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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 52-year-old man with a pedunculated ampullary carcinoma was referred for endosonography. Endoscopic retrograde cholangiopancreatography was unsuccessful because of pedunculation of the papilla. Endosonography revealed a superficial hypoechoic tumor limited to the mucosa, which was compatible with a T1 carcinoma according to the new (1987) Union Internationale Contre le Cancer TNM classification of the polypoid tumor. No lymph node metastases were found, the staging being T1N0. Local tumor resection was performed. Lymph node metastases were not found at surgery. Histology of the resected specimen confirmed the findings at endosonography. Follow-up endoscopy and endosonography 18 months after surgery showed no evidence of tumor recurrence or lymphadenopathy.
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PMID:Endosonography in staging early carcinoma of the ampulla of vater. 155 45

International collaboration has resulted in a revised and unified 1987 formulation for the TNM classification in solid tumors. The simplification and eliminations of most variables caused difficulties for the clinical use of the system in some tumors such as bladder cancer. The approval of the proposed adaptation covering the tumor mass, subdividing the T4 category and adapting the stage grouping, resolves these difficulties. Published reports demonstrate support for the TNM system as a clinical base for treatment decisions and prognosis. The TNMG stage and grade are important basic prognostic factors, but other prognostic factors, especially biologic tumor activity, are under clinical investigation. The TNM classification is the initial evaluation after histologic confirmation of cancer to guide treatment and prognosis. The quality of the evaluation is enhanced by precise communication on the employed methodology.
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PMID:Clinical staging: its importance in therapeutic decisions and clinical trials. 155 52

This study was designed to investigate issues concerning "inapparent carcinoma" of the gallbladder and the effectiveness of a radical second operation in the treatment of inapparent carcinoma. Ninety-eight patients with inapparent carcinoma were analyzed according to the "pT" category of TNM (tumor, nodes, and metastases) classification. Eighty patients underwent cholecystectomy alone, and 14 patients had a subsequent radical operation. After cholecystectomy alone it was found that (1) Patients with pT1 cancer had a 5-year survival rate (5ysr) of 100%; (2) In patients with pT2, 5ysr was 40%; and (3) Patients with pT3 showed 5ysr of 0%. Results of a radical second operation showed that (1) Patients with pT2 cancer showed a 5ysr of 90%, significantly better (p less than 0.05) than pT2 treated with cholecystectomy alone; (2) There was a prolongation of survival in patients with pT3 or pT4. It was concluded that a radical second operation should be carried out for pT2 or more advanced inapparent carcinoma, whereas follow-up without a second operation is recommended for pT1 cancer without positive margin.
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PMID:Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. 155 12

The results of this clinical trial involving 23 sites indicated that 111In-CYT-103 immunoscintigraphy identified 70% of all patients with surgically confirmed disease when interpreted by the on-site physician. The sensitivity of 111In-CYT-103 imaging was slightly lower when interpreted retrospectively by the blinded readers in the absence of any patient-specific information. 111In-CYT-103 imaging sensitivity was similar in patients with primary and recurrent disease, but lower for liver metastases than for extrahepatic disease. Thirty-three previously unknown lesions were visualized by immunoscintigraphy; tissue confirmation was available for only five lesions, and all were found to be free of tumor. Only one of the lesions evaluated was TAG-72 positive. Twenty-eight lesions were outside the surgical field or not biopsied. Although no tissue confirmation was available, seven (25%) of these lesions were identified as consistent with metastatic disease by other conventional modalities. Importantly, antibody scans detected occult tumor lesions in 11 of the 92 patients with surgically confirmed adenocarcinoma, and accurately diagnosed 7 of 10 patients with elevated serum CEA levels and negative conventional workup. Surgery confirmed the presence of tumor identified only by 111In-CYT-103 in three patients, while four patients with negative scans had no evidence of recurrent disease at surgery. Antibody scans confirmed the absence of additional disease in 18 of 22 patients with isolated hepatic or pelvic recurrences in whom curative surgery was contemplated. The results of this multicenter trial suggest that CYT-103 immunoscintigraphy can provide information that is complementary to that derived from standard diagnostic techniques. During the workup of patients with primary colorectal carcinoma, this modality assesses the entire body and allows for the identification of multiple lesions at various locations simultaneously. It can then redirect attention and further workup to those areas not originally surveyed. Of special interest in this regard is the identification of occult lesions in five patients with primary colorectal cancer. 111In-CYT-103 imaging was found superior to CT in the localization of primary colorectal cancer, but neither modality could adequately assess the extent of tumor penetration through the bowel wall (the T stage in the TNM system) or the N status. The limitations of CT in evaluating T and N are well documented, and the limitations of 111In-based immunoscintigraphy for these same lesions have recently been described. Another limitation of 111In-CYT-103 immunoscintigraphy is in the identification of liver metastases.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Multicenter clinical trials of monoclonal antibody B72.3-GYK-DTPA 111In (111In-CYT-103; OncoScint CR103) in patients with colorectal carcinoma. 157 51

Prognostically relevant factors derived from re-operative endoluminal US examination or the histopathological work-up of the surgical specimen in carcinoma of the rectum are well known. We investigated the question as to whether the DNA content of tumor cells is an independent influencing factor of prognosis after resection of rectal carcinoma. In 68 patients who underwent resection for rectal carcinoma, in addition to the TNM classification and the usual morphological evaluation, the paraffin-embedded tumor material was de-paraffinized, rehydrated and treated mechanically and enzymatically prior to application to microscope slides. These smears were analysed with the aid of automatic single cell cytometry, and DNA measurements were performed. In contrast to flow cytometry, this technique permits, on the basis of electronic selection criteria, selective analysis of the tumor cells, while artefacts, stroma and inflammatory cells can be excluded. Using DNA cytometry, we were able to differentiate between diploid, polyploid and aneuploid tumors. The best prognosis was associated with a diploid tumor, the poorest with aneuploid tumor. Regression analysis, however, showed that the DNA content of tumor cells is of only secondary significance.
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PMID:[Image cytometric DNA analysis in the evaluation of the risk of recurrence after resection of rectal carcinoma]. 157 94

Forty benign and 31 malignant breast tissues were examined using a one stage colloid-stabilising silver technique for argyrophilic nucleolar organiser regions (AgNOR). In 31 patients TNM staging was correlated to AgNOR score. There was a positive correlation with the T-stage and AgNOR score of the tumor (Spearman's rank correlation coefficient = 0.437). The N-stage and AgNOR score for breast cancers (n = 10) were inversely related, and there was a significant difference between the lymph node positive and negative groups (P less than 0.05). No significant relationship was identified between oestrogen receptor negative and positive groups and AgNOR score (P = 0.63). Mean regression analysis suggests that independent of the Bloom's grade, the AgNOR score is an indicator of tumour size.
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PMID:The relationship between clinical staging, oestrogen receptor status and silver-binding nucleolar organiser regions (AgNOR) in breast carcinoma. 158 1

Analyses of tumor size and breast cancer stage were used to determine whether biased detection of breast cancer could have materially influenced estimates of risk associated with use of oral contraceptives. In a population-based case-control study conducted from 1980-1982, surveillance for breast cancer by breast exams, but not mammography, was found to be strongly linked to use of oral contraceptives. Tumors were slightly smaller and less likely to be late-stage (TNM stage III or IV) in patients who had used oral contraceptives. The net effect of any diagnostic bias on advancing the date of cancer diagnosis, whether from breast exams or other sources, was estimated to be less than 8 weeks. This corresponds to spuriously increasing the risk of early-occurring breast cancer in oral contraceptive users by at most 2.4% (relative risk = 1.024).
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PMID:Breast cancer detection in relation to oral contraception. 158 51

One of the major short comings of the traditional TNM system is its limited potential for prognostication. With the development of multifactorial analysis techniques, such as Cox's proportional hazards model, it has become possible to simultaneously evaluate a large number of prognostic variables. Cox's model allows both the identification of prognostically relevant variables and the quantification of their prognostic influence. These characteristics make it a helpful tool for analysis as well as for prognostication. The goal of the present study was to develop a prognostic index for patients with carcinoma of the upper aero-digestive tract which makes use of all prognostically relevant variables. To accomplish this, the survival data of 800 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx or larynx were analyzed. Sixty-one variables were screened for prognostic significance; of these only 19 variables (including age, tumor location, T, N and M stages, resection margins, capsular invasion of nodal metastases, and treatment modality) were found to significantly correlate with prognosis. With the help of Cox's equation, a prognostic index (PI) was computed for every combination of prognostic factors. To test the proposed model, the prognostic index was applied to 120 patients with carcinoma of the oral cavity or oropharynx. A comparison of predicted and observed survival showed good overall correlation, although actual survival tended to be better than predicted.
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PMID:Using Cox's proportional hazards model for prognostication in carcinoma of the upper aero-digestive tract. 160 11

An attempt is made to establish the most appropriate examination procedure for staging rectal carcinoma by computed tomography (CT). Twenty-two patients with rectal carcinoma had CT performed preoperatively. The following three CT sequences were performed in all patients: a precontrast scan with 10-mm slices; a rapid sequence scan with 5-mm slices during bolus injection of contrast medium; and a postcontrast scan after a 10-min delay. Tumor extension and the presence of perirectal lymph nodes were evaluated separately and independently in all three CT sequences according to the TNM classification. All patients had surgical follow-up and the CT scans were compared to the surgical and histopathological findings. There was no significant difference in diagnostic outcome in the three CT procedures. Information obtained by frontal and lateral scout views were compared, and the lateral scout view proved more informative than the frontal scout view. For staging rectal carcinoma, narrow slice scanning and intravenous contrast media are superfluous and should be reserved for special cases. We recommend the use of lateral scout views.
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PMID:Comparison of precontrast, postcontrast, and delayed CT scanning for the staging of rectal carcinoma. 161 14

The role of the tumor registrar in TNM staging has not been clearly defined. This paper shows how this can be clarified in individual hospital cancer programs and how the tumor registrar serves as a key member of the cancer team in implementing physician TNM staging.
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PMID:Tumor registrar's role in TNM staging. 161 60


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