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

The influence of diabetes mellitus on the course of breast cancer was investigated retrospectively in 752 patients. Possible unfavourable prognostic factors like overweight, lipid disorders, age and menopausal status were considered as confounders in a Cochran-Mantel-Haensel analysis. There was no difference in primary tumor status and lymph node involvement between patients with diabetes mellitus and nondiabetic patients. Diabetic patients had more often overweight, lipid disorders and were older than nondiabetic patients. Metastatic disease was highly significant correlated with primary tumor status (p less than 10(-6)) lymph node involvement (p less than 10(-10)) and diabetes mellitus (p less than 10(-5)). Overweight, lipid disorders, age and menopausal status were not correlated with metastatic disease. A possible explanation of the correlation between diabetes mellitus and metastatic disease could be hyperinsulinism in type IIB diabetes. A type IIB diabetes in most of the patients included in this study is very plausible because of the correlation between overweight, lipid disorders, old age and diabetes mellitus. This type of diabetes is characterised by a relative resistence to insulin in the target tissues and a prolonged and exceeding insulin secretion. Experimental data demonstrate that insulin stimulates the growth of breast cancer cell in vivo and in vitro.
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PMID:[Diabetes mellitus and breast cancer. A retrospective follow-up study]. 218 18

The authors evaluate five-year ultrasonographic material (13,672 examinations) focused on non-cystic liver disease. 8212 examinations (60.1%) were made as part of examinations of the gallbladder, 4919 (36%) as part of examination of the right sub-costal area or other organs and only 541 examinations (3.96%) were focused in the first place on the liver. The total number of examined patients included 7830 women (57.3%) and 5842 men (42.7%). Most frequently the ultrasonographic picture of steatosis was found--in 747 patients (5.46%), cirrhosis of the liver in 45 patients (0.33%), primary carcinoma of the liver was present in 7 patients (0.05%) and tumour metastases in 63 patients (0.46%). The group of women with steatosis comprised 42 diabetic women (32.06%), 78 overweight women (59.5%) and 18 with excessive alcohol intake for several years (13.7%). In the group of men with steatosis there were 48 diabetics (7.79%), 92 overweight (14.9%) and 479 with excessive alcohol intake extending over several years (77.7%). In the group of 34 men with cirrhosis excessive alcohol intake for years was found in 31 (91.2%), in the group of eight women with cirrhosis in five instances (62.5%). In abdominal ultrasonography liver disease must be actively searched for, in particular in patients with long-term alcohol intake, overweight, diabetes and long-term use of various hepatotropic drugs.
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PMID:[Non-cystic diseases of the liver in a 5-year ultrasonographic study]. 266 Apr

This editorial consists of summaries of the discussions on incidence, pathogenesis, prognosis and patient follow-up, and transcripts of the discussions on detection and treatment of endometrial carcinoma, from a symposium held in Carefree, Arizona. 75% of the cancers occur in postmenopausal women; average age is 52 years, but is decreasing. Endometrial carcinoma rose from 20.3 to 46.3% of all uterine cancers in Cleveland University Hospitals from 1941-1970. Older patients are often diabetic, overweight, nulliparous, with anovulatory or familial history; young women frequently resemble mild Stein-Levinthal syndrome. Clinically, 20% of patients are assymptomatic, others may have softer or larger uterus, larger ovaries, irregular postmenopausal bleeding, or lengthy onset of menopause. The Gravlee jet wash is indicated for high risk patients and those about to take estrogen. Endometrial carcinoma first affects epithelium, then endometrial stroma, then upper myometrium, lower myometrium, then other organs, perhaps via lymphatics, vagina, tubes, but ascites is uncommon. Generally, U.S. physicians use intrauterine radium followed by surgery, British use surgery first, and Swedish use radiation only. Cases must be treated individually, e.g. surgery only for minimal cancer, radium and surgery for more serious cases, and preoperative external radiation also for advanced disease. Although radiation lessens chance of implantation during surgical trauma, insertion of intrauterine radium enhances spread of tumor cells. Injectable progestins sometimes control metastatic disease, although they require 8 weeks to act. Progestins may help those with late recurrence, squamous metaplasia, or who are under 50 years of age. Estrogens are rarely effective. Prognois for terminal patients often includes subjective improvement, bowel obstruction, lung complications, hemorrhage. Radiation side effects and menopausal symptoms are often problems for cured patients. In young cured patients the endometrium should be suppressed with progestins or oral contraceptives.
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PMID:Endometrial cancer: rising incidence, detection and treatment. 469 33

In pediatric patients, endogenous Cushing syndrome is an infrequent condition almost always due to one of two conditions. 1) Adrenal gland tumors account for 70% of Cushing syndromes in young pediatric patients. They cause rapidly progressive hypercorticism not due to increased ACTH production (elevated plasma and urine cortisol levels, very low ACTH and LPH levels unchanged by dexamethasone, metyrapone or CRH). Imaging techniques determine the side and spread of the tumor and look for metastases. Following surgical removal, patients with indicators of malignant disease (tumor weight above 30 g, extracapsular spread or metastases, independently from pathological data) are given op'DDD. 2) Cushing disease occurs in peripubertal patients and causes overweight with delayed statural gain. ACTH production is increased (positive dexamethasone suppression test and provocative metopirone and CRH tests) as a result of a pituitary adenoma which should be looked for by magnetic resonance imaging and whose removal ensures recovery in 50% of cases. Other therapeutic tools include op'DDD, radiation to the pituitary, and bilateral adrenalectomy as the last resort given the high risk of post-adrenalectomy pituitary tumor (50% of pediatric patients). Other causes are exceedingly rare: primary nodular hyperplasia of the adrenal glands and production of ACTH by a nonpituitary tumor. Corticosteroid treatment is the most common cause of Cushing syndrome in children.
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PMID:[Cushing syndrome in children]. 823 97

The results of an evaluation of thyroid homeostasis in 54 patients with thyroid cancer (TC), 12-thyroid adenoma (TA), 10-non-toxic nodular goiter (NTG) and 39 healthy controls are discussed. It was demonstrated that assays of blood serum levels of thyrotropic hormone (TTH), thyroxin (T4), triiodothyronine (T3) and thyroglobulin (TG) are useless in diagnosing TC. However, it was confirmed that routine assays of blood serum-TTH, T4 and T3 levels are needed to evaluate the effect of post-operative substitution hormone therapy. Furthermore, the presence of recurrence or metastasis was indicated by an elevated concentration of blood-TG post-operatively if it was high pre-operatively. Post-operatively, TTH levels soared up in thyroid cancer and adenoma patients, reached their peak one month after surgery and then came back to normal while blood-TG concentration dropped to normal within 6-12 months. Unlike TA patients, blood-TG showed a continuous rise in those with TC. Ten years after surgery, blood-TTH levels in TC patients, who had received substitution hormone therapy, were much lower than in those without it. Similarly, the recipients of hormone therapy showed relatively lower T3 (6 months after operation) and TG (5 years after surgery) levels. Blood-TTH in overweight (Broca index > 20%) patients with TC was much higher than in those overweight less than 20%, 2 years after surgery. Elevated concentrations of blood-TTH and T3 were recorded in radically-treated patients with TC recurrences and metastases.
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PMID:[Specifics of thyroid status and their clinical significance in primary and recurrent thyroid cancer]. 969 83

The diagnosis of pancreatic cancer usually depends upon symptoms; consequently it is late when there is no chance for cure. At this point, pain, anorexia, early satiety, sleep problems and weight loss are present. Back pain also may be prominent, which predicts unresectability and shortened survival after resection. However, earlier recognition of symptoms of pancreatic cancer might improve early detection of the cancer. For example, 25% of patients have symptoms compatible with upper abdominal disease up to 6 months prior to diagnosis and 15% of patients may seek medical attention more than 6 months prior to diagnosis. These symptoms erroneously may be attributed to problems such as irritable syndrome. Symptoms, however, may be less common. For example a quarter of patients with pancreatic cancer may have no pain at diagnosis, and half, particularly those with pancreatic head tumors, may have little pain compared with patients with body-tail tumors. However, if the tumor is suspected because of predisposing conditions, earlier diagnosis may be possible. These conditions include diseases such as chronic pancreatitis, intraductal papillary mucinous tumor (IPMT), and recent onset of diabetes mellitus, particularly if the diabetes occurs during or beyond the sixth decade. In addition inherited syndromes also are associated with an increased risk of pancreatic cancer including familial pancreatic cancer, hereditary pancreatitis, familial adenomatous polyposis syndrome (FAP) and familial atypical multiple mole melanoma (FAMMM) syndrome (hereditary dysplastic nevus syndrome). Of these conditions, recent onset of diabetes may be the best clue and should be included in a clinical profile of patients prior to the onset of symptoms to identify a high-risk group to apply screening strategies for detection of early disease. Contrary to a clinical aphorism that pancreatic cancer patients are elderly, lean and recently may have developed diabetes, we found that patients who develop pancreatic cancer are overweight prior to onset of symptoms compared to controls (body mass index, 28 vs 25). Forty percent had the diagnosis of diabetes made at the time of diagnosis of pancreatic cancer and more patients with a resectable tumor had diabetes (58%) compared to patients with locally unresectable or metastatic disease (37%). Perhaps, screening overweight persons who have new-onset diabetes may lead to a diagnosis of asymptomatic, early, resectable pancreatic cancer.
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PMID:Pancreatic cancer: clinical presentation, pitfalls and early clues. 1043 7

The effect of being overweight on survival in endometrioid carcinoma of the endometrium was examined at different ages in this article. The body mass index [body weight/height(m2)] was evaluated in 287 Japanese women with endometrioid carcinoma. Overweight individuals were defined as those with a body mass index of 24.5 or more. The subjects were divided into two groups, including a younger age group (women less than 50 years of age) and an older age group (women 50 years of age or more). Being overweight was thus analyzed to see if it had any influence on survival. The body mass index ranged from 15 to 40 (mean +/- SD; 23.0 +/- 3.9). Twenty-six (32.1%) of 81 subjects in the younger age group and 78 (37.9%) of 206 subjects in the older age group were found to be overweight. In the younger age group, we could find no effect of being overweight on survival. In the older age group, the cumulative 10-year survival rate was 75.2% in normal weight subjects and 89.4% in overweight subjects (P < 0.02). However, the histologic grade, depth of myometrial invasion, cervical invasion, lymphovascular invasion, ovarian metastases, and lymph node metastases showed no significant difference between normal weight and overweight subjects in both the younger and older age groups. In a multivariate analysis, being overweight was a better independent prognostic factor in older age group. Being overweight may contribute to the heterogenous etiology of endometrioid carcinomas in the older age group.
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PMID:The effect of being overweight on survival in endometrioid carcinoma of the endometrium at different ages. 1124 Jun 79

The aim of this study was to determine the role of body mass index (BMI) in a Western population on outcomes after esophagectomy for cancer. Two hundred and fifteen consecutive patients undergoing esophagectomy for esophageal cancer of any cell type were studied prospectively. Patients with BMIs > 25 kg/m were classified as overweight and compared with control patients with BMIs below these reference values. Ninety-seven patients (45%) had low or normal BMIs, 86 patients (40%) were overweight, and a further 32 (15%) were obese. High BMIs were associated with a higher incidence of adenocarcinoma versus squamous cell carcinoma (83%vs. 14%, P = 0.041). Operative morbidity and mortality were 53% and 3% in overweight patients compared with 49% (P = 0.489) and 8% (P = 0.123) in control patients. Cumulative survival at 5 years was 27% for overweight patients compared with 38% for control patients (P = 0.6896). In a multivariate analysis, age (hazard ratio [HR] 1.492, 95% CI 1.143-1.948, P = 0.003), T-stage (HR 1.459, 95% CI 1.028-2.071, P = 0.034), N-stage (HR 1.815, 95% CI 1.039-3.172, P = 0.036) and the number of lymph node metastases (HR 1.008, 95% CI 1.023-1.158, P = 0.008), were significantly and independently associated with durations of survival. High BMIs were not associated with increased operative risk, and long-term outcomes were similar after R0 esophagectomy.
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PMID:Prognostic significance of body mass indices for patients undergoing esophagectomy for cancer. 1722 7

This paper deals with a population-based material collected during the years 1990-1998, and comprises 439 tumours and tumour-like vascular processes from 420 dogs. Anatomic location, age, breed and gender are reported. A distinction is made between benign neoplasms, tumours of intermediate malignancy, and obvious malignant processes (angiosarcomas). Clinical behaviour, comprising recurrence and metastatic disposition, is included. Subclassification is done according to criteria used in human oncology. More than one half (242 of 439) occurred in the skin, and a great majority of skin processes (223 of 242) represented benign tumours or tumour-like lesions. The next most common site of summarised lesions was the spleen, with 110 cases, with only 17 processes in this organ being defined as benign. Splenic involvement was followed by the liver, with 13 out of 17 processes being angiosarcomas. Eleven of 12 heart tumours were angiosarcomas. A majority of skin haemangiomas was of the cavernous type (108 of 211), and more than one half (10 of 14) of the capillary haemangiomas were located on dorsal sites of the extremities. The mixed capillary/cavernous haemangiomas had a more diffuse distribution, although 20 of 31 were found in the skin of the hind limbs. Only one lymphangioma and one case of angiomatosis were observed. Most tumour-like proliferations were papillary endothelial hyperplasias. Recurrence occurred in 17 dogs, some of which had received a primary benign diagnosis. Primary metastases were observed in 63 animals, the majority in the spleen and heart. Dissemination involved a further 23 cases (22 had angiosarcoma). The male/female rate of benign tumours was 0.78, for tumour-like processes 1.83, intermediate malignant tumours 1.65, and angiosarcomas 1.60. With few exceptions, there was an overweight of all subclassified vascular lesions in animals more than 6 years of age.
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PMID:Canine vascular neoplasia--a population-based clinicopathologic study of 439 tumours and tumour-like lesions in 420 dogs. 1938 80

Laparoscopy-assisted distal gastrectomy for gastric cancer was first reported by Kitano et al. in 1991. Laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) were quickly adapted for gastric cancer limited to the mucosal layer and having no risk of lymph node metastasis. Following improvements in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), the use of LWR and IGMR for these indications decreased, and patients with gastric cancer, including those with a risk of lymph node metastases, were more likely to be managed with laparoscopic gastrectomy (LG) with lymph node dissection. Many retrospective comparative trials and randomized-controlled trials (RCT) have confirmed that LG is safe and feasible, and that short-term outcomes are better than those of open gastrectomy (OG) in patients with early gastric cancer (EGC). However, these trials did not include a satisfactory number of patients to establish clinical evidence. Thus, additional multicenter randomized-controlled trials are needed to delineate significantly quantifiable differences between LG and OG. As laparoscopic experience has accumulated, the indications for LG have been broadened to include older and overweight patients and those with advanced gastric cancer. Moreover, advanced techniques, such as laparoscopy-assisted total gastrectomy, laparoscopy-assisted proximal gastrectomy, laparoscopy-assisted pylorus-preserving gastrectomy (PPG), and extended lymph node dissection (D2) have been widely performed.In the near future, sentinel node navigation and robotic surgery will become additional options in minimally invasive surgery (MIS) involving LG. Such developments will improve the quality of life of patients following gastric cancer surgery.
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PMID:Minimally invasive surgery for gastric cancer: the future standard of care. 2147 16


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