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 purposes of this study were to (a) test the feasibility of the Cancer Total Quality Pain Management (TQPM) Patient Assessment Tool in a population of oncology inpatient and outpatients; and (b) identify factors associated with poor pain relief. The Cancer TQPM Tool was adapted from the American Pain Society's Quality Assurance Standards on Acute Pain and Cancer Pain and was tested in a convenience sample of 200 patients. The majority of patients reported that the TQPM Tool was easy to understand and to use, providing evidence for the feasibility of the tool. Factors associated with higher pain intensity included the inpatient setting, the presence of metastatic disease, hesitancy in bothering the nurse, and concerns regarding tolerance and addiction. Although there was a strong relationship between concern about addiction and concern about tolerance, fear of tolerance appeared to have a greater effect on pain intensity scores than did fear of addiction. The findings from this study suggest that the Cancer TQPM Patient Assessment Tool can be used effectively in both inpatients and outpatients to determine outcomes and the quality of cancer pain management, as well identify factors associated with poor pain control. Clinical implications include more effective education of patients and caregivers, including equivalent emphasis on tolerance and addiction.
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PMID:Barriers to cancer pain relief: fear of tolerance and addiction. 970 52

While chronic pain is experienced by approximately 50-90% of patients with metastatic cancer, little is known about sex differences in chronic cancer pain. Therefore, the purposes of this study, in a sample of oncology outpatients (n=187) who were experiencing pain from bone metastasis, were: 1) to determine if there were sex differences in various pain characteristics, including pain intensity, and 2) to determine if there were sex differences in the prescription and consumption of analgesic medications. No significant sex differences were found in any of the baseline pain characteristics. In addition, no significant sex differences were found in analgesic prescriptions or intake of analgesic medications. Of note, men reported significantly higher pain interference scores for sexual activity than women. The study findings are important because they suggest that, unlike in acute pain, sex may not influence patients' perceptions of and responses to chronic cancer pain.
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PMID:No evidence for sex differences in the severity and treatment of cancer pain. 1533 34

The mechanisms involved, and possible treatment targets, in orofacial pain due to cancer are poorly understood. The aim of the first of this two-part series is to review the involved pathophysiological mechanisms and explore their possible roles in the orofacial region. However, there is a lack of relevant research in the trigeminal region, and we have therefore applied data accumulated from experiments on cancer pain mechanisms in rodent spinal models. In the second part, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. In the present article, we provide a brief outline of trigeminal functional neuro-anatomy and pain-modulatory pathways. Tissue destruction by invasive tumors (or metastases) induces inflammation and nerve damage, with attendant acute pain. In some cases, chronic pain, involving inflammatory and neuropathic mechanisms, may ensue. Distant, painful effects of tumors include paraneoplastic neuropathic syndromes and effects secondary to the release of factors by the tumor (growth factors, cytokines, and enzymes). Additionally, pain is frequent in cancer management protocols (surgery, chemotherapy, and radiotherapy). Understanding the mechanisms involved in cancer-related orofacial pain will enhance patient management.
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PMID:Orofacial pain in cancer: part I--mechanisms. 1752 48

Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.
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PMID:Cancer and orofacial pain. 1834 31

Verrucous carcinoma is an uncommon complication of chronic osteomyelitis. The incidence of fistular carcinomas is reported to be between 0.21% and 3.36%. We present a case of verrucous carcinoma of the tibia arising after 58 years of chronic osteomyelitis. The primary presenting symptoms were acute pain, foul-smelling pus discharge and increasing lesion size. We used modern diagnostic investigations (biopsy, computed tomography, angiography, immunoscintigraphy, magnetic resonance tomography) to visualize the extent of the malignant lesion. No metastases were detected. Knee exarticulation was successful in treating the tumor and chronic infection in this case.
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PMID:Verrucous carcinoma of the tibia arising after chronic osteomyelitis: a case report. 1926 15

Necrotic testicular tumors are relatively frequent and can present a significant diagnostic challenge. Because of differing treatments for seminomas versus nonseminomas, accurate diagnosis is critical. Eleven totally (n=9) or almost totally (n=2) necrotic testicular tumors were retrieved from our consult files. The submitting pathologists favored benign processes in 4 cases, Leydig cell tumor in 1, and lymphoma in 1. The cases were evaluated for histologic features and, when material was available, by immunostaining with 7 antibodies: keratin (AE1/AE3), OCT4, placental alkaline phosphatase, alpha-fetoprotein (AFP), CD117, CD30, and S100. Only distinct reactivity in a cellular distribution in the necrotic zone was considered positive; nuclear reactivity alone was scored for OCT4 and membrane reactivity for CD117 and CD30. Mean patient age was 35 years (range 16-63). Mean tumor size was 19 mm (range 7-53). All patients presented with unilateral testicular masses (6 right, 5 left); 2 also had acute pain. The combination of histologic features, immunostains and, in 1 case, serum AFP permitted classification of 8 tumors (4 seminomas, 3 embryonal carcinomas, 1 yolk sac tumor). Three were not classifiable. The necrotic seminomas lacked associated coarse intratubular calcifications and were positive for OCT4 (4/4) and CD117 (3/3) but negative for keratin (0/4) and CD30 (0/4). The necrotic embryonal carcinomas had associated coarse intratubular calcifications and were positive for keratin (2/3), OCT4 (2/2), and CD30 (3/3). OCT4 stained 1 unclassifiable tumor, which lacked other specific markers. We did not find placental alkaline phosphatase, AFP, and S100 stains useful, although S100 did highlight tumor "ghost" cells in 1 case. Other features in most cases included intratubular germ cell neoplasia (6/11), tubular atrophy/hyalinization (10/11), tumor "ghost" cells (10/11), scar (9/11), and inflammation (10/11). Of the 5 patients with available follow-up, 3 were free of disease at 1, 5, and 8 years after orchiectomy (2 necrotic seminomas and 1 germ cell tumor, unclassified). One patient with yolk sac tumor (age 63 y) developed widespread metastases after 15 months and died of disease. The final case was initially misinterpreted as "testicular infarction, no malignancy" and 16 months later the patient developed a large retroperitoneal seminoma. Most totally necrotic testicular tumors can be placed into clinically important groups by assessment for coarse intratubular calcifications and staining reactions for keratin, OCT4, CD117, and CD30.
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PMID:The utility of microscopic findings and immunohistochemistry in the classification of necrotic testicular tumors: a study of 11 cases. 1946 7

Pain is common in patients with cancer (33-64%) and can be divided into background and breakthrough pain (BTP). BTP is a passing, acute pain that occurs despite the use of analgesia to control background pain. BTP may arise spontaneously or be provoked by certain movements or activities. It lasts 30-60 minutes and is generally self-limiting and is often undertreated. We describe 2 patients aged 68 and 57 years with metastatic disease who were admitted for pain management. BTP was inadequately managed during their hospital stay. Both patients had to wait too long before they received their BTP medication, causing the BTP to have passed its peak. After consultation with their nurses, both patients were allowed to have one dose of breakthrough medication in advance, which resulted in better treatment of their BTP. Every hospitalized patient with BTP should have one dose of breakthrough medication ready for taking in advance.
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PMID:[Treatment of breakthrough pain in cancer patients]. 2556 80