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Query: UMLS:C0178874 (tumor progression)
 40,807 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoma of the prostate is the most commonly diagnosed cancer in men. The natural history and the biological aggressiveness are primarily determined by tumor volume. At the time of diagnosis, only one third of all tumors are pathologically confined to the prostate and eligible for curative therapy. Early detection by the general practitioner with prostate-specific antigen and digital rectal examination should be the primary goal. Currently, diagnosis is best established by transrectal ultrasound-guided biopsies. For the treatment of localized prostate cancer, men who undergo radical retropubic prostatectomy have been shown to have superior long-term results when compared to those who have received radiation therapy. With an improved understanding of the prostatic anatomy and nerve-sparing surgical techniques, morbidity from impotence and incontinence are minimal. In advanced carcinoma, 70 to 80% of men initially respond well to androgen withdrawal. Unfortunately, androgen-independent cells will continue to multiply, leading to tumor progression and death. Until effective chemotherapeutic agents are developed, we can only achieve palliation in advanced disease.
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PMID:[Prostate carcinoma--a current review]. 137 72

Cryotherapy was applied to 182 rectal cancer patients in the Department of General Surgery, University of Ulm, between 4/1982 and 4/1991. Recipients of this tumor freezing therapy were patients whose general condition was bad, patients with an advanced inoperable carcinoma, patients with tumor recurrence and patients refusing operation. Rectal carcinomas, mostly in an advanced stage, were usually freezed several times. Only 4 patients with general inoperability reached the survival time margin of 5 years. In 18 patients local tumor destruction was possible by application of cryotherapy. In 80% of cases disagreeable tumor symptoms like tenesma, mucous discharge and oozing hemorrhages could be reduced or completely removed. Perianal pain and intense tumor bleeding could be relieved temporarily or definitely in only 50% of patients. An artificial anus could be avoided in 80% of cases by local tumor destruction/reduction or arrest of tumor growth. The mean survival time of patients with tumor recidivation was 11 months after onset of the recurrence. Tumor progression, incontinence and iatrogenic rectal perforation made an artificial anus necessary in 14 patients.
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PMID:[Cryotherapy in rectal cancer. A palliative local tumor treatment]. 137 57

Since April 1986, 227 patients received an ileal neobladder at our institution. Of these patients 206 underwent simultaneous radical cystectomy for bladder cancer, and 21 received a bladder augmentation. The mean postoperative follow-up ranges from 3-71 months. Perioperative mortality was 2.55 percent, 15 percent of the patients died later than 2 months postoperatively, 13.4 percent due to tumor progression, 1.5 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexia. Day and night continence was preserved in 77 percent of the patients with a follow-up of more than 2 years; severe stress incontinence was found in 2 patients, and night time incontinence needing some external device in 4.6 percent. 11.5 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for re-operation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:[Ileal neobladder]. 149 68

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. Since April 1986, 161 patients underwent this type of surgery at our institution. Of these patients 141 underwent simultaneous radical cystectomy for bladder cancer, and 20 received a bladder augmentation. The mean postoperative follow-up is 23.8 months with a range of 3-52 months. Perioperative mortality was 0.5 percent, 9.5 percent of the patients died later than 2 months postoperatively, 7.5 percent due to tumor progression, 2 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexy. Day and night continence was preserved in 78% of all patients; severe stress incontinence was found in 4.2 percent of the patients and night time incontinence needing some external device in 7.7%. 10 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for reoperation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:The ileal neobladder. 205 41

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. From April 1986 through May 1989, 113 patients underwent this procedure at our institution. Of these patients 99 underwent simultaneous radical cystectomy for bladder cancer and 14 underwent bladder augmentation. The mean postoperative followup was 14.4 months, with a range of 1 to 36 months. There was no perioperative mortality. However, 7 patients died more than 2 months postoperatively: 5 of tumor progression, 1 of pneumonia and severe metabolic acidosis, and 1 of septicemia of unknown cause. Reoperation was necessary in only 13 patients; 10 patients required urethrotomy or dilation of urethral strictures. Day and night continence was preserved in 82.1% of all patients. Stress incontinence, which must be corrected by an artificial sphincter, was found in 4 patients (4.2%) and night-time incontinence that required an external device occurred in 5 (5.3%). Eight patients (8.4%) with mild stress incontinence required no further treatment. Pressure waves exceeding 22 cm. water seldom occurred and then only at maximum capacity. Our experience with this relatively simple system without a nipple is an overwhelming success. The need for reoperation is extraordinarily low and the high reservoir capacity results in continence from the beginning in most patients. The concept is sound and offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:The ileal neobladder: experience and results of more than 100 consecutive cases. 230 60

A variety of methods for urinary diversion are employed in patients with gynecologic malignancies depending on whether there is an obstruction or fistula formation due to either tumor growth or radiotherapeutic injury. Percutaneous nephrostomy (PCN) has a low complication rate and is a good method for palliative urinary diversion or may precede some form of permanent diversion to restore the kidney function first. Indication for palliative diversion in tumor obstruction depends on many individual factors. A relative contraindication is tumor progression during therapy. 6-month survival was about 70% in patients with previously untreated tumors or recurrences. This rate is far better than reported in earlier studies, so that a palliative diversion has to be considered for these patients. Also a high rate of recanalization after therapy could be observed in the untreated group, allowing the PCN to be removed. However, this has not been shown to be a prognostic factor. In the individual patient some other aspects, such as quality of life and social status, have to be taken into account before a final decision can be made. Ureteral obstruction after radiotherapy is a rare finding and often mistaken for a more likely recurrence. Different methods to restore the urinary tract, such as reimplantation of the ureter, should be used as a first choice. When the stenosis is due to radiocystitis, enterocytoplasty will often be indicated. Diversion has then to be omitted. The poor quality of life because of permanent incontinence due to fistula formation makes diversion mandatory even if life expectancy is very short. Surgical closure of a large radiogenic fistula is rarely successful. In this situation, ileal conduit has proven its efficacy for long-term urinary diversion.
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PMID:Urinary diversion in gynecologic malignancies. 245 37

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[3 years' experience with the ileum neobladder--the first 108 patients]. 276 96

The authors performed 27 continent urinary diversions among 36 urinary diversion operations between 1992 and 1995. Fifteen orthotopic diversions (14 ileal neobladders, 1 sigma neobladder) and 12 Mainz pouch II were created. During these 3 years, 4 patients died after operation. Tumour progression was observed in four patients. Three ureteral and 1 urethral stricture developed, 1 patient had complete incontinence (after Mainz pouch II operation) and another three had stress and night incontinence. In 12 patients a modified Hautmann operation was performed (modified by the authors) and the ureters were implanted in a 15 cm long tubular afferent ileum. Also they changed the conventional Goodwin technique for ureter implantation in Mainz pouch II operation and instead they used the Paquin technique for ureter reimplantation in the sigma. The authors concluded according to the literature and their own results that continent urinary diversion (ileal or sigma neobladder or Mainz pouch II) could be the first choice after radical cystectomy to achieve for these patients a better quality of life.
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PMID:Continent urinary diversion after radical cystectomy: 3 years' experience. 911 36

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.
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PMID:[Clinical experience of ileal neobladder for bladder cancer]. 950