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

One hundred patients undergoing pelvic exenteration (total 69, anterior 13, posterior 18) at the University of Michigan Medical Center from 1964-1984 are reported. All patients were followed for at least 5 years or until time of death. The overall cumulative survival was 66% at 3 years and 61% at 5 years. The age of the patients ranged from 21-74 years (median 53). The type of pelvic neoplasm included squamous cell of the cervix, 57; adenocarcinoma of the cervix, nine; squamous cell carcinoma of the vulva, 12; squamous cell carcinoma of the vagina, eight; vaginal sarcoma, four; adenocarcinoma of the vagina, one; adenocarcinoma of the endometrium, four; uterine sarcoma, four; and adenocarcinoma of the ovary, one. The cumulative 5-year survival was significantly related to the presence of metastatic disease to the regional lymph nodes (8% 3-year and 0% 5-year survival), time interval from primary diagnosis to exenteration (within 1 year 44%, 1-10 years 60%, and over 10 years 95%), and cell type (squamous cell 68%, sarcoma 62%, and adenocarcinoma 26%). Patients with squamous cell carcinoma of the cervix (N = 57) had a cumulative 5-year survival of 73%, compared with nine patients with adenocarcinoma of the cervix, who had a 22% 5-year survival. No significant difference in survival existed for the type of exenteration, original stage of squamous cell cervical carcinoma, size of recurrent squamous cell lesion, or age of the patient. Early or late complications occurred in 49 patients. Two patients died in the postoperative period. Small-bowel obstruction was the most common complication seen in this series.
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PMID:Pelvic exenteration, University of Michigan: 100 patients at 5 years. 258 60

Lymph node metastasis is uncommon in patients with microinvasive squamous cell carcinoma of the cervix and is particularly unusual in tumors with early stromal invasion. We describe a patient with maximum stromal invasion of 0.8 mm who had extensive pelvic and para-aortic nodal metastases discovered at laparotomy. Despite combined modality therapy, she died with progressive disease. New clinical staging definitions for Stage IA cervical carcinoma incorporate measurement of both depth of invasion and lateral tumor spread and have resolved many of the descriptive controversies surrounding this entity. Our case illustrates that any degree of stromal invasion carries some risk of nodal metastasis. The management of patients with microinvasive carcinoma should be individualized. An abdominal approach should be considered for patients being treated by extrafascial hysterectomy to allow assessment of the regional lymph nodes. Whether more aggressive therapy will influence the outcome for the rare patient with lymph node metastasis is unknown.
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PMID:Widespread lymph node metastases in a patient with microinvasive cervical carcinoma. 275 28

In a retrospective study conducted at the University of Alabama at Birmingham, the University of Michigan, and the Mayo Clinic, 185 patients with previously untreated FIGO stage IB and IIA squamous cell carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy. Of these patients, 103 received adjuvant pelvic irradiation. Cancer recurred in 76 patients; the median time to recurrence was 3.1 years. The prognostic significance of patient age, clinical stage, lesion diameter, number and location of nodal metastases, and use of adjuvant radiation therapy was determined by multivariate analysis. Only patient age (P = 0.0006), lesion diameter (P less than 0.0001), and number of nodal metastases (P = 0.0004) were noted to be significant factors in determining overall survival. Rates of recurrence were also related to these factors. Employment of these significant variables led to identification of four risk groups. In general, patients with small cervical lesions (diameter less than 1 cm) and no more than two nodes with metastases fell into the low-risk category; those patients with large cervical lesions (diameter greater than 4 cm) and more than two involved nodes fell into the high-risk category. All other patients were categorized into intermediate-risk groups. Ten-year survival was 92% in the low-risk group (n = 13), 70% in the low-intermediate-risk group (n = 66), 56% in the high-intermediate-risk group (n = 66), and 13% in the high-risk group (n = 20). This risk group classification identifies subgroups of early-stage cervical carcinoma patients found to have nodal metastasis at the time of radical hysterectomy that warrant appropriately selected adjuvant therapy.
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PMID:Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early-stage squamous carcinoma of the cervix. 280 1

From June 1977 to June 1987 74 patients were treated with cisplatin for recurrent squamous cell carcinoma of the cervix as the primary chemotherapeutic agent. Sixty-eight patients were evaluable for response or survival. Patients with disease confined to the chest had a 53% complete response rate with an overall response rate of 73%. Patients with localized pelvic recurrences or persistence demonstrated no complete responses and a 21% overall response rate. Isolated chest metastases are more likely to respond to cisplatin than pelvic recurrences (P = 0.0007); however, location of recurrence did not significantly alter survival (mean 22.7 months versus 14.1 months; P = 0.24.). Concomitant disease in other locations reduced the likelihood of response in the chest (P less than 0.05) by virtue of lack of response in those other sites. Lesion size, clinical stage, patient age, and duration from primary treatment to recurrence were not of significance with regard to response or survival. When evaluating response to chemotherapy in recurrent cervical cancer, location of metastasis and effect on survival must be considered.
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PMID:Factors affecting the response of recurrent squamous cell carcinoma of the cervix to cisplatin. 292 Mar 57

Ten patients with squamous cell carcinoma of the cervix stage IB (FIGO) treated by radical hysterectomy and pelvic lymph node dissection had node biopsies taken for immunological studies. There was no evidence of metastases. Node biopsies from near the cervix (the obturator region) contained significantly more lymphoid cells per gram of tissue than biopsies from more distant (common iliac) nodes. The percentage of T cells was similar in the two nodes, but significantly lower than in mononuclear cell suspensions from peripheral blood. All patients responded to the mitogen phytohemagglutinin. Positive T-cell responses to herpes simplex virus antigen were found in seven patients. Six patients responded to stimulation by the chlamydial antigen LGV-2. Lymph node T cells gave responses higher than those from peripheral blood T cells. Obturator node T cells from patients pretreated with intracavitary radium had antigen-specific responses lower than those of the patients operated without prior irradiation. The results indicate that the pelvic lymph nodes are important reservoirs for sensitized T cells.
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PMID:Squamous cell carcinoma of the cervix stage IB: numbers and reactivities of pelvic lymph node T cells. 298 2

Malignant pericardial effusion secondary to pericardial metastases from gynecological malignancies represents an infrequent but potentially life threatening problem. A patient with recurrent squamous cell carcinoma of the cervix causing symptomatic pericardial effusion is presented, and the incidence, mechanism, pathophysiology, treatment, and outcomes of malignant pericardial effusion in patients with gynecologic malignancies are reviewed. This case represents only the fourth reported patient with metastatic carcinoma of the cervix in whom the diagnosis of malignant pericardial effusion was made antemortem, and is the longest survivor of treatment. Gratifying results, in terms of improved quality and length of survival, can be obtained in what is often perceived as a preterminal complication. Recommendations for management are presented, stressing radiation therapy and other local measures following initial pericardiocentesis.
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PMID:Successful management of malignant pericardial effusion in metastatic squamous cell carcinoma of the uterine cervix. 304 63

The effectiveness of postoperative radiotherapy and adjuvant chemotherapy was examined for patients with uterine cervical squamous cell carcinoma. Whole pelvis irradiation is unnecessary for patients with less than 2/3 of depth of cervical local involvement without pelvic regional lymph node metastases. Adjuvant chemotherapy with tegafur [1-(2-tetrahydrofuryl)-5-fluorouracil] (600 mg/day) has failed to improve the survival of patients with positive lymph node metastases.
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PMID:Is postoperative radiotherapy or maintenance chemotherapy necessary for carcinoma of the uterine cervix? 313 32

A series of 117 women with histologically defined, superficially invasive (1-5 mm) squamous cell carcinoma was evaluated to determine important histomorphologic variables, frequency of pelvic lymph node metastases, and outcome. Radical or modified radical hysterectomy with pelvic node dissection was usually performed for women with more than 1 mm invasion, whereas more conservative surgery was used when invasion was 1 mm or less. Depth of stromal invasion was the most important variable in predicting pelvic lymph node metastases. The overall incidence of pelvic node metastases was 5%, and the incidence of metastases in those patients with 3 mm or less and 3.1-5.0 mm of invasion was 2 and 13%, respectively. Although the risk of node metastases was significantly higher with deeper invasion, one patient with 2 mm of invasion had pelvic node involvement. Microscopic lymph-vascular invasion and degree of lateral spread of tumor were also associated with lymph node metastases, whereas tumor grade was not. There were no invasive recurrences in the series. We conclude that histomorphologic variables other than depth of stromal invasion should be considered when evaluating patients with superficially invasive squamous cell carcinoma of the cervix. We recommend that any trends toward less radical therapy for this disease be justified by equal cure rates and careful pathologic review.
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PMID:Superficially invasive squamous cell carcinoma of the cervix. 340 56

From April of 1969 through December of 1980, 197 patients with Stage IB, invasive, epidermoid carcinoma of the cervix received radical radiation therapy. The treatment consisted of external beam and intracavitary therapy designed to deliver 7000 to 8000 rad to Point A and 5000 to 5500 rad to the pelvic lymph nodes. The 2-, 5-, and 10-year, disease-free survival rates were 87%, 83%, and 81%, respectively. Thirty-six patients developed recurrent and/or metastatic disease. The sites that failed to remain disease-free were: locoregional in five patients (3%), locoregional with distant metastases in 15 patients (8%), and distant metastases only in 14 patients (7%). In addition, there were two patients (1%) who are considered to have died of disease but the site or sites of recurrence could not be determined. Thirty-nine patients developed complications. The complications were mild and self-limiting--Grade I--in 24 patients (12%) and of moderate severity--Grade II--in eight patients (4%). Seven patients (4%) developed severe--Grade III--complications. A correlation was found between the dose to Point A, the bladder, and the rectum and the complications. The mean dose to Point A for patients without and with complications were 7453 rad (SE +/- 91) and 7737 (SE +/- 124), respectively, with a P value of .05. The mean dose to the bladder for patients without and with urinary complications was 5590 rad (SE +/- 103) and 6335 rad (SE +/- 411), respectively, with a P value of 0.14. The mean dose to the rectum for patients without and with intestinal complications was 5837 rad (SE +/- 103) and 6810 rad (SE +/- 236), respectively, with a P value of 0.001. No correlation was found between the dose to Point A and locoregional recurrences.
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PMID:Analysis of results of radiation therapy for stage IB carcinoma of the cervix. 344 Feb 29

Thirty patients with advanced stage squamous cell carcinoma of the cervix underwent exploratory celiotomy and para-aortic lymphadenectomy prior to beginning radiation therapy. Para-aortic lymph node metastases were found in 9 patients (30%), and visceral metastases in 2 patients (7%). Findings at celiotomy prior to initiation of therapy allowed patients to be divided into 3 groups: Patients with 1) visceral metastases, 2) para-aortic lymph node metastases but without visceral or scalene lymph node metastases, and 3) patients with disease confined to the pelvis. Therapy was then based on the extent of disease present in each patient. As a result of the surgical findings, 10 of 30 patients (33%) received therapy other than standard pelvic radiation therapy. The surgical technique, operative morbidity, and prognostic significance of the surgical findings are discussed.
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PMID:The influence of pretreatment celiotomy and para-aortic lymphadenectomy on the management of advanced stage squamous cell carcinoma of the cervix. 356 35


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