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

For some small rectal cancers electrofulguration can be an attractive alternative to more extensive surgical procedures. This report is a review of 49 patients who, after careful selection, were considered ideal candidates for curative fulguration in the period 1959-1982. All had rectal adenocarcinomas and were clinically staged as Dukes' A tumors. To put the results of this analysis into perspective, they are compared to the results of those patients (34) who also had early clinical stage rectal adenocarcinomas, but for a variety of reasons underwent abdominoperineal excisions (APE, 11 patients) or low-anterior resections (LAR, 23 patients) instead of fulguration. Postoperative complications after fulguration were minimal, there were no postoperative deaths, and all patients retained anal continence. After APE or LAR there were two postoperative deaths (one myocardial infarction, one ruptured iliac aneurysm); postoperative morbidity was greater. All LAR-treated patients remained continent. Of the patients at risk 55% remained disease-free after fulguration, while 77% remained disease-free after APE or LAR (P = 0.023). This is due to a higher percentage of loco-regional recurrences occurring after fulguration than after APE or LAR (31% vs 9%, respectively, P = 0.021). The percentage of patients with distant metastases in both groups are similar. It seems that electrofulguration of rectal cancers, even in strictly selected patients in a specialized institution, can lead to an unacceptably high percentage of patients with loco-regional recurrences. Nearly all local failures occurred in patients with tumors that measured more than 3 cm in diameter and/or occupied more than one-third of the rectal circumference. Salvage operations for loco-regional failure were performed in 13 patients, 5 of whom are alive with no evidence of disease. Since there seems to be a direct relation between tumor size and the chance of loco-regional recurrence and since salvage operations for local failure are not uniformly successful, electrofulguration for cure must be reserved for the very rare patient with a very small early-stage rectal cancer.
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PMID:Early-stage rectal cancer: electrofulguration in comparison to abdominoperineal extirpation or low-anterior resection. 407 87

In a series of 171 radical nephrectomies performed by the authors, 10 patients presented vena cava extension (5.8%). The extension was infrahepatic (stage C) in 6 cases, retrohepatic (stage B) in 1 case and involved the right auricle (stage A) in 2 cases, while the upper limit of the thrombus could not be defined in the remaining case. All patients were operated upon. There was one post-operative death (stage B), while the other patients had an uncomplicated post-operative course, despite the need for open-heart surgery in two cases. Seven patients died from metastatic after an interval of 2 and 4 years. The prognosis is therefore reserved, but seems to be better than in the case of lymph node metastases, justifying an aggressive surgical approach.
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PMID:[The vena cava in surgery of renal cancer in the adult]. 409 18

The paper presents the problems of bronchogenic carcinoma and the results of surgical treatment on the basis of 10 000 patients suffering from lung cancer. 20% of all resected cases and 40% of all cases resected during the early stage lived beyond the 5-year survival limit, and during the earliest stage surgical cure can be achieved in 60% to 80% of the patients. Small cell carcinoma is just as operable as all other forms of bronchogenic carcinoma, if in addition chemotherapy and radiotherapy are administered. From the oncological point of view clip or segmental resection are not equivalent to standard lobectomy and must, therefore, remain reserved for functional risk cases. On the basis of cancer biology and in view of the frequently occurring concealed (micro)-metastases we demand adjuvant therapy after every tumor resection; this treatment will consist in immunotherapy during the early stages and in chemo- and radiotherapy during late stages.
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PMID:[Bronchial carcinoma from the surgical viewpoint]. 609 80

Four patients with Zollinger-Ellison Syndrome (ZES) are presented to highlight the difficulties in the recognition, diagnosis and management of this rare disease. The presentation of ZES is usually indistinguishable from ordinary peptic ulcer disease and in those patients with symptoms not related to peptic ulcer, i.e., diarrhoea, as their main complaint, the diagnosis is often not even considered. A high index of suspicion is required, however, in patients with recurrent ulcers, multiple ulcers and in those with resistant or rapidly relapsing ulcers after conventional therapy. A presumptive diagnosis can be made by the demonstration of grossly elevated fasting serum gastrin levels combined with a secretin stimulation test in doubtful cases. The main problem is the location of the gastrin-secreting tumour which is usually pancreatic but often too small to be detected by currently available techniques. Histamine H2-receptor antagonists in high doses are effective in controlling the gastric acid hypersecretion which is chiefly responsible for the morbidity and mortality in ZES. They provide the treatment of choice in patients where the tumour cannot be located, though every attempt should be made to do this as surgery is the treatment of choice for this invariably malignant tumour. Total gastrectomy is now reserved for those patients in whom medical therapy has failed. The role of chemotherapy in metastatic disease has yet to be established.
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PMID:Zollinger-Ellison syndrome--report of four cases and review of literature. 614 89

The authors discuss the optimal surgical attitude in the cases of 44 patients with cancers of the transverse colon (excluding the angular localizations), representing 5.4% of the total number of colic cancers operated in the Clinic over the last 20 years. All the patients were in stages C and D (according to the Turnbull and Dukes classification), and the general index of resectibility of 79%. Segmental transverse colectomy should be reserved for patients of advanced age, as well as for those with organic disturbances, altered general condition, of when there is extensive loco-regional involvement, or metastases at distance. Fifteen patients were included in these categories. Extended transverse colectomy, with radical intent from the oncological standpoint, appears to be the optimal attitude in the cases of patients which do not have any of the contraindications mentioned above. Twenty patients were in this group. The postoperative death rate was 11.4% for the entire group of patients in whom resections were performed. Five patients (25%) have survived according to our data between 5 and 11 years after extensive radical colectomy.
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PMID:[Radical colectomy in cancer of the transverse colon]. 621 16

To define prognostic factors of testicular cancer and to develop a strategic therapy based on clinical, pathological and biological findings, 77 cases of non seminomatous testis tumor, observed in G.F. Leclerc Center from 1967 to 1977, have been analysed. For all these patients early chemotherapy program was associated with surgery; radiation therapy was reserved for stages with retroperitoneal metastatic disease. Results of this review confirmed the interest of such medical treatment which improved survival in all stages of disease. Some prognostic factors could be detailed from these cases: nature of tumoral components, invading of lymph node, presence or not of biological markers; identification of these would unable us to choose the best adjuvant chemotherapy program and to define its place in the management of testis tumor's treatment.
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PMID:[Adjuvant chemotherapy in treatment of non seminomatous germinal testicular tumor. Results and reflexions about 77 cases (author's transl)]. 624 89

Eleven new cases of adenoid cystic carcinoma of the breast are added to the 95 previously reported. They were studied for their biological behavior, and an attempt was made to correlate histologic features with prognosis. A comparison was made with analogous tumors in extramammary sites, and possible relationship with carcinoid tumors of the breast explored. The patients in the study followed a biological course very similar to that described by previous studies, i.e., slow progression, local recurrence if inadequately resected, and absence of lymph node metastases. Only one patient developed distant metastases after an interval of ten years following radical mastectomy. If the diagnosis of adenoid cystic carcinoma is reserved for those lesions displaying the distinctive appearance and typical epithelial-stromal relationships which have been described, the authors feel that simple mastectomy with careful follow-up surveillance is the treatment of choice.
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PMID:Adenoid cystic carcinoma of the breast. Report of 11 new cases: review of the literature and discussion of biological behavior. 630 83

The results of radiation therapy as applied to patients with squamous cell carcinoma of the hypopharynx seen during the period 1972-1976 at the Princess Margaret Hospital are presented. Approximately 2/3 of the patient population presented with disease involving the regional lymph nodes or with systemic metastases. Ninety percent (127/141) of all patients registered were treated primarily with radiation therapy with surgery reserved for the management of residual or recurrent disease only. Seventy-seven percent (98/127) of those who received radiation therapy were treated with radical intent. The uncorrected actuarial 5 year survival rate for those patients treated radically was 19%. Five year actuarial survival rates by the UICC TNM (1974) staging system, showed that nodal disease was the most significant determinant of survival. Five year survival rates were as follows: N0 36%; N1 20%; N2N30%. When considered within each nodal category the survival of the combined T1T2 group was not significantly different from the T3 category. Forty-five percent of those patients who failed with local or regional disease had an attempt at salvage surgery. Of these, 6/24 ultimately achieved local and regional control. Comparisons with other series in the literature are discussed and reasons for differences in published results are considered.
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PMID:Carcinoma of the hypopharynx results of primary radical radiation therapy. 640 5

Some relations between metastatic bone disease and calcium homoeostasis were determined in a consecutive series of 81 patients with solid malignant tumours attending for radionuclide bone scans. Biochemical evaluation showed that bone resorption from metastatic disease was generally not enough to account for hypercalcaemia. While skeletal metastases were present in about half of the patients who developed hypercalcaemia, biochemical indices of bone resorption in these subjects were greatly increased and disproportionate to the extent of metastatic disease detected by the bone scans. Furthermore, a reduced renal phosphate threshold and increased tubular calcium reabsorption were generally observed in hypercalcaemic patients when compared with their normocalcaemic counterparts. These findings suggest that in most cases malignancy associated hypercalcaemia may be caused by the release of a humoral factor by tumour tissue which exhibits "parathyroid-hormone-like" activity with regard to bone resorption, renal phosphate threshold, and renal calcium handling. It may be postulated that this putative humoral mediator predisposes to hypercalcaemia both by stimulating generalised osteolysis and in most cases also by impairing the renal excretion of the resultant increase in filtered calcium load. While hypercalcaemia may arise as a result of metastatic bone disease alone, these data indicate that this may be the exception rather than the rule. Hence the term "metastatic hypercalcaemia" should probably be reserved for patients with extensive skeletal tumour disease in whom biochemical evaluation fails to yield evidence of an underlying humorally mediated cause.
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PMID:Relative contribution of humoral and metastatic factors to the pathogenesis of hypercalcaemia in malignancy. 642 77

One hundred and eighty-four cases of malignant melanoma of the lids and epibulbar region were seen in the Radiotherapy Department of the Royal Marsden Hospital during the period 1943-74. Some of these tumours were radiosensitive and could thus be treated by radiotherapy without loss of the affected eye. Their clinical and histological features are described. The treatment policy adopted was based on radiotherapy first, and surgery reserved for the failures. A policy of observation is advised for precancerous melanosis, and active treatment should be undertaken only if malignancy supervenes. The contraindications for radiotherapy, the factors governing radiosensitivity, and the incidence and site of metastases are reported, and the possible effect on the metastatic and survival rates of leaving the eye are discussed. Active treatment of the node-free neck is not advised. Results are given according to site, histology, and treatment method, and the frequency with which the eye was lost is shown, since the sole advantage of radiotherapy over surgery is the possibility of saving the eye without worsening the prognosis for survival.
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PMID:Malignant epibulbar melanoma: natural history and treatment by radiotherapy. 646 88


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