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

Radionuclide imaging technics to identify metastases in liver and brain have preductive values that show the expected variation depending upon the prevalence of metastatic disease in the population studied. Liver scanning combined with peritoneoscopy may prove more accurate than either study alone for routine use in staging. Brain scanning is most useful when reserved for patients selected because of suspicious neurologic findings or in following the response to therapy of established metastatic disease. "Tumor-directed" scanning agents are useful in certain cases where soft-tissue metastases are suspected but cannot be identified with more conventional procedures.
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PMID:Nuclear diagnosis of disseminated cancer of the breast. Results of liver-, brain-, and tumor-directed imaging studies. 5 98

After a mole has been evacuated there are two ways of treating the condition: routine chemotherapy from the beginning or chemotherapy reserved for selected cases. They offer the same chances of cure. Seeing that the risk of malignancy in our country is 5 per cent and that selective chemotherapy only exposes a small number of patients to the risk of such treatment, we have adopted the scheme of follow-up suggested by Bagshawe and recommended by OERTC. The follow-up is based on radio-immune assay for HCG carried out at regular intervals for two years. Only cases where the level of HCG is higher than 25,000 international units per litre, one month after curettage, or cases where the rise in HCG is associated with metastases, are treated with chemotherapy. In our experience, which is based on 20 cases, we acknowledge the value of radio-immune assaying. It is superior to immunological tests used for pregnancy diagnosis in sensitivity. It also appears to us that systematic treatment routinely administered and treatment based on raised levels of HCG two months after evacuation of a mole are useless. Only 3 cases were treated with chemotherapy out of the 20 cases that were followed up. We have had no malignancy after 2 and 3 years of checking back on the patients. Treatment given routinely from the start would have been unnecessary exposure to the risks of chemotherapy for 17 patients. Had we taken into account the abnormal rise in HCG after 8 weeks we would still have treated 7 patients instead of 3 with the same results as far as cure. We have worked out a graph for the drop in the levels of HCG after a mole has been evacuated. This may serve as a base for criteria for treatment in the future. Cases where the levels of HCG are above the 95 percentile are considered as at risk to evolve into malignant forms of disease. Consequently earlier treatment can be started (before the 6th month) without altering the number of patients who are going to be treated.
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PMID:[Prevention of the malignant form of trophoblastic disease after a hydatidiform mole: systematic or selective chemotherapy]. 18 22

This study reviews a thirty year experience with 217 patients who had a tumor of the submaxillary gland, comprising about 9 per cent of all patients with salivary neoplasms seen during the same period. Most of the tumors were malignant (56 per cent), with adenoid cystic carcinoma predominating, but the histologic type most frequently encountered was benign mixed tumor (43 per cent). Median age was fifty-four years in patients with malignant tumors compared with forty-six years in those with benign tumors, and 58 per cent were women. Asymptomatic swelling was the usual presenting complaint, and the clinical findings are summarized using a staging system recently proposed for patients with parotid tumors. Cervical lymph node metastasis occurred in at least 50 per cent of patients who had an adenocarcinoma or epidermoid, mucoepidermoid, or anaplastic carcinoma. Treatment was surgical and complete gland excision proved adequate in those with benign tumors. Radical neck dissection was performed in conjunction with submaxillary resection in most patients with malignant lesions, but radical en bloc resection was reserved for those few who had extensive or fixed disease. Net determinate "cure" rates at five and ten years (30 and 20 per cent, respectively) are distressingly low and compare unfavorably with those previously reported in patients treated for carcinoma of the parotid. The high local recurrence rate and the greater incidence in the submaxillary gland of more aggressive tumor types which metastasize readily suggest that current treatment should be more radical. It seems reasonable to expect that results might be improved if en bloc resections were more often performed in patients with less advanced disease, possibly in conjuction with intensive postoperative irradiation in selected cases.
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PMID:Tumors of the submaxillary gland. 18 26

The lymphatic drainage of the colon and rectum originates in the submucosal layer. Therefore metastases do not arise from carcinomas confined to the mucosa, and for the same reason the WHO lately recommended to call these lesions severe atypism. The term adenocarcinoma should be reserved in the case of infiltration of the carcinoma into the submucosa. According to the features outlined above adenomas of the rectum showing severe atypism can be removed by careful excision of the mucosa. Even adenomas containing an early diagnosed adenocarcinoma up to 2.5 cm in diameter often can be cured by a local resection of the rectal wall, if no metastases have occurred. From 1971--December 1, 1977, 12 rectal adenomas with severe atypism and 14 rectal adenomas with adenocarcinoma had been removed locally without complications. After 6 years there was no recurrence of carcinoma.
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PMID:[Malignant polyps and early recognized carcinomas of the rectum. Morphological aspects and selective surgical treatment (author's transl)]. 30 81

Greater precision has developed in recent decades in the selection of patients for operation for thyroid nodules suspicious for malignancy and in adapting operative procedures to the extent and pathologic variety of the individual thyroid carcinoma, when present. A thyroid lobectomy is considered to be the minimal operative procedure usually indicated for a suspicious thyroid nodule or carcinoma involving one lobe of the thyroid gland. Factors determining the extent of operation for thyroid carcinoma include the pathologic variety, gross distribution of the malignancy, and health status of the individual patient. Total or near total thyroidectomy should be considered for all patients with thyroid carcinoma except for single occult carcinomas and unilateral low grade angio-invasive carcinomas. Removal of lymph nodes in regions adjacent to the thyroid carcinoma is advisable, lateral neck dissections being reserved for patients with palpable lymphadenopathy, demonstrated metastases to lateral cervical lymph nodes, or a poorly differentiated carcinoma likely to metastasize to these lymph nodes. A modified radical lymph node dissection is satisfactory except for those carcinomas invading muscles in the neck. Anatomic neck dissections provide a better prognosis than incomplete lymph node procedures for patients with regional lymph node metastases. Following operation, patients should receive thyroid hormone therapy, be evaluated for possible treatment with radioactive iodine or other therapeutic measures, and be followed for evidence of recurrent disease as well as thyroid and parathyroid function. Adequate early operation is preferred to late ultraradical procedures, from standpoints of morbidity and prognosis. Unfavorable prognostic factors include extensive gross disease, poorly differentiated carcinoma present as the entire lesion or as foci in a differentiated carcinoma, and age over 40. With adequate surgical treatment, the prognosis for operable thyroid carcinoma is good.
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PMID:Management of carcinoma of the thyroid. 31 68

Breast cancer is the most common malignancy of women in the United States, affecting one out of every 13 women at some time in their lives. Although only 10% of patients have demonstrable distant metastases at the time of diagnosis, a majority will eventually die of disseminated disease. Chemotherapy was formerly considered to be the treatment of last resort in patients with breast cancer, reserved for those who had failed surgery, radiotherapy and hormonal manipulation. However, combination chemotherapy has now been shown to be highly effective. The most active drug combinations produce objective tumour regression in about 60% of patients with advanced disease. Parallel to the development of effective chemotherapy, there has been a renewal of interest in hormonal therapy. The ability to predict whether or not a patient will respond to hormonal therapy has been improved significantly by the clinical application of the oestrogen receptor assay. The selection of a specific treatment for the patients with advanced breast cancer must be individualised. It should take into account a number of prognostic variables, including: sites of metastatic involvement; total extent of disease; disease free interval; menopausal status; and the presence or absence of oestrogen receptor in tumour tissue. The final decision regarding treatment should then be based not only on the probability of response, but also on the anticipated degree of toxicity. Current efforts to improve the management of advanced breast cancer include the development of more effective drug regimens and the combination of chemotherapy with hormonal manipulation. For instance, it would appear that in premenopausal patients, the combination of chemotherapy with oophorectomy may yield results that are superior to those achieved with either treatment alone. The most promising development in the management of early breast cancer has been the use of chemotherapy as an adjuvant treatment in patients with operable disease.
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PMID:Drug treatment of breast cancer. 36 1

Seventy-eight advanced breast cancer patients with hormone-resistant disease or visceral metastases were randomized to receive either of two low dose regimens consisting of cyclophosphamide (C), methotrexate (M), 5-fluorouracil (F), and Adriamycin (A) as their initial chemotherapy. One group was treated with CAMF, and the other with CMF until progression, followed by A (CMF leads to A). C was given at 50 mg/m2, po, days 1-14; M at 20 mg/m2, F at 300 mg/m2, and A at 20 mg/m2, iv, days 1 and 8 of each 28-day cycle. The response rates for CAMF vs. CMF did not differ significantly (complete and partial responses-62% vs. 49%; stabilizations-23% vs. 31%). Responses by site of metasis, median times to progression and median survivals were similar for both groups. Poor and good risk partial responders had similar survivals. Twelve percent of CMF patients treated with Adriamycin at the time of progression had partial responses with an associated improved survival. Since CMF is as effective as CAMF, but has less toxicity, low dose therapy with CMF is more acceptable than CAMF as an initial chemotherapy regimen for metastatic breast cancer. Adriamycin may be reserved for subsequent regression induction.
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PMID:Low dose chemotherapy of metastatic breast cancer with cyclophosphamide, adriamycin, methotrexate, 5-fluorouracil (CAMF) versus sequential cyclophosphamide, methotrexate, 5-fluorouracil (CMF) and adriamycin. 36 74

Additive hormonal therapy remains the treatment of choice for disseminated breast cancer in postmenopausal women. Patients with hormone-dependent tumors receive excellent and long-lasting palliation from alterations in the hormonal milieu. Now that hormone receptor assays are clinically available, responses can be accuratedly predicted in a large percentage of cases. Tables 11--6 is a summary of additive hormonal therapy in postmenopausal patients. Endocrine ablative therapy remains of primary importance in premenopausal women because of the superior results, but androgens or antiestrogens may be helpful when patients are not surgical candidates. Castration continues to be the initial approach, with adrenalectomy or hypophysectomy reserved for promising candidates. In postmenopausal women the initial choice is estrogens. The exceptions are those patients with metastases limited to bone, when androgens excel because of an equivalent objective response and superior subjective and metabolic effects. Patients who respond to estrogens and then progress are observed for a rebound regression following the discontinuation of estrogen therapy. Whereas some who do not respond to androgens will respond to estrogens, the converse does not appear to be true (Kennedy, 1974). Currently progestins are the secondary hormonal agent of choice in postmenopausal women, but they may be displaced by antiestrogens as more data become available. In general, if a patient's tumor lacks estrogen receptors or the patient fails to respond to an adequate trial of endocrine or hormonal therapy, one should proceed directly to cytotoxic chemotherapy. A suggested plan for the integration of endocrine with hormonal therapy and both with other forms of palliation is diagrammed at the end of Chapter 12.
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PMID:Cancer of the breast. Endocrine and hormonal therapy. 37 52

Chemotherapy as a complement to surgery or adjuvent chemotherapy has been presented as one of the possible means of improving 5 years survival rates following the excision of a digestive tract carcinoma. Started early after excision, and given in adequate doses for a period of one to two years, it is aimed at treatment of residual sub-clinical disease. Its effectiveness may be assessed only by study of the reduction in the number of recurrences or metastases in a large number of patients treated. At the present time, published series have not made it possible to define whether there is a definite reduction in the percentage of recurrence and metastases or merely a prolongation of the clear period which precedes their clinical manifestation. The practical difficulties of treatment, together with its possible early or late toxicity, are such that it should be reserved for forms in which there is some doubt as to the prognosis. The addition of immunotherapy has to be defined.
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PMID:[Carcinomas of the digestive tract. Chemotherapy as a complement to surgery (author's transl)]. 39 79

Gallium-67 scanning was evaluated in 100 patients with proved carcinoma of the lung. It was valuable in separating primary from secondary lung tumors, determining the extent of contralateral hilar or mediastinal lymph node involvement, and detecting distant organ metastases. In addition to multiplane whole-body Ga-67 tomographic scanning, colloid liver scans, bone scans, and computerized axial tomography scans of the brain were obtained to determine the presence of distant metastasis. The gallium scan detected 11 of 12 occult metastases and identified 7 of 7 liver, 9 of 14 brain, 4 of 4 soft tissues, 1 of 4 contralateral lung, and 9 of 11 bone metastases. The whole-body gallium scan accurately detected or excluded extrathoracic metastatic disease in 11 of 12 patients examined postmortem within three months of a gallium scan. An approach is recommended using gallium scanning along with chest roentgenograms for clinical staging and preoperative evaluation of patients with carcinoma of the lung. Specific organ scans should be reserved for the occasional symptomatic patient with a negative gallium scan or for clarification of an indeterminate gallium scan.
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PMID:The role of gallium-67 scanning in the clinical staging and preoperative evaluation of patients with carcinoma of the lung. 49 98


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