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

Most patients with obstructive jaundice caused by primary pancreaticobiliary malignancies and metastatic disease cannot be cured by surgical resection when diagnosed. Biliary drainage in the management of obstructive jaundice therefore represents one of the most important issues in the palliative treatment of these patients. For more than 20 years, percutaneous transhepatic biliary drainage procedures have allowed a nonsurgical approach to the management of malignant biliary obstruction. Improvements in radiologic access systems have extended the use of the percutaneous biliary approach, especially since the advent of metallic stents. Nursing care of these patients before, during, and after the percutaneous biliary intervention is challenging. Patient and family need to be educated about the aim and consequences of the procedure as well as its complications. To care for these patients, the nurse must understand the techniques of percutaneous transhepatic biliary drainage. The purpose of this article is briefly to review the etiology of biliary obstruction, the current treatments to relieve obstructive jaundice, and the basic steps of biliary intervention techniques. The nursing management throughout the procedure, the patient preparation before the procedure, and most importantly, the postprocedural nursing care are discussed.
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PMID:Management of patients with malignant obstructive jaundice. Nursing perspective from the interventional radiology room. 1076 84

Adenocarcinoma of the pancreas is the fifth most common cause of cancer death in the United States. It affects men and women fairly equally and is most frequently diagnosed in the eighth decade of life. It may occur as part of hereditary/familial pancreatitis with an identified genetic mutation, and smokers are at increased risk. Cancer most often occurs in the pancreatic head and often leads to biliary obstruction with a clinical presentation of painless jaundice. The principal diagnostic modality is dedicated pancreatic computed tomography (CT) scanning, although other imaging techniques have a role. Endoscopic retrograde cholangiopancreatography (ERCP) is generally reserved for obtaining tissue, for which it is insensitive, or for palliative stenting. Surgery with the Whipple procedure offers the only chance of cure. Patients are staged as resectable if there are no distant metastases to lymph nodes or organs and there is no major vessel involvement. The 5-year survival rate for resectable patients is about 10% with a median survival of 12 to 18 months. Unresectable patients live about 6 months. Adjuvant chemotherapy with 5-fluorouracil (5-FU) or gemcitabine provides modest benefits. Palliative biliary decompression, pain control, and maintenance of gastric drainage are the usual forms of therapy.
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PMID:New developments in pancreatic cancer. 1095 Apr 64

We report a case of gallbladder carcinoma associated with biliary obstruction and portal vein stenosis caused by massive lymph node metastases. The patient, a 59-year-old woman, was treated with self-expandable metallic stents--a spiral Z-stent in the portal vein, and a Wallstent in the bile duct--and intra-arterial infusion chemotherapy. She returned to work immediately after leaving the hospital, and has been treated with intra-arterial infusion chemotherapy once a week at our outpatient department. At present, she has good quality of life, with patency of both endoprostheses, 8 months after the placement of the metallic stents in the portal vein and the common bile duct. This case shows that portal vein and biliary stenting, together with intra-arterial infusion chemotherapy, can be an effective modality for the palliative treatment of advanced gallbladder carcinoma involving the portal vein and bile duct, to improve quality of life.
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PMID:Palliative treatment with metallic stents for unresectable gallbladder carcinoma involving the portal vein and bile duct. 1098 36

Abdominal ultrasound is the primary imaging study for patients with suspected pancreatic carcinoma. Unless the tumor is large, this test might not be abnormal. The next appropriate test in the diagnostic work-up is the EUS. If this technique is not available, dual-phase spiral CT might be ordered instead. In cases which remain unclear or require palliative relief of biliary obstruction. It has been proposed that diagnosis and staging of a pancreatic carcinoma can be afforded by an all-in-one investigation using MRI, MRCP and MR-angiography. But at present, the superiority of MRI for diagnosing pancreatic cancer is insufficiently established. Conventional angiography does no longer play a role in the staging process. Fine-needle aspiration of focal pancreatic lesions is only recommended in patients who have unresectable lesions or who are more likely to have a focal inflammatory lesion in chronic pancreatitis. Laparoscopy is indicated if there is a high likelihood of unrecognized peritoneal or hepatic micrometastases in patients who are otherwise candidates for a surgical cure. Furthermore, laparoscopy should only be performed if the proof of metastases precludes further surgery or if palliative surgery is not necessary. Tumor markers and genetic markers might help to detect pancreatic cancer. However, the optimal screening method for the diagnosis of early and potentially curable pancreatic cancer is not in sight as yet.
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PMID:[Gastroenterology diagnosis of pancreatic carcinoma]. 1114 38

Primary carcinoma of the gallbladder is an uncommon, aggressive malignancy that affects women more frequently than men. Older age groups are most often affected, and coexisting gallstones are present in the vast majority of cases. The symptoms at presentation are vague and are most often related to adjacent organ invasion. Therefore, despite advances in cross-sectional imaging, early-stage tumors are not often encountered. Imaging studies may reveal a mass replacing the normal gallbladder, diffuse or focal thickening of the gallbladder wall, or a polypoid mass within the gallbladder lumen. Adjacent organ invasion, most commonly involving the liver, is typically present at diagnosis, as is biliary obstruction. Periportal and peripancreatic lymphadenopathy, hematogenous metastases, and peritoneal metastases may also be seen. The vast majority of gallbladder carcinomas are adenocarcinomas. Because most patients present with advanced disease, the prognosis is poor, with a reported 5-year survival rate of less than 5% in most large series. The radiologic differential diagnosis includes the more frequently encountered inflammatory conditions of the gallbladder, xanthogranulomatous cholecystitis, adenomyomatosis, other hepatobiliary malignancies, and metastatic disease.
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PMID:Gallbladder carcinoma: radiologic-pathologic correlation. 1125 93

We reviewed our experience with intrahepatic cholangiojejunostomy as a palliative therapy for patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Fifteen patients with malignant biliary obstruction were treated by cholangiojejunostomy at our hospital. Two patients had intrahepatic cholangiocarcinoma, 7 had gallbladder carcinoma, 5 had bile duct carcionoma, and 1 had pancreatic carcinoma. Segment III cholangiojejunostomies were performed in 14 patients and segment V cholangiojejunostomy in 1. Contraindications for surgical resection were locoregional invasion of tumors involving the proper and/or common hepatic artery and portal vein in 15 patients and the presence of hepatic metastases in 6 patients. Liver metastases were detected in 5 of the 7 patients with gallbladder carcinoma. Postoperative complications occurred in 2 patients (13%), but there was no leakage of the cholangioenteric anastomosis in our series. There was no operative mortality after cholangiojejunostomy. Of the 9 patients who survived for more than 6 months after surgery, 7 showed a significant improvement in performance status (PS) (82 +/- 10%) 3 months after the surgery compared with the preoperative PS (70 +/- 7%). Four of the 9 patients had recurrent cholangitis as a late complication, but 4 were completely free from jaundice. Median survival after cholangioenteric bypass was 9 months (range, 2-25 months). With respect to tumor location, the median survival time was 4 months (range, 2-25 months) in patients with gallbladder carcinoma and 15.5 months (range, 12-22 months) in those with bile duct carcinoma. While the median survival period after surgery was only 3 months (range, 2 to 8 months) in the 5 patients with hepatic metastases from gallbladder carcinoma, 2 patients without liver metastasis survived for 9 and 25 months after segment III cholangioenteric bypass. In conclusion, cholangiojejunostomy can provide useful palliation for malignant biliary obstruction when combined with careful patient selection.
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PMID:Intrahepatic cholangiojejunostomy for unresectable malignant biliary tumors with obstructive jaundice. 1145 67

Mangafodipir trisodium (MnDPDP) is a contrast agent for use in magnetic resonance imaging (MRI) of the liver. The agent is taken up by normal hepatocytes resulting in increased signal on T1-weighted imaging, and is excreted in the biliary system. Hepatocyte-containing liver neoplasms such as hepatomas or focal nodular hyperplasia (FNH), take up MnDPDP and demonstrate varying degrees of enhancement. Metastatic liver deposits and primary liver tumours of non-hepatocyte origin do not typically enhance with MnDPDP thus increasing their conspicuity compared with pre-contrast T1-weighted images. Metastases may demonstrate rim enhancement particularly on delayed imaging at 24 h, which can increase their conspicuity, thus allowing better visualization of small lesions. Functional biliary obstruction due to liver metastases can also result in wedge shaped areas of parenchymal enhancement. The MRI features of various focal liver after continuance with lesions following MnDPDP are discussed and illustrated including primary lesions such as hepatoma and secondary metastases.
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PMID:MnDPDP enhanced magnetic resonance imaging of focal liver lesions. 1247 27

Obstructive jaundice as the main clinical feature is uncommon in patients with hepatocellular carcinoma (HCC). Only 1-12 % of HCC patients manifest obstructive jaundice as the initial complaint. Such cases are clinically classified as "icteric type hepatoma", or "cholestatic type of HCC". Identification of this group of patients is important, because surgical treatment may be beneficial. HCC may involve the biliary tract in several different ways: tumor thrombosis, hemobilia, tumor compression, and diffuse tumor infiltration. Bile duct thrombosis (BDT) is one of the main causes for obstructive jaundice, and the previously reported incidence is 1.2-9 %. BDT might be benign, malignant, or a combination of both. Benign thrombi could be blood clots, pus, or sludge. Malignant thrombi could be primary intrabiliary malignant tumors, HCC with invasion to bile ducts, or metastatic cancer with bile duct invasion. The common clinical features of this type of HCC include: high level of serum AFP; history of cholangitis with dilation of intrahepatic bile duct; aggravating jaundice and rapidly developing into liver dysfunction. It is usually difficult to make diagnosis before operation, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the BDT preoperatively. Despite recent remarkable improvements in the imaging tools for diagnosis of HCC, such cases are still incorrectly diagnosed as cholangiocarcinoma or choledocholithiases. Ultrasonography (US) and CT are helpful in showing hepatic tumors and dilated intrahepatic and /or extrahepatic ducts containing dense material corresponding to tumor debris. Direct cholangiography including percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) remains the standard procedure to delineate the presence and level of biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) is superior to ERCP in interpreting the cause and depicting the anatomical extent of the perihilar obstructive jaundice, and is particularly distinctive in cases associated with tight biliary stenosis and along segmental biliary stricture. Choledochoscopy and bile duct brushing cytology could be alternative useful techniques in the differentiating obstructions due to intraluminal mass, infiltrating ductal lesions or extrinsic mass compression applicable before and after duct exploration. Jaundice is not necessarily a contraindication for surgery. Most patients will have satisfactory palliation and occasional cure if appropriate procedures are selected and carried out safely, which can result in long-term resolution of symptoms and occasional long-term survival. However, the prognosis of icteric type HCC is generally dismal, but is better than those HCC patients who have jaundice caused by hepatic insufficiency.
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PMID:Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. 1263 82

Malignancies may cause cholestatic jaundice through well-recognized mechanisms (e.g., bile duct obstruction or widespread hepatic infiltration). Paraneoplastic syndromes associated with malignancy, particularly with renal cell carcinoma (Stauffer's syndrome) and malignant lymphoproliferative diseases, can induce a reversible form of cholestasis through an unclear pathogenetic mechanism. Prostate cancer presenting initially with cholestatic jaundice without any obvious cause (i.e., obstruction or infiltration) has been reported in 2 cases in the medical literature. We report a patient who presented with pruritus and cholestatic jaundice. During the diagnostic work-up, prostate cancer was diagnosed. Conjugated bilirubin and alkaline phosphatase levels were increased markedly with modest increases of gamma-glutamyltranspeptidase and transaminase levels. The results of appropriate investigations performed during the patient's hospitalizations indicated no evidence of hepatic metastases or extrahepatic biliary obstruction. After treatment with flutamide and leuprolide, the patient's symptoms and the laboratory abnormalities reversed rapidly. We regard the cholestatic jaundice of this patient as part of a paraneoplastic syndrome; the cause of cholestasis remains an enigma. Patients with unexplained cholestasis should be investigated for malignancies, including prostate cancer.
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PMID:Cholestatic jaundice as a paraneoplastic manifestation of prostate adenocarcinoma. 1501 48

Pancreatic adenocarcinoma accounts for 80% of pancreatic tumours. The majority are unresectable at diagnosis and only 10% of patients survive to 1 year. Therefore, selection of appropriate palliative procedures for jaundice, gastric outlet obstruction or pain is a vitally important aspect of the management of these patients. Overall survival is equivalent following surgical or non-surgical palliation of biliary obstruction. Operative biliary bypass is a more major intervention but is associated with longer relief of symptoms and fewer readmissions compared to non-operative procedures. Prognostic factors such as histopathology, presence of metastatic disease and C reactive protein levels may allow better prediction of survival, therefore aiding selection of the most appropriate palliative techniques.
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PMID:Palliation of pancreatic neoplasms. 1523 86


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