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)

Only patients with localized lung cancer benefit from curative resection. Curative radiotherapy is recommended in patients with a resectable tumor in whom surgery is precluded for medical reasons. Adjuvant preoperative or postoperative therapy of any type does not improve the results of surgery except in patients with Pancoast tumor. Therapy for nonlocalized tumors does not affect survival. Radiotherapy has a palliative effect in 50 to 75 per cent of patients presenting with symptoms from either a primary lesion or metastases and should therefore be recommended in symptomatic patients. The palliative effect of chemotherapy is limited in lung cancers other than small cell carcinomas. However, chemotherapy alone or in association with radiotherapy produces remarkable tumor regression and some improvement of survival in small cell carcinoma. The use of immunotherapy in the treatment of lung cancer is still under evaluation.
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PMID:Lung cancer. 7 94

Metastases from transitional cell carcinoma of the bladder are not widely appreciated radiographically, although they are commonly found at autopsy. Radiographic evidence of metastatic disease was reviewed in 51 patients. Sites included lung, 28; bone, 24; mediastinum, eight; liver, eight; brain, three; urethra, one; abdominal nodes, one; and extradural space, two. The patterns of lung metastases consisted of solitary nodules, multiple nodules, sigmental infiltrates, pulmonary edema, and a Pancoast tumor. A sarcoidlike pattern with hilar and interstitial disease was also seen. One patient had a malignant pleural effusion. Mediastinal lymph node enlargement was isolated or associated with lung involvement. Bone metastases demonstrated either an osteoblastic or a mixed osteolytic-osteoblastic pattern in 47% of the instances. Ivory vertebrae were identified in three patients. Because of the significance of identifying metastatic disease before any extensive curative bladder surgery, we recommend at least a preoperative chest radiograph, a bone scan, and a liver scan.
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PMID:Metastatic transitional cell carcinoma from the bladder: radiographic manifestions. 10 47

We analyzed the sonographic appearance of the ribs when there was tumor involvement in 16 patients (12 men and 4 women). The tumors included 11 carcinomas, 3 nonepithelial malignancies and 2 benign tumors. Three sonographic patterns on the cross section of abnormal ribs were identified. Pattern I was an eccentrical hyperechoic plate-like shadow inside a hypoechoic tumor. Pattern II was a round hyperechoic shadow or ring in the center of a hypoechoic tumor. Pattern III was a hypoechoic tumor only. The Pancoast tumor manifested pattern I. Metastatic cancer, mostly squamous cell carcinoma, manifested pattern II, and both malignant and benign tumors could manifest pattern III. In sonography, the margin and shape of the tumors, the change in the acoustic shadow of the rib and the pleural line did not differentiate the malignant tumors from benign tumors. When we routinely took a biopsy of these tumors under sonar guidance, the diagnostic yield was 100% without any complications. We conclude that the rib should be evaluated in chest sonography, and that pattern recognition and biopsy under sonar guidance are most useful.
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PMID:Sonographic patterns of ribs with tumor involvement. 167 7

The treatment results obtained in patients with both small and non small cell lung cancer have remained stagnant for years. Therefore, in order to select patients who will have a profit from radiotherapy the indication has to take into account prognostic factors such as tumor stage, extent of resection, patient's age, lymph node status, weight loss and the patient's performance status. Non small cell lung cancer: Postoperative radiotherapy seems to benefit only in patients with hilar or mediastinal lymph node involvement, where a five-year survival rate of up to 30% of cases can be achieved. Postoperative irradiation should not be applied following curative resection and negative lymph node status (R0 N0). In inoperable cases conventional fractionated radiotherapy may definitively have a favourable effect on the patient's survival time, even when the treatment was originally intended to be merely palliative. Only those patients will live five years, who received more than 50 Gy to the hilar and mediastinal nodes and at least 60 Gy to the primary lesion. The volume to be irradiated must include the primary tumor, the ipsilateral and contralateral hilum, the mediastinum, and both supraclavicular regions. If a Pancoast tumor is present, radiotherapy alone obtains a similar result as preoperative irradiation followed by resection. Small cell lung cancer: Radiation treatment of the primary tumor region and the lymph drainage area increases the remission rate by roughly 20% compared with chemotherapy alone, considerably reduces the incidence of local recurrences and exerts a beneficial effect on the survival of the patients. Recently, this has been confirmed by prospectively randomised protocols. Prophylactic brain irradiation has been found to decrease the risk of cerebral metastases to 4-6% in patients affected by limited disease and complete tumor remission under chemotherapy, and to improve the quality of life without, however, showing the benefit on survival time. Future efforts in radiotherapy should be aimed not only at increasing dose intensities but also at developing less toxic treatment modalities to the benefit of the quality of life.
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PMID:[The role of radio-oncology in the treatment of bronchial cancer]. 215 88

This study examines retrospectively the natural history, classification, clinical and pathological features and results of treatment of intractable pain associated with lung cancer in 221 patients. The 3 chief causes of malignancy-related pain were skeletal metastatic disease (34%), Pancoast's tumour (31%) and chest wall disease (21%), together comprising 78% of the cancer-related pain problems. The median interval between cancer diagnosis and pain onset was 1 month. Overall pathological types of cancer were similar to those of lung cancer in general. Treatment modalities were varied and included radiation, percutaneous cordotomy, regional deafferentation and pharmacotherapy. The median survival from pain onset was 10 months.
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PMID:Intractable pain with lung cancer. 361 55

Until 1956, surgical attempts to remove a Pancoast tumor had proven futile, since the neoplasm invades the endothoracic lymphatics, the sympathetic chain, intercostal nerves, ribs, bodies of the vertebrae, and subclavian vessels. In 1956, a man believed to have a nonresectable tumor received 3,000 rads over the upper right chest. Three weeks later, his superior sulcus tumor had shrunk to one-half its original size. At operation, en bloc resection of portions of the upper three ribs, along with the upper lobe of the lung, was accomplished. The patient is alive 27 years later and has only minor complications. Several other patients were successfully treated with this combined therapy, although those with distant metastases, supraclavicular tumefaction, obvious erosion of the transverse processes, extensive involvement of the brachial plexus, and vena caval obstruction are not suitable candidates for this approach.
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PMID:Pancoast's tumor. 671 36

A 36-year-old man developed progressive pain in the left thorax radiating to the shoulder, associated with weight loss as well as axillary and supraclavicular lymph-node swellings, and a left Horner's syndrome. The radiological diagnosis was Pancoast tumour. Computed tomography of the thorax revealed that the tumour had almost completely infiltrated the left lung and hilus. Sonography demonstrated metastases in the liver and retroperitoneum. Histological examination of an excised axillary lymph-node metastasis showed an undifferentiated small-cell tumour. Immunohistochemical tests revealed expression of protein S 100 and neurofilamental proteins, i.e. evidence of a peripheral malignant neuroectodermal tumour. The tumour also expressed vimentin. Treatment consisted of two chemotherapy cycles according to the EVAIA scheme (daily three times 235 mg etoposide, 2 mg vincristine, three times 0.8 mg actinomycin D, three times 3.2 g ifosfamide, three times 30 mg doxorubicin, and three times 12 mg dexamethasone), without any effect on the rapid progression of the disease. He died 17 weeks after the diagnosis had been made.
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PMID:[Pathology and clinical aspects of peripheral neuroectodermal tumors]. 840 99

This chapter of the Lung Cancer Guidelines addresses patients with particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLC), and solitary metastases. For patients with a Pancoast tumor, a multimodality approach, involving chemoradiotherapy and surgical resection, appears optimal provided appropriate staging has been carried out. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. When carefully staged and selected, however, such patients appear to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment from what would be dictated by the primary tumor alone. On the other hand, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLC do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and those with a second primary lung cancer, although criteria to distinguish them have not been defined. Finally, some patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit substantially from resection.
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PMID:Lung cancer. Special treatment issues. 1252 83

Metastatic lesions to the oral region are uncommon and account for approximately 1% of all malignant oral tumors. In 25% of the cases, oral metastases are found to be the first sign of the metastatic spread; and in 23% of the cases, it is the first indication of an undiscovered malignancy at a distant site. Metastases to oral soft tissues are even less frequent than jaw bones. Because of its rarity, the clinical presentation of a metastatic lesion in the oral cavity can be deceiving, leading to a misdiagnosis of a benign process; therefore, in any case where the clinical presentation is unusual, especially in patients with a known malignant disease, a biopsy is mandatory. Here, we are presenting a rare case of multiple secondary tumors in the attached gingiva in an otherwise apparently healthy patient with no other symptoms of the primary tumor. It subsequently led to the diagnosis of Pancoast tumor (bronchoalveolar carcinoma) metastasizing simultaneously to multiple sites in the oral cavity and bilateral adrenal glands.
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PMID:Multiple metastatic tumors in the oral cavity. 2252 84

Pancoast tumors account for less than 5% of all bronchogenic carcinomas. These tumors are located in the apex of the lung and involve through tissue contiguity the apical chest wall and/or the structures of the thoracic inlet. The tumors become clinically evident with the characteristic symptoms of the "Pancoast-Tobias syndrome" which includes Claude-Bernard-Horner syndrome, severe pain in the shoulder radiating toward the axilla and/or scapula and along the ulnar distribution of the upper arm, atrophy of hand and arm muscles and obstruction of the subclavian vein resulting in edema of the upper arm. The diagnosis will be made by the combination of the characteristic clinical symptoms with the radiographic findings of a mass or opacity in the apex of the lung infiltrating the 1(st) and/or 2(nd) ribs. A tissue diagnosis of the tumor via CT-guided FNA/B should always be available before the initiation of treatment. Bronchoscopy, thoracoscopy and biopsy of palpable supraclavicular nodes are alternative ways to obtain a tissue diagnosis. Adenocarcinomas account for 2/3 of all Pancoast tumors, while the rest of the tumors are squamous cell and large cell carcinomas. Magnetic resonance imaging of the thoracic inlet is always recommended to define the exact extent of tumor invasion within the thoracic inlet before surgical intervention. Pancoast tumors are by definition T3 or T4 tumors. Induction chemo-radiotherapy is the standard of care for any potentially resectable Pancoast tumor followed by an attempt to achieve a complete tumor resection. Resection can be made through a variety of anterior and posterior approaches to the thoracic inlet. The choice of the approach depends on the location of the tumor (posterior - middle - anterior compartment of the thoracic inlet) and the depth/extent of invasion. Prognosis depends mainly on T stage of tumor, response to preoperative chemo-radiotherapy and completeness of resection. Resection of the invaded strictures of the thoracic inlet should me made en bloc with pulmonary parenchyma resection, preferably an upper lobectomy. Invasion of the vertebral column is not a contraindication for surgery which, however, should be performed in oncologic centers with experience in spinal surgery. Surgery for Pancoast tumors is associated with 5% mortality rate and the complication rate varies from 7-38%. The overall 2-year survival rate after induction chemo-radiotherapy and resection varies from 55% to 70%, while the 5-year survival for R0 resections is quite good (54-77%). The main pattern of recurrence is that of distant metastases, especially in the brain.
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PMID:Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment. 2410 7


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