemiology, etiology, patients' risk profiles, biology of metastases, and prognosis differ markedly between these two major esophageal tumor types. The preoperative work-up of patients with Barrett's cancer is primarily directed toward assessing the chances for R0 resection and estimating the risk of the patient to survive an esophagectomy. If R0 resection appears likely and the surgical risk is acceptable, the indication for an operative approach is given. From the oncologic point of view there is no difference between a radical transmediastinal approach and a transthoracic approach. A possible advantage of a transthoracic approach is the extension of lymphadenectomy to the upper mediastinum. Lymph node metastases in the upper mediastinum, however, usually indicate advanced lymphatic and subclinical systemic tumor dissemination, i.e., a poor prognosis even with extended surgery. Consequently the controversies about the surgical approach are reduced to technical and functional aspects. A better swallowing function argues for an intrathoracic anastomosis; the lower morbidity, for a cervical approach. We prefer transthoracic en bloc esophagectomy with an intrathoracic anastomosis in patients with moderate risk and early tumor stages. In all other patients radical transmediastinal esophagectomy with a cervical anastomosis is the procedure of choice. The overall 5-year survival rate of more than 40%, which is superior to most published data, supports this therapeutic strategy.
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PMID:Surgical approach to invasive adenocarcinoma of the distal esophagus (Barrett's cancer). 1292 5

Mucoepidermoid carcinoma of the esophagus (MEC) is uncommon and has not been fully investigated. The biological behavior and clinical aspects of MEC were studied. The clinical features of eight patients with MEC were compared with 51 cases of squamous cell carcinoma of the esophagus (SCC). Proliferating cell nuclear antigen (PCNA), p53, and carcinoembryonic antigen (CEA) were stained in the resected specimens by immunohistochemistry. Seven out of 8 cases (87.5%) had stage III by TNM classification. Four cases died of widespread metastases and 2 cases died of local recurrence within 2 years after the surgery. Neither chemotherapy and radiotherapy were effective against MEC. Overall median survival periods were 10.8 months for MEC and 32.1 months for SCC (P<0.05). When patients in stage III alone were compared, MEC tended to have a worse prognosis than SCC (P=0.058). Immunohistochemical studies revealed that the positive rates of PCNA and CEA were significantly higher in MEC than in SCC (P<0.05), while there was no significant difference in p53 positive rate. Esophageal MEC had an aggressive biological nature and was resistant to adjuvant therapies. The poor prognosis of esophageal MEC may be caused by high proliferative and metastatic potential.
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PMID:Biological behavior of mucoepidermoid carcinoma of the esophagus. 1457 40


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