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)

Although the exact proportion of patients with carcinoma in situ in whom disease will progress to invasive lung cancer is not known, and although there have been reports that some individuals may continue to show malignant cells in sputum for several years without symptoms or abnormality on chest radiograph, untreated or suboptimally treated carcinoma in situ has been shown to progress to invasive cancer or metastatic disease. A study by Frost and co-workers showed that cancer developed in approximately 10% of individuals with moderate atypia and 40% of those with severe atypia in sputum cytology. Therefore, the proportion of individuals with carcinoma in situ in whom invasive cancer will develop is likely to be greater than 40%. Lung cancer is almost uniformly fatal when untreated, and, if the disease is allowed to progress to the invasive stage, the results of currently available therapy are poor. A lesson must be learned from cervical cancer screening. As has been shown by Anderson and co-workers, if individuals harboring dysplasia or carcinoma in situ are actively sought for and treated by laser or cryotherapy, the incidence and mortality of invasive cervical cancer can be reduced to extremely low levels. If current work directed toward detecting early lung cancer in sputum cytology specimens in high-risk groups using quantitative image cytometry or molecular markers is successful, the ability to localize small preinvasive lesions with fluorescence bronchoscopy will become even more important for the pulmonologist or thoracic surgeon. Endoscopic ultrasound can be used to determine the depth of tumor infiltration into the bronchial wall or adjacent structures. Biopsy of mediastinal and peribronchial lymph nodes can be performed under sonographic guidance for more accurate staging. By coupling sensitive diagnostic tools to new treatment modalities, such as chemoprevention and various endobronchial therapies, it is hoped that the traditionally poor prognosis for patients with lung cancer can be altered in the near future.
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PMID:Future diagnostic procedures. 872 84

This study describes the patterns of cervical and breast cancer among pregnant mothers who were treated at the NN Petrov Institute of Oncology in Russia during 1960-94. The sample included 476 patients admitted with invasive cervical cancer that was diagnosed during pregnancy or after birth or abortion. Findings were compared to a control group of 640 invasive cervical cancer patients and 240 breast cancer patients of reproductive age. 95.3% of cancers were malignant. 60.9% were tumors of the cervix, breast, and ovaries. The percentage of cervical cancer cases was 23.5% of reproductive age women. In 69% of the cervical cancer patients, the depth of tumor growth into the stroma exceeded 1 cm compared to only 32% in the control group. Cervical stage I cancer during pregnancy spread to the regional lymph nodes twice as frequently as in the control group. Lymphatic metastases were greatest in patients with regional metastases during the second and third trimester or after birth. 21.4% of pregnant patients and 15.5% of nonpregnant patients had stage III cervical cancer. 5-year survival rates after prompt treatment was 58.4% compared to 78.8% for controls. 2% of breast cancer patients were pregnant at the time of diagnosis, and most had the lobular form. Regional metastases were 1.5-2.0 times higher for breast cancer cases diagnosed during pregnancy compared to nonpregnant cases. The cancers diagnosed in the last two trimesters or during breast feeding tend to be aggravated. The 5-year survival rate is poor. The prognosis for the fetus is better if diagnosed in the third trimester, but better for the mother if diagnosed in the first trimester. Pregnancy does not increase the risk of malignant tumors and is not likely to accelerate tumor growth. IUD contraception should be used by breast cancer patients post-treatment. Cervical cancer patients should begin contraceptive use about 2 years after favorable prognosis.
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PMID:Fertility, pregnancy and cancer. 922 28

We describe a 27-year-old woman with systemic chemoresistant and radioresistant metastatic disease secondary to a recurrence of human papillomavirus (HPV) 18 infected cervical adenocarcinoma of the uterine cervix who received adoptive transfer of peripheral blood T cells stimulated with HPV 18 E7-pulsed autologous dendritic cells (DC). Extensive in vitro characterization of the DC-activated T cells derived from peripheral blood mononuclear cells (PBMC) included phenotypic analysis, cytotoxicity and intracellular cytokine production. High cytotoxicity activity was observed by CD8+T cells against autologous tumor cells, but not against NK-sensitive K562 cells, autologous Con-A lymphoblasts, or autologous Epstein-Barr virus-transformed lymphoblastoid cells. Blocking studies demonstrated that lytic activity was significantly inhibited by pretreatment of tumor targets with MAb specific for HLA class I as well as that of effector cells with anti-CD8, anti-LFA-1, but not anti CD3 MAb. Two-color flow cytometric analysis of the cytotoxic T cells revealed that a significant proportion of CD8+ cells was also CD56+. These double positive CTLs were thymically derived, as shown by expression of heterodimeric CD8 molecules (alpha/beta CD8) and were endowed with high cytotoxic activity against tumor cells. Analysis of intracellular cytokine expression showed that the striking majority of E7-pulsed DC activated CD8+ T cells strongly expressed IFN-gamma, TNF-alpha and IL-2 but not IL-4. The patient received two infusions of cytotoxic tumor-specific T cells at 2 week intervals, and in vivo distribution of the T cells was followed by 111 oxine labeling and serial gamma camera imaging. Persistent accumulation of radioactivity in the lungs, which harbored extensive metastatic disease, was detected up to 120 hrs after the infusion. Taken together, these results illustrate the potential of E7-specific and tumor-specific CTL-based immunotherapy for the treatment of patients with invasive cervical cancer.
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PMID:Development, characterization and distribution of adoptively transferred peripheral blood lymphocytes primed by human papillomavirus 18 E7--pulsed autologous dendritic cells in a patient with metastatic adenocarcinoma of the uterine cervix. 1072 12

The survival of patients with cervical cancer has not improved much over the past few years. Cervical cancer is characterised by a degree of heterogeneity. Some patients undergoing surgery die a few months after diagnosis and treatment, whereas others live for longer and metastases only occur at a later stage. Over the past few years a new prognostic factor of cervical cancer has been identified. Neoangiogenesis can predict the possible metastasization of lymph nodes, disease-free survival, recidivation and therefore which patients require specific postoperative adjuvant therapies. This oncogenetic model, which also correlates the degree of neoangiogenesis with metastasization, and hence the level of tumour aggression, has been well demonstrated in lung cancer and skin melanoma. The microscopic discovery of increased tumour vascularization might be a useful independent prognostic factor in patients otherwise regarded as low risk. Cervical cancer with intense neoangiogenesis at an early phase may undergo rapid growth, early invasion and an increased capacity for metastasization. Neoangiogenesis is expressed as the density of microvessels inside the stroma of the neoplasm in invasive cervical cancer. It is predictive of recurrent disease and mortality independent of other prognostic factors. Patients with a high density of microvessels have a risk of fatal recidivation. The quantification of angiogenesis in primary tumours may be a useful prognostic factor in patients with cervical cancer. The quantification of neovascularization in neoplasms today is made easier by immunohistochemical staining procedures with greater specificity and sensitivity compared to conventional stains. It is to be hoped that this method will be used systematically by pathologists in biopsies to identify the most appropriate surgical and adjuvant therapies.
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PMID:[Impact of neoangiogenesis on the survival of patients of patients with stage Ib-IIb cervical carcinoma]. 1090 80

The objective of this paper was to analyze the 5-year survival rate and prognostic factors for stage Ib and IIa cervical cancer treated by radical hysterectomy. A total of 366 patients with invasive cervical cancer treated by radical hysterectomy from June 1985 to June 1994 at Chonnam National University Hospital, Kwangju, Korea were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier estimator. Multivariate analysis was performed using the Cox proportional hazards regression model. The overall 5-year survival rate was 92% in stage Ib and 87% in stage IIa. Factors assessed for prognostic value included age, FIGO stage, cell type, tumor size, depth of invasion, lymphovascular space invasion (LVSI), and pelvic lymph node metastases (LNM). In the multivariate analysis, age, cell type, and lymph node metastases were independent predictors of survival. Lower survival was associated with age greater than 50 years, adenocarcinoma, and presence of lymph node metastases. The higher survival rates in patients with single lymph node involvement or lymph node metastases below the level of the common iliac nodes (85 and 84.6%, respectively) versus multiple or extrapelvic lymph node metastases (50 and 20%, respectively) were statistically significant (P < 0.01). In conclusion, patients who had lymph node metastases, adenocarcinoma, and were older than 50 years had a poorer survival rate. Such patients require more intense postoperative treatment and closer surveillance. Low-risk patients with a single lymph node metastasis below the level of the common iliac nodes may benefit from thorough lymphadenectomy without adjuvant therapy to prevent unpleasant complications.
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PMID:Overall 5-year survival rate and prognostic factors in patients with stage IB and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection. 1124 Jun 91

Fertility and gynaecological malignancies have an important relationship. A clear inverse relationship exists between family size and the incidence of ovarian and endometrial cancer. Current methods of fertility control have an influence on subsequent development of various gynaecological malignancies. A slightly increased risk of breast cancer has been reported in current users and those who had used hormonal contraceptives (OCs) within 10 years; this risk declined with time and disappeared after 10 years. Women who started OC before age 20 had a higher relative risk; the disease did not spread beyond the breast in the majority. Most studies found OC to reduce the risk of ovarian and endometrial cancer. The relative risks of squamous cell carcinoma and adenomatous carcinoma of the cervix have been reported to be 1.3 and 1.5, respectively in ever-users of OCs; however, the aetiology of cervical cancer is multifactoral. Several reports suggest the beneficial effect of tubal ligation and breast feeding in reducing the risk of ovarian cancer. Therapy of gynaecological malignancies may have an influence on subsequent fertility. Amenorrhoea developing after treatment of hydatidiform mole may be due to choriocarcinoma, recurrent mole or a normal pregnancy. Choriocarcinoma can also develop after a partial mole. The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or immediately following the treatment cycles. Fertility is not impaired following chemotherapy. Successful pregnancies have occurred in women who have had widespread GTD including cerebral metastases. In the young patient with gynaecological malignancy preservation of fertility is possible. Fertility-sparing surgery may be safe in early ovarian epithelial cancers and even in advanced germ cell tumours. Recently, the fertility-sparing surgery of radical trachelectomy and pelvic lymphadenectomy has been carried out for early invasive cervical cancer in young women. Gynaecological cancer occurring in pregnancy is uncommon; it presents the clinician with a difficult situation to manage. In most instances the cancer is treated as though the patient is not pregnant; the timing and mode of delivery needs individualization. The overall prognosis for breast cancer complicating pregnancy is poor. Survival in cervical cancers diagnosed antepartum is similar to the non-pregnant patient. Ovarian cancer in pregnancy has a good prognosis because of the early stage at diagnosis.
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PMID:Chien-Tien Hsu Memorial Lecture. Fertility and gynaecologic malignancies. 1133 Jul 24

For many decades, invasive cervical cancer has been considered more or less chemoresistant and chemotherapy has been limited to patients presenting with overt metastatic disease or those suffering from pelvic recurrences which could not be advised to secondary local treatments. However, more than 20 different single agents are considered active in cervical cancer. Recent cooperative clinical trials have demonstrated the superiority of multi-modality strategies for patients with high-risk cervical cancer. These studies integrating chemotherapy as part of the primary therapeutic concept have provided the most significant improvement of locally advanced disease in more than three decades. This review summarizes current standards of chemotherapy for invasive cervical cancer and shows new developments which may improve systemic treatment of the disease.
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PMID:The role of chemotherapy in invasive cancer of the cervix uteri: current standards and future prospects. 1170 45

We assessed the feasibility of sentinel lymph node detection using technicium-99 radiocolloid lymphatic mapping for predicting lymph node metastases in early invasive cervical cancer. Thirty patients with cervical cancer (stages IA2-IIA) underwent preoperative lymphoscintigraphy using technicium-99 intracervical injection and intraoperative lymphatic mapping with a handheld gamma probe. After dissection of the sentinel nodes, the standard procedure of pelvic lymph node dissection and radical hysterectomy was performed as usual. The sentinel node detection rate was 100% (30/30). There were seven (23.3%) cases of microscopic lymph node metastases on pathologic analysis. All of them had sentinel node involvement. Therefore, the sensitivity of sentinel node identification for prediction of lymph node metastases was 100%, and no false negative was found. Preoperative lymphoscintigraphy, coupled with intraoperative lymphatic mapping, located the sentinel nodes accurately in our study patients. This sentinel node detection method appears to be feasible for predicting lymph node metastases.
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PMID:Sentinel node detection with radiocolloid lymphatic mapping in early invasive cervical cancer. 1582 11

Cervical cancer is the second leading cause of cancer death among women worldwide and remains an important health problem for women, especially in underserved and minority groups in industrially developed nations. Although radical surgery and radiotherapy represent effective modalities of treatment for invasive cervical cancer, up to 35% of these patients overall will develop recurrent/metastatic disease for which treatment results remain poor. Novel therapeutic strategies that are effective in reducing the risk of recurrence/metastatic disease are still needed desperately. Human papillomavirus (HPV) infection represents the most important risk factor for the development of cervical dysplasia and cervical cancer. Since HPVE6 and E7 oncoproteins are constantly expressed in these lesions, these foreign proteins represent ideal tumor-specific target antigens for immunotherapy of cervical cancer. Recently, the recognition of dendritic cells (DC) as powerful antigen-presenting cells, capable of inducing primary T-cell responses in vitro and in vivo, has generated widespread interest in DC-based immunotherapy of several human malignancies. This review summarizes the therapeutic clinical trials and the different preclinical research strategies that are under investigation, with a particular emphasis on the use of autologous DC-pulsed HPV16 or 18 E7 oncoproteins as therapeutic vaccines against cervical cancer.
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PMID:Advances in dendritic-cell-based therapeutic vaccines for cervical cancer. 1794 71

Worldwide, cervical cancer is the second most common malignancy in women, and is a major cause of morbidity and mortality. Accurate tumor staging is essential for optimal treatment planning and prognosis. Cervical cancer is staged by clinical examination according to the International Federation of Gynecology and Obstetrics staging system. However, clinical staging has inherent deficiencies in evaluating several parameters that are critical for treatment planning. It is now widely accepted that cross-sectional imaging, and in particular MRI, has an important role to play in the staging of these tumors. MRI is an excellent modality for depicting invasive cervical cancer: it can provide objective measurement of tumor size and provides a high negative predictive value for parametrial invasion and stage IVA disease. MRI and positron emission tomography (PET)/computed tomography (CT) play key roles in identifying recurrent disease. PET/CT is also useful in detecting nodal and distant metastases and in radiotherapy planning. Diffusion-weighted MRI is an emerging imaging technique that is currently being evaluated for the detection of primary and recurrent disease and in the assessment of treatment response.
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PMID:MRI and PET scans for primary staging and detection of cervical cancer recurrence. 2018 30


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