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

A case of high-grade mucoepidermoid carcinoma of the breast with a dominantly epidermoid component is presented. The tumour was biochemically oestrogen and progesterone receptor negative. Though the primary tumour was small (1 cm) and without axillary lymph node metastases at mastectomy, the clinical course was rapid. Despite radio-, chemo- and hormonal therapy the patient died 25 months after mastectomy with widespread systemic disease. The metastatic pattern was that of typical breast carcinoma despite the unusual histological appearance of both primary and metastatic tumour tissue.
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PMID:High-grade mucoepidermoid carcinoma of the breast. 405 47

In 1985, breast cancer will be diagnosed in approximately 120,000 women; in 90% of these women, the disease will apparently be limited to the breast and axillary lymph nodes. Despite advances in early diagnosis and primary treatment with surgery, radiation therapy, or both, more than a third of these patients will develop systemic disease and ultimately die. In the broadest sense, all of these patients are potential candidates for some form of systemic adjuvant therapy. Adjuvant therapy of breast cancer involves the use of cytotoxic drugs or endocrine therapy after definitive primary therapy. The rationale is to eradicate occult metastatic disease that otherwise would be fatal. The goal of adjuvant therapy is to significantly prolong survival, while maintaining an acceptable quality of life. Three measures are important in evaluating whether this goal is met by specific treatments: 1. The effect of therapy on overall survival: the length of time a woman survives following a diagnosis of breast cancer. 2. The effect of therapy on disease-free survival: the length of time a woman remains free of any recurrence of disease. Prolonged periods of disease-free survival may be advantageous in their own right, since quality of life is likely to be better before than after relapse. There is also some evidence that longer periods of disease-free survival may translate into better overall survival rates. 3. The effect of therapy on quality of life: in choosing an adjuvant therapy program, potential benefits must be balanced against both short-term and long-term side effects. Also important are the substantial psychological, social, and economic problems women may experience as a result of treatment. An increasing number of important prognostic variables have been identified that define the natural history of breast cancer. These include well-established factors such as histological status of axillary lymph nodes, primary tumor size, steroid hormone receptors, menopausal status or age, and histopathology. Assessment of cell differentiation and proliferation, which can be determined by newer techniques, may also be significant. The pathological status of the axillary lymph nodes remains the single most important prognostic variable, and four lymph node categories have been defined (negative, one to three positive nodes, four to nine positive nodes, and ten or more positive nodes). Since definitions of menopausal status vary widely among clinical trials, age (less than 50 vs greater than or equal to 50 years) can be substituted as a prognostic variable.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Consensus conference. Adjuvant chemotherapy for breast cancer. 406 89

Hypophysectomy was studied for its possible effects on cancer by alt eration of the endorcines at the New York Hospital-Cornell Medical Center beginning in 1953. The major effort has been the treatment of 850 cases of metastic breast cancer. In 80 patients with other types of metastatic cancer benefit was found only in 50 cases of prostatic cancer. Prolactin is mediated directly from the anterior pituitary to breast tissue where it aids and abets the growth of breast cancer; its secretion is largely dependent on the estrogen produced in ovaries and adrenals. In humans estrogen given after total hypophysectomy is found to be ineffective in altering metastases. Growth hormone is also produced in the anteriod lobe of the pituitary but its production is not dependent on an estrogen feed-back mechanism. If the primary cancer is dependent on the presence of prolactin, failures with hypophysectomy are explained the tumor having gained autonomy and being no longer so dependent. Contraindications to hypophysectomy include extensive pulmonary, liver, or brain metastases and any systemic disease that would preclude major surgery. Following a remission after oophorectomy, another remission with hypophysectomy may often be obtained. Neither the pathological type of a breast cancer nor the location of metastases alter the results. However the longer the interval between mastectomy and reactivation of the tumor, the more favorable the outlook. Maintenance substitution therapy following removal of the pituitary employs daily hydrocortisone, 17.5 mg orally, or equivalent steroid preparations. The mortality rate is 2% in the first 30 days after operation. In 88 patients evaluated 2 years after operation those who had received a remisssion lasting over 6 months survived nearly 5 times longer than those unbenefitted by the operation. The intracranial procedure is preferred. In cases of failure or when a remission terminates, male hormone therapy, chemotherapy, or radiation may have limited value.
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PMID:Hypophysectomy for metastatic cancer. 466 60

CLM developed in 60 of 526 patients (11%) with SCLC seen at the NCI between August 1969 and June 1980. Life table analysis revealed an overall 25% risk of CLM at 3 years. CLM was diagnosed during all phases of the patients' clinical course, but the majority (83%) were cases diagnosed at the time of progressive systemic disease. Univariate log rank analysis indicated that pretreatment factors associated with the development of CLM included: involvement of the brain, spinal cord, bone marrow, liver or bone; extensive disease; and male sex. Patients who did not obtain a complete response to systemic therapy were at greater risk of developing CLM than complete responders. Multivariate analysis of these factors indicated that liver metastases were most strongly associated with the time to development of CLM, followed in order of importance by bone and CNS metastases. Patients usually presented with signs and symptoms reflecting involvement of multiple areas of the neuraxis including the cerebrum, cranial nerves and spinal cord; 51 of the 60 patients had intracerebral metastases and 27 had spinal cord lesions during their clinical course. Autopsy features including focal or diffuse involvement of the leptomeninges with infiltration of the Virchow-Robin spaces were similar to meningeal lymphoma and leukemia, except that CLM was rarely the sole manifestation of CNS tumor. Median survival following the diagnosis of CLM was 7 weeks. However, most deaths were attributed to systemic disease, and treatment with intrathecal chemotherapy and irradiation often provided palliation. With the increased awareness of this complication, an antemortem diagnosis increased from 39% prior to 1977, to 88% of patients after 1977.
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PMID:Carcinomatous leptomeningitis in small cell lung cancer: a clinicopathologic review of the National Cancer Institute experience. 627 48

Experimental evidence suggests that regional lymph nodes (RLN) are important in the initiation and possibly the maintenance of tumor immunity. "Negative" nodes denote strong tumor immunity and "positive" nodes low. The latter also serve as markers of systemic disease. From histological and immunological studies, and mostly from recent clinical studies in breast cancer, the following practical recommendations are made: (1) Clinically positive axillary nodes are best eliminated by surgery. (2) Resection of positive internal mammary nodes appears to increase survival of patients with central and inner quadrant lesions; however, destruction of these nodes by irradiation, although improving local disease control, may decrease survival. (3) Negative RLN should be preserved, as they appear to prevent lymph node metastases and stimulate systemic immunity. Only a small fraction of unresected RLN harboring micrometastases will ultimately develop palpable disease, and their elimination at that late phase yields the same results as when these nodes are treated prophylactically.
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PMID:The contribution of regional lymph nodes in the resistance against breast cancer: practical implications. 637 83

Once a chest-wall recurrence is diagnosed, it should be treated by modalities effective for both local and systemic disease, since it is a cutaneous marker of distant metastases. If the chest-wall recurrence can be controlled, short-term prognosis is much improved, although all patients in this study eventually died of systemic breast cancer. The results of this retrospective study suggest that appropriate timing of breast reconstruction depends on the pathologic status of the axillary nodes and completion of adjunctive therapy. A patient with stage I breast cancer can undergo a subpectoral or musculocutaneous flap reconstruction of the breast without fear of masking a local chest-wall recurrence.
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PMID:Appropriate timing for breast reconstruction. 661 54

To determine factors which affect survival in patients with pleural involvement by breast carcinoma, we reviewed records of all patients at two community teaching hospitals presenting with malignant pleural effusion over a 6-year period. Forty-five patients had had mastectomy for breast cancer, no history of other malignancy, and cytologic confirmation of subsequent pleural metastases. All had received conventional combination systemic chemo- or hormonal therapy. Ten patients (group 1) in whom effusion was the initial and only site of recurrent disease had a median survival of 48 months. The median survival was 12 months in 35 patients (group 2) who developed effusion in association with other metastatic disease. Half of the patients in group 1 had no axillary node involvement at mastectomy. Twenty-eight patients (80%) in group 2 had had more advanced disease at initial diagnosis. This, and behavior of the effusion as regional rather than systemic disease, suggested by the high incidence of effusion on the ipsilateral side of the mastectomy, probably accounts for the better outlook in patients with effusion alone.
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PMID:Survival of patient with pleural involvement by breast carcinoma. 661 18

The natural history of Stage D1 adenocarcinoma of the prostate remains unclear. In a series of 50 patients with positive pelvic lymph nodes at the time of staging lymphadenectomy, metastatic disease developed in 43 per cent of the patients treated for cure within the period of time of follow-up. Several series from the literature confirm those findings. Positive pelvic lymph nodes most probably represent systemic disease, and the patients are incurable by current surgical and radiotherapeutic modalities.
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PMID:Stage D1 adenocarcinoma of prostate. 669 75

A series of 47 patients with clinically demonstrated metastatic disease to the eye were evaluated for treatment with radiation therapy. Of the 37 patients who completed treatment, 88.9% responded with demonstrated tumor regression and improvement of symptoms. The breast and lung remain the two most common sites of origin for metastatic disease involving the orbit although the reason for this remains undetermined. The most common site of orbital involvement is the posterior choroid and no predilection for involvement of either the right or left eye could be determined. Radiation doses in the range of 3000-4000 rad delivered over a 3- to 4-week period of time, with care being taken to spare the lens, is recommended. Aggressive radiation therapy is indicated when the eye metastasis occurs without systemic disease or with stable systemic disease. The median survival in this group of patients was 8.5 months in those patients in whom adequate follow-up information was available.
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PMID:Radiation therapy for metastatic disease involving the orbit. 670 18

Leishmania tropica infections of P/J mice are characterized by the development of progressive nonhealing cutaneous lesions, followed by visceral metastases to liver and spleen. To analyze the genetic control of this disease, we produced F1, backcross (BX), and F2 progeny by breeding susceptible P/J mice with L. tropica-resistant C3H/HeN mice. Infections in these hybrid animals suggested that genetic control of the cutaneous lesion was by a single, autosomal, dominant gene. Resistance was the dominant trait. Analysis of liver and spleen impression smears in these animals, however, indicated that development of the cutaneous lesion segregates independently of the second component of L. tropica infections, systemic disease.
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PMID:Susceptibility of inbred mice to Leishmania tropica infection: genetic control of the development of cutaneous lesions in P/J mice. 672 56


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