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)

A review of sixteen consecutive patients who underwent substernal gastric bypass (SSGB) for middle and upper thoracic esophageal cancer is presented. All patients were alcoholics and heavy smokers with significant medical risk factors. All had locally advanced, long, circumferential, obstructing lesions with regional metastases. The operative mortality rate was 36% in this group of high-risk patients with advanced disease. This high mortality rate may decrease with the modifications discussed. The previously described technique of SSGB is detailed with special reference to a modification for widening the thoracic inlet. The palliation afforded was excellent in all survivors, and the median survival time was a surprisingly long 10 months. Alternative approaches are discussed in a review of the literature. SSGB provides quite possibly the superior approach for palliative management of these difficult lesions.
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PMID:Substernal gastric bypass for palliation of esophageal carcinoma: rationale and technique. 617 31

Autopsy findings for 111 cases of esophageal cancer are presented. Residual tumor in the esophagus was present in 75% of the cases. Lymph node metastases were found in 74.5% and visceral metastases in 50% of the cases. Autopsy revealed a second primary tumor in 21% of the cases; 12% of these were oropharyngeal-laryngeal (OPL) carcinomas, and 9% were visceral carcinomas or malignant lymphomas. Nonmalignant disease found in association with esophageal cancer was dominated by conditions related to chronic alcoholism. Autopsy findings thus revealed that the patients bore not only esophageal lesions, but also patterns of other associated malignant and nonmalignant diseases which would seem to correspond to a complex pathologic state occurring in association with chronic alcoholism. The time between onset of symptoms and autopsy averaged 10.6 months and between first consultation and autopsy, 6.3 months. The brevity of survival from onset of symptoms would seem to confirm that by the time esophageal cancer manifests clinically, it is already at a stage of development beyond the scope of treatment.
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PMID:Autopsy findings in 111 cases of esophageal cancer. 645 43

We present the autopsy findings in 171 patients with primary esophageal cancer and compare our results with those of other investigators. The ratio of men to women was 5.84:1. The average age of the women was 72.9 years. The average age of the men was 61.6 years. Squamous cell carcinomas were found in 91.8% of the cases, adenocarcinomas in 6.4% of the cases, and sarcomas in 1.8% of the cases. In the cases of squamous cell carcinoma, there was an ulcerating and infiltrating growth, primarily. In the cases of adenocarcinoma, there was a polypoid exophytic growth and an ulcerating growth. Most of the tumors were localized in the medial third of the esophagus (50.9%), followed by the distal third of the esophagus (39.7%), and, lastly, the proximal third of the esophagus (9.4%). Of all the tumors, 42.7% had an extension of more than 5 cm in the longitudinal axis at autopsy. The trachea was the organ most commonly infiltrated (21%). No metastases occurred in 28.6% of the cases. Lymph node metastases existed in 67.3% of the cases, and visceral metastases were present in 29.8% of the cases.
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PMID:Esophageal cancer. Autopsy findings in 171 cases. 654 3

Six patients with esophageal cancer with liver metastasis are reported and the clinicopathological features are discussed based on collected autopsy cases. 1) The incidence of liver metastasis was higher when the primary site was in the lower part of the esophagus. 2) There were many cases without abdominal lymphnode metastasis. 3) Metastasis was noted primarily as small nodules in the left lobe of the liver. 4) The prognosis was poor; liver metastasis was rarely the cause of death. In esophageal cancer, liver metastasis seems to occur via the portal route and combined liver resection is indicated when possible.
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PMID:[Carcinoma of the esophagus with hepatic metastasis]. 662 May 76

Nine cases of superficial carcinoma of the esophagus were described. Although 3 patients complained of abdominal sensations on swallowing or dysphasia, 6 patients did not present with any symptoms related to the esophageal lesion. The radiologic diagnosis is particularly difficult in cases with superficial type esophageal cancer, and no definitive findings were obtained in three such cases. However, esophagoscopy using Lugol spray was far more effective for the recognition of these superficial lesions. Although surgical resection of the esophagus is technically easier in these cases, the indications of surgery should be carefully evaluated. One operative death occurred in our series. In cases that are good indications, however, wide lymph node dissection should be carried out, since metastases occur even to distant lymph nodes, particularly in cases with cancer invasion of the submucosal layer. The histopathologic diagnosis was squamous cell carcinoma in 8 cases, but in one case it was adenocarcinoma of mucus-secreting gland origin in the mid-thoracic esophagus.
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PMID:Superficial carcinoma of the esophagus. 665 88

A long-term experience with dissemination of tumor of different parts of the esophagus was evaluated using the results of resected material examination and post-operative follow-up. Schemes of treatment for different degree of metastatic spread of esophageal cancer are discussed. Diagnostic laparatomy is recommended prior to surgery, radiation or combination treatment of tumor of the median or lower thirds of the esophagus; laparatomy should remove paracardial lymph nodes, nodes of the lesser omentum as well as retroperitoneal nodes located along the left gastric artery, those in the vicinity of the bifurcation of gastric artery and along the upper boundary of the pancreas. If retroperitoneal lymph nodes are involved, resection of the esophagus is useless and radiation treatment may be recommended as palliation only. Cases of metastases in paracardial lymph nodes or those of the lesser omentum should be provisionally referred to a group of candidates for surgery, while the actual expediency of surgical, radiation or combined treatment of such cases is subject to further evaluation, as more data accumulate. In cases of cancer of the lower third of the esophagus, revision and surgery (radiation) should be carried out in the mediastinal lymph nodes located along the esophagus up to the bifurcation of the trachea; when the median third is involved--along the entire thoracic part of the esophagus; in cases of cancer of the upper third--along the esophagus up to the bifurcation of the trachea, including the cervicosubclavicular lymph nodes.
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PMID:[Therapeutic approach in cancer of the esophagus with special reference to its potential metastasis]. 682 58

We report our experience with radiation therapy in 2 patients with anaplastic esophageal cancer with extensive distant metastases. Radiotherapy was given to the primary esophageal lesions and in both patients the tumors completely disappeared after irradiation with 2000 to 3000 rads. However, the metastatic lesions of the bone and liver did not respond despite the administration of BLM + PT -207 + BEMP in one case and METVFC + FT -207 in the other. Both patients died 4 and 5 months, respectively, after beginning the treatment. Effective chemotherapy of metastases needs to be developed because the primary lesions of anaplastic esophageal cancer are highly sensitive to radiation therapy.
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PMID:[Radiotherapy for anaplastic esophageal cancer]. 687 92

A clinico-pathologic study of 173 patients with esophageal cancer was done. The median survival for all patients was 6.4 months. Persistent tumor in esophagus at the time of death was present in 78% of patients treated with radiation alone. Metastases to mediastinal, intraabdominal and supraclavicular nodes were found in 73%, 49% and 20% of patients respectively. Systemic metastases were found in 57% of patients, liver being the most common site. In 15% of patients, fistulae developed between esophagus and trachea or bronchus because of direct extension of the primary tumor. Local and regional tumor caused the death of 111 patients, whereas distant metastases led to death in only 27 patients. This study confirms the extensive intra- and extrathoracic spread of malignancy in a majority of patients with cancer of the esophagus.
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PMID:Carcinoma of the esophagus: sites of failure. 715

To investigate genetic features of esophageal cancer, we have examined 93 squamous cell carcinomas of the esophagus for loss of heterozygosity (LOH), using 41 restriction fragment length polymorphism (RFLP) markers representing all autosomal chromosomes. Allelic losses at frequencies of at least 30% were observed at loci on chromosomal arms 3p (35%), 3q (30%), 5q (36%), 9p (57%), 9q (60%), 10p (33%), 13q (43%), 17p (62%), 17q (46%), 18q (38%), 19q (32%), and 21q (37%). These results suggest that several putative tumor suppressor genes, in addition to the cyclin D and TP53 genes that are sometimes mutated in esophageal carcinomas, may be associated with development and/or progression of esophageal cancer. By a comparison of LOH on each chromosomal arm with clinicopathological parameters, we have found a significant correlation between LOH on 19q and regional lymph node metastases. Interestingly, the frequency of LOH on 17q was significantly higher in tumors in female patients (12 of 14 cases) than in those in male patients (20 of 56 cases) (P = 0.0009 by Fisher's exact test). Furthermore, we examined for mutations of the APC gene on chromosome arm 5q. Screening of nearly one third of the APC coding region, including the MCR (mutation cluster region), revealed no alterations. Therefore, although allelic loss at the APC locus is frequent in squamous cell carcinomas of the esophagus, it is likely that a gene on 5q other than APC is involved in esophageal tumorigenesis.
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PMID:Allelotype study of esophageal carcinoma. 752 40

Laboratory studies have suggested that rapidly alternating chemotherapy and radiation therapy might act synergistically. We undertook this study to evaluate the toxicity and effectiveness of this approach in patients with carcinoma involving the hypopharynx or esophagus. Between 1987 and 1991, we treated 47 patients (23 with carcinoma involving the hypopharynx and 24 with carcinoma involving the esophagus) by three cycles of chemotherapy (during weeks 1, 4, and 7) rapidly alternating with twice-a-day radiation therapy (during weeks 2, 5, and 8). Chemotherapy consisted of cisplatin 100 mg/m2 and 5-fluorouracil 3-4 g/m2 given over 4 days. Radiation therapy consisted of 180-200 cGy twice each day to 2000 cGy/cycle, total 6000 cGy over 7 weeks. The histology was squamous cell carcinoma in 44 patients and adenocarcinoma in 3 patients with esophagus cancer. Median follow-up is 2 years (range 1-5 years). The observed survival rate for all 47 patients was 54% at 1 year and 38% at 2 years. Acute toxicity was considerable. Twelve patients (25%) died during therapy from toxicity, without tumor progression, leaving 35 patients (18 hypopharynx, 17 esophagus) evaluable for response. Among the hypopharyngeal patients, 83% had a complete response, 11% had a partial response, and 6% had no response. Among the esophageal patients, 94% had a complete response, and 6% had a partial response. Local control was better for the esophageal patients than the hypopharyngeal patients (98% vs. 52% at 2 years, p = 0.038). The incidence of distant metastases was 25% at 2 years and not significantly different between the two groups. A high rate of local control was achieved, particularly in esophageal cancer, by delivering chemotherapy and radiation therapy in a rapidly alternating fashion. This was achieved at a considerable cost in terms of toxicity, however. Although our response rates and local control compare favorably with those of other recently published studies of combined modality therapy in esophagus or head and neck cancer, much additional work is required to reduce the toxicity and, in hypopharyngeal cancer, to further improve the local control.
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PMID:Chemotherapy rapidly alternating with twice-a-day accelerated radiation therapy in carcinomas involving the hypopharynx or esophagus: an update. 758 5


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