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

Neuroendocrine tumors of the intestinal tract have low malignant potential but can result in decreased survival if they spread to the liver. The estimated 5-year survival of patients with liver metastases from neuroendocrine tumor is only 20%. Further, morbidity related to the Carcinoid Syndrome and other endocrine symptoms may also greatly reduce the quality of life. Treatment options for liver neuroendocrine tumor include long-acting somatostatin receptor antagonists (LAR), inteferon-alpha, chemotherapy and hepatic artery embolisation with and without chemotherapy. Surgical resection is feasible in select patients, but it may result in major morbidity and even mortality. In our series of 18 patients with liver neuroendocrine tumors, there was no operative mortality and acceptable morbidity. All 10 patients with the Carcinoid syndrome had complete amelioration of symptoms and the 5-year actuarial survival was 80%. Aggressive major surgery for liver neuroendocrine tumor metastases can be performed safely with acceptable mortality by experienced surgeons. Results have been similar for patients with gastrinoma and pancreatic neuroendocrine tumors. Surgical resection appears to result in outstanding long-term survival and amelioration of symptoms. It should be the first-line therapy for patients with liver neuroendocrine tumors in whom the tumor can be completely removed.
Best Pract Res Clin Gastroenterol 2005 Aug
PMID:Endocrine tumours of the gastrointestinal tract. Surgical treatment of neuroendocrine metastases. 1618 28

Hepatic metastases are frequent in patients with gastroentero-pancreatic (GEP) endocrine tumours; their presence significantly influences overall prognosis. Surgery, although the treatment of choice for hepatic metastases, is frequently impossible due to disease extent. Systemic chemotherapy in patients with diffuse and/or progressive liver metastases yields disappointing results especially in patients with metastases from midgut origin. In addition, in patients with carcinoid syndrome, the efficacy of somatostatin analogues wanes due to disease progression and development of tachyphylaxis. Locoregional strategies with vascular occlusion inducing ischemia in these highly vascular GEP tumours are indeed other options and may be performed using either surgical or radiological techniques (e.g. surgical ligation of the hepatic artery, transient hepatic ischemia, or sequential hepatic arterialization). Trans-catheter arterial chemoembolization is efficacious in both the control of hormonal symptoms and yields reliable objective tumour responses. Treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy and may also be considered in certain circumstances.
Best Pract Res Clin Gastroenterol 2005 Aug
PMID:Chemoembolization and other ablative therapies for liver metastases of gastrointestinal endocrine tumours. 1618 29

Patients with neuroendocrine tumours often present with synchronous liver metastases or develop hepatic metastases in the course of their disease. A complete removal of liver metastases with an intention to cure may be accomplished by liver resection or, if hepatic disease is disseminated or hormonal symptoms and pain cannot be controlled medically, by total hepatectomy and transplantation. The indications for orthotopic liver transplantation for metastatic neuroendocrine tumour disease should be anchored in a multimodal and multidisciplinary therapeutic approach. Approximately, 120-130 cases of orthotopic liver transplantation for neuroendocrine tumours have been published so far, but follow-up after transplantation has been limited, and most reports comprise a small number of patients. After considering published studies and data, some recommendations may be given, although these are based on a low level of evidence. After excluding extrahepatic tumour manifestations by imaging procedures and diagnostic laparoscopy, the indication should be chosen restrictively. Few prognostic markers, for example age below 50 years and absence of concurrent extensive surgery, were identified by multivariate analysis in a large retrospective analysis. The prognostic impact of primary tumour localisation is still controversial. However, further indicators of favourable long-term prognosis are needed. Tumour biology characterised by Ki67 and E-cadherin expression may help to identify patients with a favourable outcome so that patient selection can be improved, but this needs further evaluation in larger patient cohorts. Orthotopic liver transplantation for patients with remission of disease or stable disease under medical treatment, and orthotopic liver transplantation for palliative reasons, should be restricted to selected individual cases.
Best Pract Res Clin Gastroenterol 2005 Aug
PMID:Endocrine tumours of the gastrointestinal tract. Transplantation in the management of metastatic endocrine tumours. 1618 32

Gastric endocrine tumours (gastric carcinoids) usually grow from enterochromaffin-like (ECL) cells. Three types of tumour may be distinguished on the basis of the background gastric pathology: type I, which develops in atrophic body gastritis (ABG); type II, which is associated with multiple endocrine neoplasia and Zollinger-Ellison syndrome; and the sporadic type III, which is not associated with any background pathology. This classification plays a major role in determining the optimal approach to these diseases. In fact, type I carcinoids can be considered to be benign lesions, with exceptional risk of metastases. Type II, in contrast, may be associated with distant metastases, which are also common in type III carcinoids. The therapeutic approach is based mainly on endoscopic excision and somatostatin analogues in types I and II, or on surgical resection in type III. Both types I and II grow under the stimulus of hypergastrinaemia through a well-described sequence. However, gastrin is sufficient to cause ECL cell hyperplasia and dysplasia, but not transformation, which is due to menin defects in MEN-I patients, or to other unknown alterations in ABG. Several other candidates--including Bcl2, p53 and MMP9--have been linked with carcinoid initiation and progression. The biology of type III tumours which are not associated with hypergastrinaemia is still poorly understood.
Best Pract Res Clin Gastroenterol 2005 Oct
PMID:Endocrine tumours of the stomach. 1625 92

Midgut carcinoids originating in the small intestine are the most common cause of the carcinoid syndrome. These tumours typically progress slowly and have an extended disease course, and although they often present with metastases at diagnosis, surgical treatment has become increasingly important for their management. Surgery should include efforts to remove mesenteric metastases, which may cause severe long-term abdominal complications with typical fibrotic intestinal entrapment and small-bowel ischaemia due to compression of mesenteric vessels. Attempts should also be made to surgically remove or ablate liver metastases, since this may provide considerable palliation of the carcinoid syndrome. For patients with the carcinoid syndrome surgery is combined with continuous biotherapy with long-acting somatostatin analogues, which may alleviate symptoms and stabilize disease or slow progression. Favourable survival and appreciable quality of life can be expected with this combined treatment, even in patients with advanced midgut carcinoids.
Best Pract Res Clin Gastroenterol 2005 Oct
PMID:Midgut carcinoid tumours: surgical treatment and prognosis. 1625 96

Neuroendocrine tumours (NETs) of the appendix (formerly 'carcinoids') are rare and are usually detected incidentally after appendectomy. Histopathologically they derive from a subepithelial cell population, which is different from NETs in other sites. They are preferentially located at the tip of the appendix. Tumours <1 cm hardly ever metastasize and are treated by appendectomy. Tumours >2 cm require right hemicolectomy because of a significant risk of metastatic spread. Treatment for lesions 1-2 cm is controversial and needs further characterization of the tumour (i.e. mesoappendiceal invasion, vascular invasion, mitotic activity, proliferation markers) and careful patient risk evaluation. Goblet-cell carcinoids have features resembling both carcinoid and adenocarcinoma and should be treated by hemicolectomy. Overall prognosis of small appendiceal NET is excellent in all ages.
Best Pract Res Clin Gastroenterol 2005 Oct
PMID:Neuroendocrine tumours (carcinoids) of the appendix. 1625 97

Neuroendocrine tumours of the colon and rectum are rare but distinct with regard to clinical symptoms, diagnostic and therapeutic management and prognosis compared to other neuroendocrine tumours of the gut as well as ordinary colorectal cancer. Therapeutic algorithms are proposed depending mainly on analogous TNM categories and grading considering conventional and experimental surgical and non-surgical therapy. Colonic neuroendocrine tumours are often misdiagnosed as undifferentiated adenocarcinoma and are therefore not properly treated with adjuvant and additive chemotherapy. As most rectal neuroendocrine tumours are benign because of submucosal extension only, the size and infiltration depth correlates with lymph-node and distant metastases and therefore with the prognosis. It is unknown whether endoscopic ultrasound can improve the diagnostic accuracy compared to size-related conclusions, and therefore whether it can change therapeutic strategies and improve survival by modern rectal surgery.
Best Pract Res Clin Gastroenterol 2005 Oct
PMID:Endocrine tumours of the hindgut. 1625 98

Pancreaticoduodenal tumours (PETs) occur in a majority of MEN-1 patients, and have appeared as a major cause of disease-related death. Previous discussions about treatment have mainly dealt with management of various functioning tumours and clinical syndromes of hormone excess. However, hormonal syndromes often occur late with MEN-1 pancreatic tumours, and when developed indicate presence of metastases in up to 50% of the patients. Prospective screening is therefore recommended in MEN-1 with biochemical markers and endoscopic ultrasound for early detection of PETs, and early surgery before metastases have developed. Surgery is recommended in patients with or without hormonal syndromes in absence of disseminated liver metastases. The suggested operation includes enucleation of tumours in the head of the pancreas, excision of duodenal gastrinomas together with clearance of lymph node metastases, and distal 80% subtotal pancreatic resection as prophylaxis against tumour recurrence. This strategy with early and aggressive surgery is believed to reduce the risks for malignant progression.
Best Pract Res Clin Gastroenterol 2005 Oct
PMID:Pancreatic tumours as part of the MEN-1 syndrome. 1625 3

Pathological fracture is a devastating complication of osteolytic bone metastases. The progression of osteolysis and its effect on bone fracture risk are poorly understood. The goal of this study was to determine the temporal changes in bone strength following tumor inoculation in a preclinical model of tumor osteolysis. In addition, a predictive model was developed between non-invasive radiographic measures and bone strength. The right femora of female nude mice were injected with breast cancer cells; the left limb served as a sham-operated control. Radiographs and DEXA scans were obtained at the time of surgery and at 3, 6, and 9 weeks. Groups of mice were euthanized at each time point for mechanical assessment. Micro-CT analysis was performed on a sub-set of mice with advanced state disease to quantify bone loss. Radiographs documented an increase in tumor osteolysis over time, with 58% of the mice showing signs of osteolysis at 3 weeks, 75% at 6 weeks, and 81% at 9 weeks. BMD measurements revealed a 21.6% increase from baseline in the controls whereas tumor-injected femora failed to increase in BMD over the same time course. Tumor-bearing limbs exhibited statistically significant decreases in torque at failure (86%), energy to failure (88%), and initial stiffness (94%) compared to the controls. Both lysis scores and BMD measurements proved to be modest predictors of mechanical strength, accounting for approximately 73% and 41% of variation in torque at failure, respectively. Micro-CT analysis revealed decreases in both total bone volume in the distal femur (31%) and metaphyseal fractional trabecular bone (89%). We have shown that non-invasive radiographic techniques provide a useful tool for monitoring the progression of tumor osteolysis and for predicting the mechanical strength of tumor-bearing bones in this model. By integrating non-invasive measures of tumor osteolysis and fracture risk, we have validated a clinically relevant platform for evaluating new therapeutic approaches for preserving and/or restoring bone affected by metastatic disease.
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PMID:Temporal changes in bone mass and mechanical properties in a murine model of tumor osteolysis. 1627 5

Accurate staging of rectal and anal carcinoma is crucial for planning surgery and indicating adjuvant therapy. Although, computed tomography and magnetic resonance imaging are very sensitive in detecting metastatic disease, the local staging of rectal cancer with these techniques has been disappointing. Endorectal ultrasound (ERUS) and anal endosonography (AE) remain the most accurate methods for staging rectal and anal cancer. Anal endosonography is also of value in evaluating perianal sepsis: it can assist the surgeon in planning the surgical strategy by delineating the anatomy of fistula tracts, and can aid in puncturing abscesses in the operating room. Continued research and development has made the instrumentation for ERUS and AE more accurate and user-friendly. New techniques that have contributed significantly to the evolution of ERUS include three-dimensional ERUS, high-frequency miniprobes, transrectal ultrasound-guided biopsy techniques and hydrogen peroxide-enhanced endosonography. Further improvements can be expected from contrast enhancement with microbubbles and colour Doppler imaging. In this new millennium, new developments in ERUS and anal endosonography, such as tri-dimensional ERUS and anal endosonography and radial electronic probing, widen the role of ERUS in the staging of rectal and anal carcinoma, as well as for perianal inflammatory conditions.
Best Pract Res Clin Gastroenterol 2006 Feb
PMID:Anorectal ultrasound for neoplastic and inflammatory lesions. 1647 4


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