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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The best treatment of advanced rectal cancer remains uncertain. The aim of this study was to determine the outcome after palliative procedures in patients with advanced rectal cancer. One hundred and three patients treated over a seven-year period were identified, including 30 with local invasion, 18 with local metastases, and 55 with distant metastases. Patients were grouped into two groups: those who underwent palliative resection (68) and those who were treated without rectal resection (55). The nonresected group included patients who underwent diverting colostomies (28) and those who received multimodality therapy without surgery (7). The average age of all patients was 63.1 years. Patients in the nonresected group had more distant disease (68 percent) than the resected group (46 percent). Significant pelvic pain was a more common problem in the nonresected group (15 percent) than in the resected group (4 percent). Similarly, pelvic sepsis was more common in the nonresected group (14 percent) than in the resected group (9 percent). Postoperative mortality was 4.3 percent after palliative resection and 3.8 percent after diverting colostomy. Survival of the resected group at one year was 65 percent and at two years 20 percent. Survival of the nonresected group at one year was 20 percent and at two years 0 percent. Survival in the resected group was significantly (P less than .01) better than the nonresected group but probably can be attributed to the more extensive disease generally present in the patients who did not undergo resection. These results suggest that patients with advanced rectal cancers should undergo palliative resection whenever possible because resection decreases pelvic complications and may improve quality of life.
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PMID:Advanced rectal cancer. What is the best palliation? 246 Feb 99

For the majority of patients with unresectable recurrence of rectal cancer, persistent pain is the most distressing problem. This brief study describes a method to control pain in 10 patients with unresectable rectal cancer confined to the pelvis after standard therapy failed. All of the patients had percutaneous placement of infusion catheters in both internal iliac arteries. A continuous intraarterial infusion of 800 mg/m2 of 5-fluorouracil per day was given for 7 days and 10 mg/m2 of mitomycin C was administered as a bolus injection on the seventh day only. Four patients also received whole body hyperthermia by way of a Erbotherm 434 mHz microwave generator on the second and fifth days of infusion. Relief of pain occurred in three of the six patients who received intraarterial chemotherapy only. All four patients who also received hyperthermia achieved prolonged pain relief when it was added. We have concluded that intraarterial chemotherapy may be beneficial in patients with uncontrolled pelvic pain due to recurrent rectal cancer. The addition of hyperthermia may augment the benefit.
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PMID:Intraarterial chemotherapy and hyperthermia for pain control in patients with recurrent rectal cancer. 309 28

Local radiofrequency hyperthermia combined with chemotherapy was performed on five patients with pelvic recurrence of rectal cancer. Relief of pain was obtained in all four patients with uncontrolled pelvic pain due to recurrent rectal cancer. In some patients, CEA levels of peripheral blood were decreased and tumor necrosis was proved histologically. These results suggest that this combined therapy may be useful for patients with pelvic recurrence of rectal cancer.
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PMID:[Local chemo-hyperthermotherapy of recurrent rectal cancer]. 338 4

Eighty-five patients who developed pelvic recurrence after abdominoperineal resection for carcinoma of the rectum have been reviewed. The average period of latency was 16 months, with increasing incidence of recurrence in the more advanced stages of the disease. Eighty per cent of recurrences occurred within two years of surgical treatment and a further 20% between two and five years after operation. The prominent manifestations were pelvic pain (100%) and mass (54%), which responded to palliative radiotherapy in 92% and 80% of the cases respectively. The mean duration of palliation was 6.5 months. Patients with pelvic recurrence secondary to rectal carcinoma benefit from palliative radiation therapy, and this should be given whenever possible.
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PMID:The use of radiotherapy for pelvic recurrence following abdominoperineal resection for carcinoma of the rectum: a 10-year experience. 694 May 42

Previously irradiated recurrent pelvic malignancy is refractory to most treatment modalities. Ten patients with local recurrences (six with rectal cancer; three, anal cancer; and one, anorectal melanoma) were treated with a total of 17 courses of isolated pelvic perfusion chemotherapy (12 with multiple agents) using standard hemodialysis technology. Aortic and inferior vena caval occlusion was maintained via transfemoral balloon catheters, with a single intraoperative balloon disruption. Mean pelvic-systemic drug exposure ratios were 9.8:1 for fluorouracil, 4.8:1 for cisplatin, and 4.4:1 for mitomycin C. Results were three partial responses (two patients subsequently underwent resection) and three minor responses, all in patients with a visible tumor. Pelvic pain was relieved in six of eight symptomatic patients (mean duration, 4 months). Using limited access, this procedure produces high pelvic-systemic concentration gradients, prolonged palliation for recurrent pelvic cancers, and increased resectability in selected patients.
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PMID:Isolated pelvic perfusion for unresectable cancer using a balloon occlusion technique. 768 72

In the last few years, an enormous progress has been achieved in the treatment of Colorectal Cancer due to a better know ledge of the biology, natural history, prevention and treatment of colon and rectum adenocarcinoma. Genetic alterations produce changes in thecolonic mucosa that lead to the formation of adenoma and eventually, its transformation into cancer. At present, it is well established that the Adenomatous Polyp preceeds Colorectal Cancer. The average span of time from normal mucosa to Adenomatous Polyp is about 5 years, and it takes around 5 more years for the Adenomatous Polyp to transform into cancer. The treatment of patients with Colorectal Cancer varies from Endoscopic Polypectomy or formal surgical resection to combined multidisciplinary strategies, according with the stage of the disease. Endoscopic Polypectomy has helped to avoid multiple operations that were performed in the past, it also reduces significantly the development of a second cancer in cured patients who had suffered Colon Cancer. The prognosis of node-negative patients is excellent with a 5 year survival of 80 per cent. Adjuvant chemotherapy has proven to be effective in node-positive Colon Cancer, improving the overall survival. In Rectum Cancer, the use of staplers and changes in the surgical technique have reduced the number of abdominoperineal resections, preserving the annal sphincter and improving the quality of life in patients. Adjuvant chemoradiation control groups and historical controls show a local recurrence of 20-45 per cent in node-positive Rectum Cancer, and 15-30 per cent in node-negative patients. Recently, the improvement of the lateral dissection reduces recurrence in 10 per cent, avoiding pelvic pain, although overall survival has not been improved. Local excision of early lesions from the rectum is an interesting choice in patients who have been carefully selected. We believe that in the following years, the clinical appearance of Colorectal Cancer can be prevented with a better knowledge of its molecular biology.
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PMID:[COLON AND RECTUM CANCER SURGERY] 1227 38

This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n=30, CT alone n=6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m(-2) day(-1) for 12 weeks) with mitomycin C (MMC) (7 mg m(-2) i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m(-2) day(-1) and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4-9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range=40-85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI=64-91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in one patient. Neoadjuvant systemic chemotherapy as a prelude to synchronous chemoradiation can be administered with negligible risk of disease progression and produces considerable symptomatic response with associated tumour regression.
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PMID:Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer. 1267 97

The management of rectal cancer has been revolutionised over the last 20 years through improvements in staging, surgery and the use of radiotherapy and combination chemoradiotherapy. The traditional approach involved surgery followed by pathological assessment of the specimen reporting the completeness of excision. Incomplete excision in many cases led to local recurrence of the cancer within the pelvis with the disabling symptoms of pelvic pain, bowel fistulation and bowel and bladder dysfunction. Indeed, many patients died with local recurrence alone and salvage therapy in these patients was rarely successful. However, the recognition of the advantage of pre-operative therapy for patients in whom surgery would not provide local cure has been a major advance. The ability to downstage/downsize the tumour before curative surgery has improved outcome. However, these pre-operative therapies are toxic and not without their own complications, therefore the select use, targeted at the appropriate patient, represents the 'gold-standard'. The development of magnetic resonance imaging staging that accurately predicts operability has completed this triad approach which is focused through the weekly multidisciplinary team meeting. National acceptance of these techniques and standards can only improve the outcome for patients with this disease.
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PMID:Bowel cancer: the outcome is improving. 1635 55

This study is a part of a clinical trial in preoperative radiotherapy of low rectal cancer, conducted as a prospective and partly retrospective clinical study. It was designed to estimate the influence of long-term radiotherapy on symptoms of locally advanced rectal cancer. We included 49 patients with T3/4 stage adenocarcinoma (diagnosis confirmed by clinical, pathological and CT examinations) of the lower two thirds of the rectum, who were treated with long-term radiotherapy (45 Gy in 20-25 fractions) and questioned for the presentation of symptoms before and after the treatment. The chief complaints of these patients were the presence of blood in stool, abdominal and pelvic pain, straining (tenesmus) and the alteration in bowel movement. We found a significant decrease in symptoms and signs of the illness after the radiotherapy as well as the improvement of the quality of life.
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PMID:Influence of long-term radiotherapy on symptoms and signs of locally advanced primary rectal cancer of distant localisation. 1906 94

INTRODUCTION. During the last 30 years, the multidisciplinary treatments of colon and uterus neoplasm have yielded an increase in total survival rates, fostering therefore the increase of cases with regional relapse involving the urinary tract. In these cases the iterative surgery can be performed, if no disease secondary to pelvic pain, haemostatic or debulking procedure is present, and must be considered and discussed with the patient, according to his/her general status. MATERIALS AND METHODS. From 1997 to August 2007 we performed altogether 43 pelvic iterative surgeries, with simultaneous urologic surgical procedure because of pelvic tumor relapse in patients with uterus neoplasm and colon and rectal cancer. In 4 cases of anal cancer, the urological procedure were: one radical prostatectomy with continent vesicostomy in the first case, while in the other 3 cases radical pelvectomy with double-barrelled uretero-cutaneostomy. In 23 cases of colon cancer, the urologic procedures were: 9 cases of radical cystectomy with double-barrelled uretero-cutaneostomy, 4 cases of radical cystectomy with uretero-ileo-cutaneostomy according to Bricker- Wallace II procedure, and 9 cases of partial cystectomy with pelvic ureterectomy and ureterocystoneostomy according to Lich-Gregoire technique (7 cases) and Lembo-Boari (2 cases) procedure. In 16 cases of uterus cancer, the urological procedure were: 7 cases of partial cystectomy with pelvic ureterectomy and uretero-cystoneostomy according to Lich-Gregoire procedure; in 3 cases, a radical cystectomy with urinary continent cutaneous diversion according to the Ileal T-pouch procedure; 2 cases of total pelvectomy and double uretero-cutaneostomy, and 4 cases of bilateral uretero-cutaneostomy. RESULTS. No patients died in the perioperative time; early systemic complications were: 2 esophageal candidiasis, 1 case of venous thrombosis. CONCLUSIONS. The iterative pelvic surgery in the case of oncological relapse involving the urinary tract aims to achieve the best quality of life with the utmost oncological radicality. The equation: eradication of pelvic neoplasm and urinary tract reconstruction, with acceptable quality of life, will be the future target; nevertheless, it is not possible to establish guidelines beforehand, and the therapy must be adapted to each single case.
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PMID:[Urologic surgical procedures in patients with uterus neoplasm and colon-rectal cancer]. 2108 75


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