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

There is a relatively long delay in diagnosis of malignant tumors of the small bowel and operation is often carried out too late. These tumors cause symptoms in about 90% of the cases (according to our own experiences in 20 of 21 cases). In the discussion of the symptoms there is a description given that might be a help for "earlier thinking of it". Anamnesis and exploratory laparotomy are of paramount importance for the diagnosis in time. Operation carried out in time leeds to a relatively favourable prognosis. Out of 5 patients who did not have metastases at the time of operation there are 3 alive for longer than 8 years post operationem. From the German literature of the past 10 years (288 cases) the following data were subsumized in a table: radical resection, operation mortality, 5-year-survival, delay of diagnosis, ileus/perforation, diagnosis by barium studies of the small bowel.
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PMID:[Primary small-intestinal neoplasms. Discussion of own experiences and of the literature]. 38 70

Small bowel leiomyosarcomas are uncommon but potentially curable tumors often diagnosed at an advanced stage. Twenty such lesions were studied, and 19 of these produced symptoms and signs. Clinical findings included abdominal pain in 17 (85%), rectal bleeding in 8 (40%), anemia in 7 (35%), intraperitoneal perforation in 6 (30%), and abdominal mass in 4 (20%). Various abdominal x-ray examinations revealed nonspecific abnormalities (ileus, bowel obstruction, abdominal mass) in about half the cases in which they were obtained, but in only one instance was the correct diagnosis of small bowel tumor made preoperatively. Five of 12 patients undergoing resection in hope of cure survived five years. These tumors tend to metastasize by hematogenous dissemination, peritoneal implantation, local invasion, and, uncommonly, lymphogenous spread. Wide small bowel resection with adjacent mesentery is suggested for most lesions. Five year survival following resection approximates 50% in reported series.
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PMID:Leiomyosarcomas of the small intestine. 45 59

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.
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PMID:[Analysis of postoperative deaths in colon and rectal cancer (author's transl)]. 84 78

A case of the carcinoid tumour of ileum causing hormone producing multiple hepatic metastases was described. Sometimes after feeding and drinking of beer the "flush" and the diarrhoea appeared. Multiple hepatic metastases were established by ultrasound. Two and a half years ago the patient already was examined and treated by another hospital. In this time the origin of the primaer carcinoid tumour was not found and the superselective embolisation of the right lobe of the liver was made which caused a carcinoid crisis. Later the complaints were renewed and once more the patient was examined. The origin of the illness was proved in the lower ileum by CT (computer tomography), angiography and I131 MIBG (metajod-benzyl-guanidin) scintigraphy. Another embolisation of the liver caused a newer carcinoid crisis. The operation of primaer carcinoid tumour was decided because of the danger of carcinoid crisis and ileus. In the perioperative period the patient was protected against carcinoid crisis by Sandostatin (made in SANDOZ, Basel), because the preoperative therapy, the anaesthetics and the surgical manipulation could have caused a carcinoid crisis. In Hungary the authors used for the first time somatostatin in perioperative period to protect the patient against carcinoid crisis.
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PMID:[Prevention of carcinoid tumor crisis]. 134 72

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.
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PMID:Surgery for melanoma metastatic to the gastrointestinal tract. 168 96

The authors analyse 62 patients suffering from carcinoma of the colon with metastases in the lungs. Six patients were operated on not only for primary tumor of the colon but also in solitary metastatic affection of the lungs. The interval during which a solitary metastasis in the lung was detected lasted 18.1 months on average. Palliative resection of the colon when distal metastases were found in the lungs was conducted in 21 patients; in 7 of these patients, metastases in the lungs were recognized before the operation while in 2 the diagnosed solitary metastasis was mistaken for carcinoma of the lung and only during operation for ileus was the tumor of the colon discovered. The postoperative mortality was 23.8%, in 17.7%, death was caused by incompetence of anastomosis sutures.
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PMID:[Treatment of colonic cancer with metastases to the lungs]. 169 93

The standard operation for gastric cancer is carried out for advanced gastric cancer with serosal invasion accompanying patent disseminative metastasis to the peritoneum of the omental bursa and lymph node metastases. It consists of subtotal or total gastrectomy, omentobursectomy and extended lymph node dissection. An early stage cancer, which in Japan accounts for almost a half of the resectable cases of gastric cancer, shows no serosal invasion, and lymph node metastases are rare if the cancer remains intramucosal. Such cases represent about a half the cases of the early stage cancer. The diagnosis of the early stage cancer, especially if it remains intramucosal, is made by means of preoperative radiological and endoscopic examinations and intraoperative examination. Since 1977 we have been performing a modified operation as well for cases of the early stage cancer. The surgical procedure is as follows: reduction in the size of gastric resection by 2/3, pylorus-preserving gastrectomy and proximal gastric resection; preservation of the distal portion of the greater omentum and transverse incision of the upper abdomen instead of upper midline incision to prevent ileus due to intestinal adhesion to abdominal wound around umbilicus; sparing bursectomy; narrowing the area of lymph node dissection; sparing thoracotomy for cancer in the esophagogastric junction; sparing splenopancreatectomy; preservation of the hepatic branch of the vagal nerve and postoperative temporary oral administration of cholagogue to prevent postgastrectomy cholelithiasis. In addition, the primary lesion is isolated from the blood circulation by means of ligation of the drainage veins to diminish metastasis through the blood vessels (hepatic metastasis, etc.), which is the main cause recurrence after surgery for the early stage cancer. The results of this new surgery are satisfactory; the five-year postoperative survival rate is 100.0% and it reduced the time needed for surgery, anesthesia and blood transfusion.
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PMID:[Modified operation for an early stage gastric cancer]. 202 97

Reported is the case of a 66-year-old woman who complained of a pain in the upper abdomen. A barium enema revealed a stenosis in the transverse and sigmoid colon and since her ileus worsened, an emergency operation was performed, which revealed an unresectable transverse colon cancer with a diffuse peritoneal metastases. After closing the wound, the patient was treated with local thermotherapy of the abdomen using an RF wave in combination with chemotherapy and immunotherapy. Later, since the tumor could not be palpated and the tumor markers dissipated, a reoperation was performed, and it was found that diffuse metastases had completely disappeared from the peritoneum. Further, a histopathological study did not disclose any tumor cells. Therefore, as the cancer was remarkably reduced, a partial transverse and descending colon colectomy was performed.
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PMID:[An unresectable colon cancer with a diffuse metastases that turned resectable following thermotherapy with chemoimmunotherapy]. 212 46

A 51-year-old man with congenital diaphragmatic hernia and enterothorax was found to have persisting leucocytosis (25,000/microliters), diarrhoea and weight loss (20 kg). Computed tomography (CT) revealed intrahepatic space-occupying lesions. CT-directed needle biopsy demonstrated adenocarcinoma metastases. Colon contrast enema was ambiguous. Since no primary tumour had been found, ambulatory treatment with 5-fluorouracil was started. After initial improvement diarrhoea and obstipation alternated so that the patient finally gave permission for coloscopy to which he had not consented at first. It revealed a carcinoma of the colon located in the thorax about 10 cm oral to the left colonic flexure. Progressive ileus necessitated an ileodescendostomy for palliation. The patient died three months later while on symptomatic treatment.
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PMID:[Colonic carcinoma localized in the chest in enterothorax due to congenital diaphragmatic hernia]. 220 44

In a prospective study of 103 patients with carcinoid tumors consecutively referred for medical treatment, the most common sites of the primary tumors were the ileum (73%), bronchi (7%), and jejunum (4%). All patients had local metastases, and 96 (93%) also had liver metastases. The most common initial symptoms were diarrhea (32%), ileus (25%), and flush (23%). The overall frequency of diarrhea was 84% and of flush was 75%. Heart insufficiency caused by cardiac valve disease was seen in 33% of the patients. The carcinoid syndrome, including flush, diarrhea, and elevated urinary 5-hydroxyindole acetic acid (5-HIAA) concentrations, was manifested by 69 patients (67%), 64 of whom (93%) had carcinoid tumors of mid-gut origin. Elevated urinary 5-HIAA was found in 91 patients (88%), of which 89 displayed liver metastases. The plasma concentration of the tachykinin neuropeptide K (NPK) was elevated in 67 patients (66%), 63 of whom had tumors of the mid-gut region. Serum pancreatic polypeptide (PP) and human chorionic gonadotrophin alpha levels were elevated in 43% and 28% of the patients, respectively, and the highest levels were found in patients with metastatic bronchial carcinoid tumors. Thirty-nine of the 103 patients are now dead; 18 died of tumor progression, whereas 14 patients died of heart failure secondary to a carcinoid tricuspidal valve insufficiency. The estimated median survival from the time of histologic diagnosis was 14 years, and from the time of carcinoid syndrome was 8 years.
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PMID:Malignant carcinoid tumors. An analysis of 103 patients with regard to tumor localization, hormone production, and survival. 244 Mar 90


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