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)

Our Department of Surgery was founded in 1982 by Prof. Inoko who performed reportedly the first gastrectomy for gastric cancer in Japan. Prof. Mine developed the auto-suture device which was world first one in 1958. We have carried out novel therapeutic methods for metastases and invasions in gastrointestinal cancer. For the management of lymph node metastasis, we developed emulsion and activated carbon particles containing anticancer agents which were selectively delivered to lymph nodes. Activated carbon particles visualized the regional lymph nodes as blackened nodes which can be easily dissected at time of surgery. Mitomycin C bound to carbon particles was effective for prophylaxis and treatment of peritoneal metastasis in prospective randomized control study. For prevention of postoperative local recurrence of rectal cancer, we developed preoperative 3 combined treatments with radiation, hyperthermia and 5-Fluorouracil suppository therapy. This 3 combined treatments resulted in improvement of survival and decreasing the local recurrence. For the new challenge to metastasis we have tried to apply the monoclonal antibody drug conjugate, angiogenesis inhibitor and immuno-guided surgery.
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PMID:[Paths of innovative surgery in gastrointestinal cancer in our department]. 937 Jan 40

Port-site metastasis has been an unexpected finding after laparoscopic surgery in gastrointestinal cancer patients. No clear explanation exists for this phenomenom. The aims of this study were to evaluate the dissemination pattern in an experimental model of hepatocarcinoma in the rat and summarize current knowledge about the risks and the results of experimental studies on cancer dissemination during laparoscopic surgery. NDA-induced hepatocarcinoma was obtained in Sprague-Dawley rats. Tumors were manipulated during laparoscopy (group 1, n = 11) or laparotomy (group 2, n = 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery was undertaken. Both models were associated with implants in parietal wounds [1/11 in group 1 (9%) vs. 1/12 in group 2 (8%), p = NS]. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization, and cells can be recovered in trocars, filtered exhaust gas, and instruments. Postoperative immunosuppression, the biologic aggressiveness of the tumor, and the gas used for laparoscopy also influence tumoral growth. Port-site metastases are secondary to multiple factors, including the technical skill of the surgeon, the biologic properties of the tumors, and local environmental aspects. Undoubtedly, laparoscopy can help disseminate aggressive tumors and should be reserved for diagnostic and staging procedures or for treatment of low-grade malignant tumors. Therapeutic resection, especially of colon cancer, should be restricted to prospective and randomized trials until there are enough hard data to rule out the clinical importance of this potentially severe complication.
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PMID:Cancer dissemination during laparoscopic surgery: tubes, gas, and cells. 1107 77

Down-regulation of KAI1 mRNA expression has been shown to be associated with the formation of metastases or disease progression in pancreatic cancer. Whether KAI1 possesses similar characteristics in other malignancies of the gastrointestinal tract is not known. Here, we compared the patterns of KAI1 mRNA expression in 41 esophageal cancers and 35 stomach cancers to assess whether KAI1 might also be of biological relevance in the metastatic ability of these tumors. By Northern blot analysis, KAI1 mRNA levels ranged widely in both normal and cancerous esophageal and gastric tissue samples, with no statistical differences. No association between KAI1 mRNA expression and tumor stage or tumor differentiation was seen in these tumors. In addition, KAI1 mRNA expression was similar in primary esophageal and gastric cancer samples with or without metastases. By in situ hybridization, KAI1 mRNA expression was evident in the cytoplasm of most squamous epithelial cells in the normal esophagus and in nonmucosal epithelial cells of the normal stomach. The staining intensity in the esophageal and gastric cancer cells was similar to that in the normal controls. This differential pattern of KAI1 mRNA expression in esophageal and gastric cancers in comparison to pancreatic cancer indicates that KAI1 seems to influence the potential of gastrointestinal cancer cells to metastasize differently. In esophageal and gastric cancers, the formation of metastases is not dependent on the reduction of KAI1 in the cancer cells.
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PMID:KAI1 is unchanged in metastatic and nonmetastatic esophageal and gastric cancers. 948 31

Due to the recent widespread use of detailed endoscopy together with careful scrutiny of the mucosa using dye-spraying techniques, there has been a general acceptance in Japan that early malignancies in the alimentary tract may not appear polypoid or ulcerative. Regardless of organ, superficial early cancers have been reported. These lesions appear as faint mucosal irregularities or discolorations, which may be difficult to distinguish from nonspecific inflammation or trauma. The recognition of these malignancies has prompted the development of new techniques for their treatment. Endoscopic mucosal resection (EMR) which can resect lesions as completely as specimens removed at open surgery, has become the first choice of treatment for early digestive cancer. The lesions that can be removed by EMR should be those which hardly ever carry lymph node metastases. Endoscopically, they are shown to be flat esophageal cancers, gastritis-like cancers and colorectal cancers less than 2 cm in flat elevated type or less than 1 cm in depressed type. In spite of the advances in characterizing early cancers and an emerging consensus on indications and contraindications for EMR, much work remains to be done. New techniques will continue to push the limits of what can be achieved via an endoscope.
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PMID:Endoscopic diagnosis and treatment of early cancer in the alimentary tract. 970 35

The therapy of gastrointestinal cancer is currently based on the surgical removal of the primary tumor or the metastases, respectively. A major improvement of the five year survival rate or an effective cure from advanced tumors will mainly depend on adjuvant therapeutic concepts even after surgical R0-resection. Such concepts can be developed nowadays with major expectations for success based on our advanced molecular biological knowledge on (i) increased proliferation, (ii) reduced apoptosis rate, (iii) the dissemination and (iv) the mechanisms of invasive growth of malignant cells.
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PMID:[Synopsis of modern tumor therapy with molecular biology methods]. 993 86

Circulating vascular endothelial growth factor (VEGF) was measured in gastric and colorectal cancer patients using an enzyme-linked immunosorbent assay (ELISA). Firstly, serum and plasma samples were collected from 20 normal controls to compare the values of VEGF and to determine which specimen type was most suitable for detecting circulating VEGF. Seventeen of 20 normal controls had plasma VEGF levels under the limit of detection (15 pg/ml) and the levels of the remaining three controls were 21, 22 and 38 pg/ml. In contrast, all serum samples indicated high levels of VEGF (mean 238 pg/ml), ranging from 44 to 450 pg/ml. In a time-course test of two normal controls serum VEGF values increased markedly between 30 and 60 min and remained high, whilst plasma VEGF values were low up to 480 min. Thus, plasma samples are more suitable for the measurement of circulating VEGF. Next, plasma VEGF levels were examined in 44 patients with gastric cancer (8 early, 7 advanced without remote metastasis and 29 metastatic), 13 with colorectal adenoma (2 with focal cancer) and 26 with colorectal carcinoma (8 advanced without metastasis and 18 metastatic) before treatment. An extremely high plasma concentration of VEGF was seen in some cancer patients with metastasis. To discriminate these patients, a cut-off level was determined, considering both the distribution of the sample concentration and the upper limit of 95% confidence area of VEGF in the cancer patients without metastasis. The cut-off value was 108 pg/ml and most cancer patients without metastases had VEGF levels below the cut-off value. In 11 of 29 metastatic gastric cancer patients (38%) and 9 of 18 metastatic colorectal cancer patients (50%), plasma VEGF levels were higher than the cut-off value. Survival was also analysed in the patients with metastasis. It was significantly longer in the patients with low VEGF levels (below the cut-off) than in those with high VEGF levels (logrank test, P = 0.042). 34 patients with metastasis (19 gastric cancer and 15 colorectal cancer) were treated with systemic chemotherapy, and their pretreatment levels of plasma VEGF and conventional tumour markers (CEA and CA19-9) were evaluated in relation to response. The response to chemotherapy was significantly higher in patients with low VEGF levels (< or = 108 pg/ml) than in those with high VEGF levels (P = 0.047). Such a difference was not observed with CEA/CA19-9. In conclusion, plasma VEGF is a useful marker for tumour metastasis and patient survival, and a possible predictive factor for the response of patients with gastrointestinal cancer to chemotherapy.
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PMID:Clinical significance of plasma vascular endothelial growth factor in gastrointestinal cancer. 1007 Mar 8

Pancreatic cancer is the second commonest gastrointestinal cancer, after colorectal cancer, in Canada, and most other European and North American countries. Unfortunately, most patients present with advanced locoregional or metastatic disease. For the 10-20% of patients who have localized disease, pancreatic resection is generally the preferred treatment option. Because pancreaticoduodenectomy can be performed safely in expert hands, it has become a more accepted procedure for patients with pancreatic cancer. Furthermore, it has also meant that there is increasing scrutiny of the longterm outcome of patients, especially their nutritional status and quality of life. In a study of 25 unselected patients who had a Whipple procedure at least 6 months previously and were not known to have residual or recurrent disease, patients appeared to have few gastrointestinal symptoms compared to control patients. However, none of the subjects appeared to be clinically malnourished. Dietary intake and lean body mass were comparable to that of the control group. Quality of life was excellent in these patients. The mean utilities were 0.98 and 1.0 suggesting near normal wellbeing. Similarly, results using the SIP and GIQLI suggested no/minimal impairment in general wellbeing and gastrointestinal function. Two other studies suggest that median survival and performance status are improved in patients having a resection, but it may be due to their disease being more favorable rather than the treatment being beneficial. Further studies objectively assessing the quality of life of all patients undergoing treatment for pancreatic cancer at the various disease stages are required.
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PMID:Quality of life, nutritional status and gastrointestinal hormone profile following the Whipple procedure. 1043 41

Identifying the sentinel lymph node has been shown to carry prognostic and therapeutic implications in the surgical treatment of solid tumors. Recently, sentinel lymphadenectomy has been described for gastrointestinal malignancies, but its clinical value remains uncertain. We describe the case of a patient with appendiceal carcinoid who underwent a right hemicolectomy 4 months after appendectomy, out of concern over residual local or regional disease. One sentinel lymph node was identified in the colonic mesentery using the blue dye technique. This sentinel node and 35 others were negative for metastases, but one lymph node not identified through blue dye carried evidence for micrometastatic disease on hematoxylin and eosin (H&E) and immunohistochemical chromogranin stains. The case raises some issues about the value and limitations of sentinel lymph node biopsies in gastrointestinal cancer. Aspects related to technique, learning curve, gastrointestinal lymphatic drainage patterns, the impact of prior operations, and the limited therapeutic implications compared to cutaneous or subcutaneous solid malignancies are discussed. We conclude that at this point in time, the information obtained from biopsies of sentinel lymph nodes during the surgical treatment of gastrointestinal cancer should be utilized with due caution.
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PMID:Use of the sentinel lymph node to determine metastases of gastrointestinal malignancies: a word of caution. 1044 Jul 62

Gastrointestinal malignancy is the second commonest cancer and is associated with a high mortality. Although definitive surgery could be offered for most tumour sites in the gastrointestinal tract, the majority of patients will still develop incurable recurrent or metastatic disease. Therefore, palliation is an important part of management. Radiotherapy has long been recognized as an effective palliative modality in gastrointestinal cancer. It was previously offered in cases where surgical resection was not feasible either due to the advanced nature of the disease or the presence of metastatic disease. Planning and delivery of radiation techniques have improved over the years and it is now possible to offer high-dose radiation to the tumour with acceptable side-effects. The dose of radiation offered is important to achieve worthwhile palliation. The advent of high-dose brachytherapy has contributed significantly to the role of radiotherapy as an effective palliative modality used either alone or as a boost to external beam radiotherapy. The addition of chemotherapy to radiation has been used in most tumour sites in the gastrointestinal tract and has been shown to improve the therapeutic ratio; however, one should be aware of the increased toxicity and careful selection of patients is necessary. Chemoradiation could help to down-stage locally advanced tumours which are otherwise unresectable. This approach has led to improved local control in certain tumour sites, e.g. anal canal and oesophagus. Whether this translates into improvement in survival remains to be seen. However, with increasing use of multi-modality therapy, increases in toxicity to the patient and in cost to healthcare providers must be taken into account.
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PMID:The role of radiotherapy in the palliative treatment of gastrointestinal cancer. 1078 89

Purposes: The Montefiore Medical Center (MMC) experience with Krukenberg tumors (gastrointestinal cancer metastatic to the ovary) was reviewed 1) in order to determine whether it could be used to make clinical management recommendations, eg, differences in treatment based on menopausal status, secondary debulking, prophylactic oophorectomy; 2) to compare the MMC experience to the reported literature, since one of our patients survived 1912 months beyond the generally accepted mean of this rare tumor.Methods: 1) Prospective study from January 1985-April 1996 of 5 patients followed at MMC with a diagnosis of gastrointestinal (GI) cancer metastatic to the ovary; 2) retrospective chart review of all female patients admitted to MMC with a diagnosis of GI cancer during the same time period; 3) computerized literature review from 1966 to 1996.Results: Five patients were followed prospectively. Retrospective chart review identified 1,016 female patients admitted with gastric (231) or colon (785) cancer, 2 additional cases of Krukenberg tumor were identified. Of the 7 patients with Krukenberg tumors the primary tumor was colon in 5 and gastric in 2. The average age at presentation was 49.3 years (range 35-80); 5 were premenopausal, 2 were postmenopausal, and 2 (28.6%) were postpartum. The average survival of these 7 patients was 12.3 months (range 4 days to 26 months). The 5 patients who had ovarian metastases removed at first laparotomy survived an average of 10.8 months. The 1 patient who had a secondary debulking survived longest (26 months). The 1 patient who had no surgery lived 6 months. These numbers are not statistically significant, but do suggest that further study is warranted. Including the prospectively studied patients, 1,021 patients were evaluated. Seven of 1,021 (0.7%) had Krukenberg tumors. Two of 11 (18.2%) premenopausal gastric cancer patients had a Krukenberg tumor, whereas none of the 222 postmenopausal gastric cancer patients did. Similarly, 3 of 41 (7.3%) premenopausal colon cancer patients had a Krukenberg tumor compared to 2 of 747 (0.3%) postmenopausal colon cancer patients. This difference in menopausal status is significant by Fisher's Exact test (P <.001). Nineteen patients underwent oophorectomy at the time of primary colon cancer surgery: 11 had normal or atrophic ovaries, 2 thecomas, 4 simple cysts, and 2 Krukenberg tumors. Three of 19 (15.8%) were premenopausal.Conclusions: Review of the literature has identified a number of diagnostic and management issues that appear to impact on survival. These include timing of definitive diagnosis of Krukenberg tumors, ie, before, after, or at the same time as diagnosis of the GI primary tumor; menopausal status; concurrent pregnancy; role of debulking; prophylactic oophorectomy. The prognosis worsens when the primary tumor is identified after the metastasis to the ovary is discovered. Krukenberg tumor is more common in premenopausal women than in postmenopausal women. The number of patients with Krukenberg tumors discovered postpartum in our study was significantly increased compared to the other series in the literature. The number of patients who received prophylactic oophorectomy or secondary debulking in our study was inadequate to draw conclusions regarding a benefit of these procedures. However, a benefit may be suggested for debulking, as survival appears to be increased. More importantly, there may be a role for prophylactic oophorectomies in both pre- and postmenopausal patients, as this would eliminate the need for a repeat laparotomy. A randomized trial is needed to evaluate the role of prophylactic oophorectomy and debulking. Since the clinical and pathologic details in the literature vary widely, it is extremely difficult to compare studies, particularly the treatment and survival of patients with Krukenberg tumors. Reports should include age, site of GI primary, time from diagnosis of primary to ovarian metastasis, and overall survival as well as survival from the time of diagnosis and treatment of the Krukenberg. We wish to alert the clinician that persistent GI symptoms always warrant investigation. Pelvic inflammatory disease, pregnancy, and postpartum endometritis may mask the GI symptoms. Delays in diagnosis should be avoided. During surgery, the gynecologic surgeon must do a complete upper abdominal exploration, and the general surgeon must do a complete pelvic evaluation. Since Krukenberg tumors are rare, a national registry should be started to gather information on these patients; this might lead to better diagnosis and treatment.
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PMID:Management of Krukenberg tumors: an 11-year experience and review of the literature. 1083 92


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