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)

The extent of tumour growth beyond the muscularis propria (mesorectal spread) was measured in specimens from 167 consecutive patients with rectal cancer. The 5-year survival was significantly greater in patients with slight mesorectal spread (4 mm or less) than in those with more extensive mesorectal spread (55% [95% confidence interval 42-66%] vs 25% [13-38%]). The prognostic value for survival of mesorectal spread was independent of the presence of lymphnode metastases. There were also significant differences in survival between patients with slight and extensive mesorectal spread among patients with Dukes' stage B tumours (66% [41-82%] vs 37% [14-60%]) and those with Dukes' stage C tumours (30% [12-52%] vs 18% [6-34%]). Thus mesorectal spread of rectal cancer is an important determinant of survival, and its accurate measurement may serve to subdivide Dukes' B and C cases. In this study tumour involvement of the lateral resection margin was not a useful predictor of local recurrence, but it did correlate with poor prognosis.
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PMID:Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. 197 82

In the management of the patient with intra-abdominal recurrence of colorectal carcinoma, surgery remains the primary mode of therapy when cure or significant palliation is anticipated. Appreciation of the importance of close follow-up after primary resection coupled with improved diagnostic modalities has allowed the surgeon not only to detect earlier recurrence but also to select the patients most likely to benefit from resection of recurrent disease. Improved surgical techniques with resultant decreases in the rates of morbidity and mortality have allowed safe hepatic resection of metastatic disease. In selected patients, this procedure produces 5-year survival rates approaching 50%. Although a clear consensus has not been reached, most studies agree that positive prognostic indicators include absence of extrahepatic disease, a small number of intrahepatic lesions, a low CEA level, and a better Dukes stage of the primary. Likewise, in the patient with recurrent disease locally, surgery provides the only means of cure and also plays a significant role in palliation. Aggressive resection with generous surgical margins in patients with contained disease may yield 5-year survival rates approaching 35%. In patients with unresectable disease and even in those with carcinomatosis, palliation can be obtained by surgical therapy. Judgment is necessary in treating these patients both preoperatively and intraoperatively. Surgical intervention for obstruction, perforation, or other anatomic or physiological compromise is often indicated and can improve the quality of life of the patient with intra-abdominal recurrence.
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PMID:Reoperation for colorectal carcinoma. 170 30

The development of hepatic metastases in 344 patients with colorectal carcinoma was examined for correlation with the presence of both venous invasion by the primary tumor and basement membranes in the tumor tissue. The former was detected by Victoria blue and hematoxylin-eosin staining and the latter by antilaminin antibody. A significant difference in the incidence of venous invasion was noted between patients with and those without liver metastasis at surgery. Basement membrane deposition was found in half of all cases of well differentiated adenocarcinoma, which was significantly high compared with other tumor types. This was more distinct in metastatic foci in the liver and lymph nodes than in the primary lesion, but less marked in intravascular tumor tissue. Basement membrane deposition was seen more frequently in Dukes' A tumors than in B tumors, although this was not statistically significant. No relationship was found between basement membrane laminin positivity and five-year survival, nor was there any correlation between the incidence of liver metastasis and tumor histologic type. Venous invasion was considered to be intimately related to the development of liver metastasis. Deposition of laminin-positive basement membrane was dependent on the grade of tumor differentiation, whereas it had no direct relation to the development of liver metastasis.
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PMID:Development of liver metastasis in colorectal carcinoma. With special reference to venous invasion and basement membrane laminin. 171 35

In colorectal cancer an association has been found between lack of epithelial basement membrane (EMB) immunostaining in the tumour centre and more extensive malignant spread. Interestingly, ultrastructural investigations suggest that EBM loss at the tumour periphery may be part of an invasive mechanism. To further assess the significance of EBM deficiencies in different tumour areas, we carried out a detailed study of the basement membrane laminin immunostaining patterns in 130 cases of colorectal carcinoma. We find that discontinuous EBM staining in the tumour centre is associated with poor tumour differentiation (p less than 0.005), presence of lymph-node metastases (p less than 0.02), and more advanced Dukes stage (p less than 0.02). The latter association is strengthened by excluding cases in which numerous polymorphonuclear leukocytes (PMNs) are present adjacent to EBM breaks, suggesting that these inflammatory cells are a confounding factor. Discontinuous EBM staining is more frequently observed in tumour deep to muscularis propria than in submucosal tumour (p less than 0.02), indicating intra-tumoral variation. At the tumour periphery, extensive EBM discontinuity shows no association with lymph-node involvement, but is linked with deeper local invasion (p less than 0.05). While EBM staining patterns around central and peripheral tumour glands are related (p less than 0.001), staining around peripheral glands is almost invariably more discontinuous. However, EBM lack at the tumour periphery is not as absolute as previously suggested, since in 18% of tumours fewer than 25% of peripheral tumour glands show EBM breaks. This appears consistent with the hypothesis that invasive changes at the tumour periphery are temporary and reversible.
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PMID:Relationships between epithelial basement membrane staining patterns in primary colorectal carcinomas and the extent of tumour spread. 171 74

From 1967 through 1988, 36 patients underwent local excision of a distal rectal cancer as an initial operative procedure with curative intent. A diagnostic, preoperative protocol was performed to assess the histologic grade of the tumor, the depth of penetration in the rectal wall, and the presence of positive lymph nodes or distant metastases. All patients had a transanal local excision performed under general anesthesia. If preoperative criteria were not confirmed by histopathologic specimen examination, a major operation was advised. To increase the chance of local control, external adjuvant radiotherapy was used in T2 cancers. Postoperative mortality was 0 percent. The postoperative complication rate was 9.3 percent. The observed local recurrence rate was 3 percent, and the rectal cancer-specific death rate was 6 percent. We compared these results with those obtained in 70 concomitant patients operated on by us employing a traditional resection for Dukes' A rectal cancer. There are no statistically significant differences between groups. In light of our findings, a policy of curative local excision is justified in accurately selected cases of distal rectal cancer.
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PMID:Conservative surgery for early cancer of the distal rectum. 173 14

This debate examines the arguments for and against the proposal that surgical excision alone is adequate treatment for primary colorectal cancer. The arguments in favour are that the results from curative surgery are excellent and that despite many trials of adjuvant chemotherapy, radiotherapy and immunotherapy, the proposed benefits remain unproven. Recent improvements in surgical technique, particularly for dissection of rectal tumours, have shown the way towards further improvement using surgery alone, and it is clear from a national survey that technical factors related to individual surgeons play a large part in determining recurrence rates. With optimum primary treatment, surgical excision alone is indeed adequate therapy. The arguments against this motion are that although a considerable number of patients do survive with surgery, the 5-year survival rate is poor when there is extensive local invasion or lymphatic metastases. Surgery starts therapy by reducing the tumour load, but other modalities are required to destroy the cells which might subsequently develop into metastases. Trial results with adjuvant therapy are encouraging, although many contain too few patients. We cannot be content with the results of treatment of Dukes' Stage B and C tumours; more trials are needed to determine the best treatment for these patients.
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PMID:Surgical excision alone is adequate treatment for primary colorectal cancer. 173 98

Twenty-nine patients undergoing hepatic resection for colorectal metastases from 1980 to 1986 were studied. The overall cumulative survival rates were 82%, 63% and 32% at 1, 2 and 3 years, respectively. The possible prognostic factors, i.e., Dukes' staging of the primary lesion, the number of metastatic nodes, synchronous versus metachronous appearance of metastases, and curative versus non-curative resection were estimated. Evaluation of those categories did not provide any significant information for prognosis after hepatic resection for liver metastases. The growth patterns of the tumor boundary were classified into three types as sinusoidal, expansive, and mixed. There was no significant difference in the survival rates among these groups. The significant factor affecting prognosis was only whether the secondary tumors were encapsulated or not. Patients with encapsulated tumor of the interval longer than 2 years between colon resection and hepatic resection had a significantly better survival rate.
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PMID:Clinico-pathological features of liver metastases from colorectal cancer in relation to prognosis. 177 10

The aim of this study was to measure the serum level of the tumour markers CA 195 and CEA in patients with either colorectal or pancreatic cancer both before and at serial intervals after operation. CA 195 and CEA were measured in 199 patients with colorectal cancer and 52 patients with pancreatic cancer. The median concentrations of CA 195 were 3.0 u/ml (interquartile range 3.0-4.5 u/ml) in patients with a Dukes' stage A lesion, 5.8 u/ml (3.0-18.2 u/ml) in patients with a Dukes' stage B lesion, 6.1 u/ml (3.0-24.7 u/ml) in patients with a Dukes' stage C and 23.8 u/ml (11.1-409.0 u/ml) in patients with metastatic disease (normal range 0-7 u/ml). The median levels of CEA were 2.6 ng/ml (1.7-3.3 ng/ml) for Dukes' stage A, 3.3 ng/ml (1.7-7.2 ng/ml) for Dukes' stage B, 3.7 ng/ml (2.2-7.9 ng/ml) for Dukes' stage C and 34.5 ng/ml (13.3-289.4 ng/ml) for metastatic disease. A rising level of CA 195 or CEA after operation suggested recurrence of the tumour. In none of these patients was the recurrence operable. In patients with pancreatic adenocarcinoma, the level of CA 195 was significantly higher in patients with metastatic disease but it did not discriminate between resectable and unresectable disease. The duration of survival correlated with the initial level of CA 195 (Rs = -0.66, p less than 0.001).
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PMID:The tumour marker CA 195 in colorectal and pancreatic cancer. 179 32

For a longer period of time the question of indication for adjuvant postoperative radiotherapy of the rectal cancer has been discussed and handled in practice with a lot of controversy. The lymphnode status plays a very important role as an prognostic indicator for the development of the disease. This already has been shown in large collections of patient data. According to our opinion, this evidence should lead to an increase of indication of the adjuvant postoperative radiotherapy. After the introduction of the computer-aided planned, small volume four-field-technique, the former problem of an additional significant damage through adjuvant postoperative radiotherapy are no longer of importance. The life quality of living of the patient with progressive disease often shows much earlier and decisive decrease by local failure comparing a metastatic disease to the liver and lung with few symptoms over a long period of time. Our radiation therapy on 135 patients in Dukes stage B2 to C2 has shown a rate of only 7.6% local failure and in Dukes stage B an even minimaly better outcome with 5.6% compared to stage Dukes C, which expectedly shows the worst result (12.7%). The median followup of 20.4 months corresponds about to the critical 2-years period. Comparing these excellent results with the literature, one has to notice that the 5-year survival rate according to the actuarial method of Kaplan-Meier in our group is as low as 27.6% (compared to the rate of about 60% in the literature). We explain this difference with the specific age structure and the relatively high rate of distant metastasis in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Adjuvant postoperative radiotherapy of rectal cancer with special reference to the problem of local recurrence]. 179 54

DNA ploidy patterns in 11 poorly differentiated adenocarcinomas of the colorectum were examined by flow cytometry using paraffin-embedded specimens. Measurements of DNA content were made of the superficial (Sup) half and deeper (Deep) half of the primary tumors in all cases, and of lymph node metastases in five cases. All the primary tumors showed invasion beyond the muscularis propria of the colorectum. Aneuploidy or polyploidy in either Sup or Deep of the primary tumor was found in six of the 11 (54.5%) tumors. Out of the six aneuploid tumors, five were in Dukes' stage C with distant metastases at the time of operation, and four died within one year of surgery. Conversely, out of five diploid tumors, none had distant metastases at the time of operation and two survived for longer than three years after surgery. The DNA ploidy pattern of Deep differed from that of Sup in four out of six aneuploid tumors, and two showed aneuploidy in Sup and diploidy in Deep. All the lymph node metastases in the five tumors had a diploid pattern, although three had aneuploid patterns in the primary tumors. The findings suggest the DNA ploidy pattern of a primary tumor to be correlated with the degree of metastasis at the time of operation or prognosis, but the population of tumor cells having different DNA contents may be apt to change between Sup and Deep in aneuploid tumor.
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PMID:Flow cytometric DNA analysis of poorly differentiated adenocarcinoma of the colorectum. 180 45


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