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

Alternatively to the usual evaluation summary, a characteristic of small cell lung cancer, is the probability of significant diffuse metastases; the prognosis is directly linked to the extent of these metastases. Moreover, the assessment of the initial extension becomes heavier and more costly as investigations continue and each new technology appears. In order to evaluate the contribution of each examination, a classification has been established as a function of the time-scale to obtain the results, of the technology involved, or whether the investigation is painful or not and any likelihood of iatrogenic side-effects. An assessment in three stages is proposed to achieve the most effective and cheapest diagnosis possible. In relation to the usual technique of assessment this sequential approach allows for a 27% reduction in the time-scale for the diagnosis of diffuse disease, 51.3% in terms of technical involvement, 46.3% in terms of pain and discomfort and 53.9% in terms of iatrogenic potential. At the same time a reduction in cost of 47.5% is observed.
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PMID:[Clinical and economic evaluation of the initial assessment of small cell cancer of the lung. Alternatives to classic evaluation. LGTO. The Lyon Group of Thoracic Oncology]. 825 31

Endoscopic stent placement has become accepted palliative therapy for malignant biliary tract obstruction. Because stent occlusion remains a significant late complication, prophylactic replacement has been suggested, although the appropriate time interval remains unclear. Patients with malignant biliary strictures who received 10F or 11.5F stents were analyzed with respect to clinical response, occlusion rates at 3 and 6 months, and survival rates. Seventy stents were placed in 50 patients. Pancreatic carcinoma was the most common underlying malignancy. Overall, obstructive symptoms resolved in 94% of cases. Occlusion rates at 3 months (4.2%) and 6 months (10.8%) were not significantly different. Median overall survival averaged 22 weeks. Results were also stratified by underlying diagnosis, with the worst clinical response and survival being seen in the group of patients with metastatic cancer. Findings suggest that the time interval for stent replacement can be extended safely from 3 to 6 months, resulting in decreased patient discomfort and cost and obviating any replacement in that significant percentage of patients who expire before 6 months.
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PMID:Optimal timing for stent replacement in malignant biliary tract obstruction. 838 45

Adenocarcinoma of the endometrium in patients 45 years old or younger accounts for 3-8% of all endometrial cancers diagnosed. Ten women of age = 45 years treated for endometrial cancer stage I in our Clinic of Obstetrics and Gynaecology from December 1979 to December 1988. Two cases were nulliparae, none of the 10 patients had Polycystic ovary syndrome and only was obese. In 80% of these cases the presenting symptom was abnormal vaginal bleeding and one patient had coexisting ovarian neoplasia (endometrioid carcinoma). Atypical endometrial hyperplasia was diagnosed in only one case. None of the patients had metastases or capillary like spaces invasion. Our policy was to treat these patients by hysterectomy (Piver 1 or 2), bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy. One patient received adjuvant postoperative radiation therapy (49.5 Gy). One women was submitted two years later to radical mastectomy for ductal carcinoma of the breast. Endometrial adenocarcinoma in premenopausal women is generally of favourable histotype, at early stage and low grade, with excellent prognosis. The problem of quality of life is therefore of utmost importance. After surgical castration 4 of our patients experienced discomfort and excessive weight gain. The implications of long-term estrogen deprivation in younger patients must be seriously considered against as the change of ovarian conservation of hormonal replacement therapy.
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PMID:[Endometrial adenocarcinoma during the fertile age]. 846 59

Rising incidence, resulting from diagnosis together with the increasing age in the population, and high mortality combine to make cancer of the prostate a leading cause of death in men. Despite early, and unfortunately overly optimistic, hopes placed in oestrogen therapy, management of patients with metastatic cancer of the prostate remains one of the major challenges facing urologists. For stage D1 (invasion of the iliac nodes), systemic treatment is required, based on androgen deprivation, with five years disease free survival ranging from 55% to 95%. Radical prostatectomy is not indicated in cases of pathologically confirmed macroscopic nodal involvement, but the question remains controversial for patients with microscopic metastases. Pelvic radiotherapy at "curative doses" is not indicated because of the lack of any improvement over hormone therapy alone. Controversies still exist about timing of androgen deprivation (early or deferred endocrine treatment) either for stage D1 or stage D2 asymptomatic patients, but controlled studies are ongoing. Immediate endocrine therapy is however clearly indicated in stage D2 symptomatic disease and leads to improvement of symptoms (mainly bone pain) in up to 80% of patients. When there is spinal cord compression adding corticosteroids can be useful; surgery or radiotherapy are indicated particularly in cases of vertebral instability or neurological involvement. Current protocols are based on maximal androgen deprivation combining medical or surgical castration and anti-androgens. Prognosis is very poor at relapse despite hormone therapy (stage D3). Survival rate at 1 year is only 50%. It is essential that anti-androgens be withdrawn at this time since clinical improvement can be observed in some patients (anti-androgen withdrawal syndrome). None of the second line treatments (hormonal or chemotherapy) have led to any improvement in survival time. Treatments only alleviate patient discomfort and improve quality of life. The lack of progress over the last 50 years in the treatment of advanced stage cancer of the prostate means that the only way to cure future patients will be conditioned by early diagnosis and treatment during the less advanced stages.
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PMID:[Treatment of metastatic cancer of the prostate]. 854 43

Insufficiency fractures of the pelvis are commonly overlooked as causes of severe hip and low back pain. Predisposing factors include postmenopausal osteoporosis, corticosteroids, and local irradiation. Differential diagnosis includes metastatic disease to bone. We present the case of a 65-year-old woman who had a two-month history of low back pain and left groin pain. Her medical history included osteoporosis and endometrial cancer that was treated with radiation therapy to the pelvis 1 year prior to presentation. Despite bed rest, analgesics, and therapeutic modalities, her pain remained intractable and prevented ambulation. Plain radiographs showed no fracture. Computed tomography (CT) and magnetic resonance imaging showed fractures of the pelvis but were suggestive of malignancy. CT-guided bone biopsy was consistent with radiation osteonecrosis. After diagnosis and continued therapy, the patient progressed to ambulation with moderate discomfort. Failure to diagnose insufficiency fractures could lead to further pelvic irradiation, compromising already weakened bones and causing prolonged disability.
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PMID:Pelvic insufficiency fractures after irradiation: diagnosis, management, and rehabilitation. 860 69

Laparoscopic pelvic lymph node dissection (PLND) is the most commonly performed laparoscopic procedure in urology today. Indications for laparoscopic PLND are being refined to selectively identify patients who are at high risk for lymphatic metastases. From a technical standpoint, the anatomic detail and number of lymph nodes retrieved by the laparoscopic approach are comparable to open PLND. Laparoscopic PLND is associated with a steep learning curve and increased operative time; however, the decreased postoperative discomfort, shortened hospital stay, rapid resumption of normal activities, and enhanced cosmesis are clear advantages over open PLND.
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PMID:Laparoscopic pelvic lymphadenectomy: transperitoneal approach. 868 78

In addition to qualitative information, specific quantitative psychiatrics tests (regarding anxiety and depression) and objective psychological tests specific to cancer populations were used to compare psychological variables in two groups of metastatic cancer patients treated with chemotherapy. The study also recorded 24 possible symptoms (somatic and psychic) allowing the self-evaluation of individual quality of life. The evaluation was performed at 7 different times (from before the beginning of treatment up to the 6th course). In comparison to traditional treatment, the results showed a better psychosocial adaptation for patients receiving chronoprogrammed administration of anticancer medication, with better social relations, less feelings of loss of independence, less anxiety, depression, and somatic discomfort.
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PMID:Comparative psychological aspects of two different types of chemotherapeutic administration (chronotherapy vs. traditional chemotherapy) on quality of life of cancer patients at advanced stage. 872 5

The skeletal system is a frequent site of metastatic involvement from breast cancer, whose pattern of spread is such that cure becomes practically impossible. The best palliation with the minimum discomfort for the patient must therefore be the major objective. With an increasing number of reports about major surgical procedures for spinal metastases, we reviewed our series of patients submitted to radiotherapy. Of 2,189 breast cancer patients, we selected 28 who might have been potential candidates for surgical resection (with lesions only in the spine, only one or no more than three contiguous bodies involved and no other metastases). All these patients had been treated with 20 or 30 Gy plus systemic (chemo, hormone, or both) therapy. Follow-up revealed that all of them had developed new metastases outside the treated field within one year. Local control was achieved in 68% of patients and 75% of them had stable or better performance status at 3 months. Median survival was 36 months. From our analysis, even patients with a so called "solitary lesion" seem not to have a better prognosis than others. We conclude that radiotherapy is still the method of choice to treat vertebral metastases from breast cancer. The role of surgery should be limited to patients with neurologic compression or severe mechanical instability.
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PMID:[Is radiotherapy still the first choice treatment in spinal metastases from breast cancer?]. 904 51

Traditionally the radionuclide bone scan has been the cornerstone of prostate cancer staging. Previous widespread use of bone-scan imaging was certainly reasonable, even in the asymptomatic patient, as clinicians had no methodology to predict who would or who would not have osseous metastases. Now, in the era of PSA testing, clinicians do have a timely, cost-effective method to determine those patients who are highly unlikely to have osseous metastases. As evidenced by several clinical studies noted previously, a radionuclide bone scan should not be obtained in staging the asymptomatic, newly diagnosed prostate cancer patient with a serum PSA level less than or equal to 10 ng/mL. Incorporation of clinical stage and tumor grade does not significantly improve the predictive value of PSA. Those patients with bone discomfort, however, should undergo bone imaging, regardless of the serum PSA level. Similarly, the serum PSA level may be used to avoid unnecessary bone-scan imaging in the patient with recurrent prostate cancer following definitive treatment. At this time, we do not have enough clinical information to determine the optimal PSA level that will predict precisely which patients will have osseous metastases. From the above reports, however, and the present authors' clinical experience, it would seem reasonable to avoid bone-scan imaging if the post-radical prostatectomy serum PSA level is not more than 2 ng/mL. No absolute data are available about recurrence after radiation therapy or for men being managed with watchful waiting. In an attempt to clarify this issue, there is currently a clinical study underway at the University of Michigan. This study assesses the minimum serum PSA elevation that necessitates bone imaging in restaging the asymptomatic patient with recurrent prostate cancer after radical surgery or definitive radiation therapy. The radionuclide bone scan continues to be the gold standard for the detection of osseous metastases in prostate cancer. Nevertheless, it is unnecessary in the specific situations outlined above. Serum PSA testing allows the physician to refine the use and application of this imaging study, thus providing an opportunity to eliminate expensive and time-consuming studies that ultimately do not contribute additional information. The national economic impact of doing so is tremendous.
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PMID:Using prostate-specific antigen to eliminate the staging radionuclide bone scan. 912 36

A retrospective oncological study was performed in 25 woodworkers, in whom an adenocarcinoma of the ethmoid sinuses was discovered between March 1985 and December 1993. All patients were males with a mean age of 57 years, and a mean duration of wood dust exposure of 24 years. Signs of nasal obstruction, drainage, and discomfort were present in all cases. Ophthalmological findings were a poor prognosis indicator. It was possible to precisely evaluate treatment and outcome in 23 cases. The majority of tumors were classified as T3 or T4 (72%), with extension beyond the ethmoid sinuses; all were in contact with the roof of the ethmoidal sinuses. Extension was predominantly into the orbital and intracranial cavities as compared with extension posteriorly or into the maxillary sinuses. Treatment was identical in the 25 patients: a) combined surgery including a paranasal and a neurosurgical approach, b) postoperative radiotherapy. Results were expressed in terms of morbidity related to surgery and the oncologic outcome. Operative morbidity and mortality were substantially reduced with reconstruction of the roof of the ethmoidal sinuses. Meticulous excision, in addition to postoperative radiotherapy, resulted in a decreased rate of local recurrence (26%). On the other hand, metastasis were encountered more frequently (30%). Radiotherapy was insufficient when macroscopic excision was incomplete. Chemotherapy was used as palliative treatment in the event of a recurrence and/or metastases. Survival rate was 68% at 3 years, and 48% at 5 years. Most complications and recurrences arose within the first two years. Exophthalmos, intracranial extension, incompleteremoval, and extensive class T4 tumors were associated with a poor prognosis. Optimal therapy for malignant tumors of the ethmoid sinuses requires combined transfacial and neurosurgical approaches that allow precise assessment of tumor extension and adequate excision, yielding an improved oncologic outcome. Followed by radiotherapy, this association can result in a remission. Patient prognosis depends essentially on management of the initial lesion.
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PMID:[Adenocarcinoma of the ethmoid sinus in woodworkers. Retrospective study of 25 cases]. 929 54


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