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)

Changes in serum tumour marker levels in non-seminomatous germ cell testicular tumours (NSGCTT) are used to monitor tumour growth and response to treatment. A novel method of calculating the actual tumour marker production (TMP) per day is reported; estimation of the rate of change of TMP is a measure of the tumour growth or regression rate. TMP is calculated mathematically from the rate of increase in serum marker level and its natural half life. TMP is assumed to be proportional to the number of marker producing cells in the tumour. TMP was calculated over the time between orchidectomy and the start of chemotherapy. The rate of increase in TMP with time is expressed as the marker production doubling time (MPDT) and is a measure of the growth rate. In a group of 51 patients with metastatic NSGCTT, TMP varied from 0.012 to 5985 iu/l/day (AFP) and 0.08-5404 iu/l/day (HCG). MPDT varied from 0.5 to greater than 80 days (45 cases) for AFP + ve patients and from 1.8 to greater than 80 days (34 cases) for HCG + ve patients; greater than 80% of cases had a MPDT less than or equal to 32 days. In 45/51 (88%) patients, there was no discrepancy in MPDT between markers. The use of changes in serum marker level to follow tumour progression and regression is simple, but the calculation of actual TMP provides clearer information about the change in number of marker producing cells and can be used as non-invasive method for measuring the tumour growth rate of metastatic disease and response to treatment.
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PMID:The growth rate of metastatic non-seminomatous germ cell testicular tumours measured by marker production doubling time--I. Theoretical basis and practical application. 183 1

Between February 1986 and July 1988 a total of 21 children aged 1 to 16 years with malignant germ cell tumours (MGCT), 18 with either metastatic disease or unresectable primary tumour, received the JEB regimen - carboplatin dosage calculated from the EDTA glomerular filtration rate (approximately 600 mg m-2), etoposide 120 mg m-2 daily x 3, and bleomycin 15 mg m-2 weekly. Primary sites were: testis (6), ovary (8), sacrococcyx (4), pineal gland (2) and vagina (1). AFP levels were elevated in 19, beta-HCG in 8. Complete marker response was achieved in 19 out of 19 evaluable patients and complete remission of measurable tumour in 16 out of 19, 12 with chemotherapy alone and 4 with the addition of surgery. A reduction in glomerular filtration rate greater than 10% occurred in 3 of 12 evaluable patients; in none greater than 20%. Sequential audiography was normal in 11 out of 12 evaluated. The regimen was myelosuppressive with WHO grade III or IV myelosuppression occurring in 12 patients. Three patients have relapsed; one with a pineal germinoma who relapsed in the abdomen six months after diagnosis, and two with sacrococcygeal teratomas and lung metastases. Two of these remain in second complete remission after further treatment. There was one death from probable bleomycin pulmonary toxicity. We conclude that this regimen is simple to administer and, apart from myelosuppression, it is well tolerated. It appears to have comparable efficacy to cisplatin-based regimens but with much less nephrotoxicity and ototoxicity and avoids the use of alkylating agents and anthracyclines.
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PMID:'JEB'--a carboplatin based regimen for malignant germ cell tumours in children. 169 31

During a 5-year period (1981-86) 588 consecutive patients with nonseminatous germ cell tumors of the testis were included into a prospective Swedish-Norwegian multicenter study (SWENOTECA) and clinically staged according to the Royal Marsden system. A total of 370 patients (63%) had early clinical stages (CS) of disease; 295 (50%) had CS1, 32 (5%) had CS1Mk+ (CS1 with pathological serum tumor marker patterns after orchiectomy) and 43 (7%) had CS2A disease. Pathological staging with retroperitoneal lymph node dissection (RPLND) of the retroperitoneum was performed in 345 (93%) of the early CS patients and 128 (37%) had pathological stage 2 (PS2) disease; 27% of the CS1, 100% of the CS1Mk+ and 66% of the CS2A patients. The overall clinical staging accuracy was 75%. All the 40 patients with pathological serum AFP and/or HCG patterns before RPLND had PS2 disease, compared to 81/282 (29%) of patients with normal marker patterns. The PS2 patients with pathological marker patterns had significantly more and larger retroperitoneal metastases than those with normal AFP and HCG values. Elevated pre-orchiectomy AFP level indicated significantly reduced risk of PS2 disease in CS1 patients, but this effect became non-significant if the CS1Mk+ and CS2A cases were included into univariate or multivariate analyses. We suggest that the 'good risk' effect of pre-orchiectomy AFP elevation for CS1 cases may be caused by a selection mechanism during the clinical staging process.
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PMID:Early clinical stages (CS1, CS1Mk+ and CS2A) of non-seminomatous testis cancer. Value of pre- and post-orchiectomy serum tumor marker information in prediction of retroperitoneal lymph node metastases. Swedish-Norwegian Testicular Cancer Project (SWENOTECA). 170 12

Markers for hepatocellular cancer include the best and worst of cancer detection. Although hepatocellular cancer is relatively infrequent compared to other cancers in the western world, HCC has a very high incidence in parts of Asia and Africa. It is estimated to be one of the most common cancer worldwide. High risk factors for HCC include previous hepatitis B infection, heavy alcohol consumption, cirrhosis, and aflatoxin exposure. Alpha fetoprotein may be the best human cancer marker that appears in the serum, but levels of this marker are often not elevated until the tumor is beyond surgical treatment. No other serum or tissue marker is particularly useful. Screening of high-risk populations in China has detected previously undiagnosed HCC in 1,000 of 5 million individuals tested and has led to an increase in survival from 5.5 to 61.6% with surgical resection over those who are later diagnosed with HCC without screening. Elevations of AFP due to yolk sac tumors may be differentiated from those due to HCC on the basis of Concanavalin A reactivity. Immunodetection using radiolabeled anti-AFP and immunoscintigraphy have given inconsistent results that are not as sensitive as ultrasonography in detecting HCC in the liver. Various enzymes, isoenzymes, and other markers may be useful as adjuncts to diagnosis in selected cases, but are not generally as good as AFP alone. If a patient has an AFP-producing tumor, the serum levels of AFP provide an excellent means of monitoring its progression. If the serum AFP levels drop to normal and stay there, cure is almost certain. If, however, the serum AFP level does not fall at the normal catabolic rate after therapy, or subsequently rises, regrowth of metastases are indicated. Immunotherapy using anti-AFP has not been shown to induce remission, but experimental studies indicate that drug-conjugated anti-AFP is effective in inhibiting growth of AFP-producing tumors. Clinical trials using drug-conjugated anti-AFP are now underway. Monoclonal antibodies have not yet identified the "antigens" useful for the diagnosis or treatment of HCC, but epitopes identified by monoclonal antibodies have been studied experimentally in rats which indicate multiple cellular lineages to HCC in cases of experimental chemically induced hepatocarcinoma.
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PMID:Markers for hepatocellular carcinoma. 171 67

The term "unknown carcinoma" may be referred to any tumour that is not revealed by clinical examination or by routine diagnostic measures; the same term can indicate metastases whose source remains unknown until revealed by autopsy. The definition of the tumour histotype is mandatory for a correct choice of curative or a palliative treatment; therefore, a recognition of primary tumour should be cunningly aimed at. With regard to imaging diagnostics, some highly paramagnetic molecules for RM will shortly be available; with regard to nuclear medicine, some gamma-releasing immuno-specific markers reacting with tumour-associated antigens are also made available. Laboratory advances nowadays afford a better definition of biopsy samples, namely monoclonal antibodies versus cytospecific antigens and/or tumour-associated antigens; immuno-histochemical markers, such as anti-AFP and anti-HCG monoclonals, that detect the testicular source (germinal tumours) of a highly undifferentiated retroperitoneal mass; etc. It seems therefore possible the foresee a reduction in the incidence of "unknown" carcinomas.
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PMID:[Occult carcinoma in urology. Nosography and diagnosis]. 220 66

We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non-seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage IIa (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM+) and 121 had normal tumour markers (CSIM-). Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM-, in 19 of 33 patients with CSIIM+ and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half-life were predictive factors for PSII. These 2 factors enabled a group of non-seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases. Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post-operative complications. In addition, "dry ejaculation" was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients). The comparative cost to the health service during the first year of follow-up was estimated for low risk non-seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable. It was concluded that a surveillance policy should be followed in low risk non-seminoma CSI patients provided that frequent follow-up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve-sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.
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PMID:Is routine primary retroperitoneal lymph node dissection still justified in patients with low stage non-seminomatous testicular cancer? 234 Mar 72

A 38-year-old man was admitted to Nara Medical University Hospital on Feb.7,1983, because of swelling of the scrotal contents on the right side and elevated serum AFP, beta-HCG and LDH suggestive of testicular tumor. Right orchiectomy was carried out and a pathological diagnosis of embryonal cell carcinoma of the right testis (pT3N0M1) was made. The patient, upon evidence of multiple pulmonary metastases, was treated with a combination chemotherapy of cis-Diamminedichloroplatinum, vincristine and peplomycin. After three courses of combination chemotherapy, pulmonary metastases were decreased, but their foci persisted. The patient was then treated with Etoposide 62 mg/m2 daily for 5 days every three weeks, and after this course, complete remission of pulmonary metastases was obtained. The patient recieved 3 courses of Etoposide and retroperitoneal lymph node dissection, and has since shown no evidence of disease for 2 years and 4 months after surgery.
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PMID:[Complete remission obtained in advanced testicular cancer treated by etoposide (NK-171)]. 242 Feb 82

Between 1977 and 1985, 149 male patients with anaplastic germ cell tumours (AGCT) completed chemotherapy with POMB/ACE (platinum, vincristine (oncovine), methotrexate, bleomycin, actinomycin D, cyclophosphamide and etoposide). By increasing the number of courses of POMB in 1979, we have been able to compensate for adverse prognostic factors. Since then each patient has received at least three courses of POMB and 118 patients have completed therapy. The overall survival rate since 1979 is 89% and for the 100 patients who had not received prior radiotherapy it is 92%. We established that an initial serum concentration of human chorionic gonadotrophin (HCG greater than 50,000 iu/l) and/or alphafetoprotein (AFP greater than 500 ku/l) indicated a poor prognosis. Between 1977 and 1979 the survival rate in 12 patients in this category was only 45%. After increasing the number of courses of POMB, the survival rate rose to 89% in 31 patients. However, patients who had received prior radiotherapy and who presented with high tumour markers (HCG greater than 50,000 iu/l and/or AFP greater than 500 ku/l) continue to have a poor survival rate (20% in five patients). With this chemotherapy, 14 of 16 patients (88%) presenting with liver metastases and 6 of 7 patients (86%) presenting with brain metastases are in complete remission. Neither the stage at presentation nor the volume of metastatic disease was a major adverse prognostic variable. We believe that POMB/ACE chemotherapy, followed by surgery in selected cases, is currently the best treatment for patients with AGCT.
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PMID:Current optimum management of anaplastic germ cell tumours of the testis and other sites. 242 38

The growth rate of 49 cases with recurrent gastric cancer was investigated with two tumor markers (AFP & CEA). The average doubling time of liver metastases (24.7 +/- 11.9 days) in 18 cases was significantly shorter from that of lymph node metastases (41.1 +/- 22.4 days) in 13 cases and of peritonitis carcinomatosa (42.2 +/- 19.6 days) in 18 cases. Latent period of recurrent cancer calculated by these doubling times was ranged from 1.0 to 3.5 years (mean 1.7 years) in liver metastases, from 1.0 to 5.0 years (mean 2.7 years) in lymph nodes metastases and from 1.5 to 6.0 years (mean 2.7 years) in peritonitis carcinomatosa. Only in liver metastases, positive correlation between the doubling time (X) and the duration of survival (Y) was observed by expressing the formula Y = 0.45 X-0.58 (R = 0.661, p less than 0.05). It is noteworthy that there is a significant correlation in spite of large differences in background subjects (systemic condition, size of metastatic lesion, etc.) and the growth rate of tumor is considered to play a very important role for determining the degree of biological malignancy of individual cancer patients in relation to survival.
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PMID:[Chronology of recurrent gastric cancer]. 242 66

HCC occurs infrequently in Western countries, with recent increases being reported in California and parts of Europe. Southeast Asia, Japan, and South Africa continue to have a high incidence of this tumor with HBV, cirrhosis, and the ingestion of aflatoxins being identified as probable risk factors. Although the majority of patients present with abdominal pain or mass indicative of extensive tumor, asymptomatic, small HCCs are being detected with increasing frequency. Early detection in high-risk individuals is best accomplished by screening with serum AFP determinations and liver ultrasonography. CT and arteriography are valuable preoperatively in defining anatomy and determining resectability. Five-year survival following resection for cure of HCC ranges from 20 to 40 per cent, with improved survival reported for small asymptomatic tumors. Resection of metastatic liver tumors from colorectal primaries results in 48 per cent 2-year and 24 per cent 5-year survivals, with an additional 5 per cent dying of recurrent cancer after 5 years. Although patients with simultaneous and metachronous metastases do equally well after resection, the presence of four or more individual deposits adversely affects survival. Hepatic artery ligation or embolization can produce a significant palliative reduction in total tumor mass in patients with unresectable liver metastases. Regional chemotherapy using implantable hepatic artery drug infusion pumps is promising, with reports of prolonged survival compared with historical controls. Regional hyperthermia, laser vaporization of tumor, and cryosurgical techniques may prove to have useful roles in the selective treatment of liver cancer in the future. Orthotopic liver transplantation has been successful primarily in those in whom the malignancy is found incidentally in the chronically diseased liver.
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PMID:Malignant tumors of the liver. 242 9


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