Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0699790 (colon cancer)
 28,837 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The original CA 125 serum tumor marker test is a homologous double-determinant (OC 125 monoclonal antibody based) assay for the quantification of tumor associated mucin-like CA 125 molecules present in the serum. Commercial kits, now supplied by various manufacturers (and in different versions, e.g. IRMA, EIA, etc.) are currently widely applied in the following clinical situations: (i) Monitoring of disease. Doubling or halving of CA 125 serum values correlated (in 87% of all cases) with tumor progression or regression, respectively. (ii) Early prediction of outcome. Deviation from the ideal CA 125 regression curve predicts poor outcome within 3 months of cytostatic treatment. (iii) Tumor status after completion of therapy. Patients with CA 125 > 35 U/ml have (in 95% of all cases) still tumor present (at second look surgery). However, patients with CA 125 < 35 U/ml have in 50% (mostly minimal) residual disease. (iv) Early detection of recurrence. After a complete remission, a rise in CA 125 precedes tumor recurrence in 75% of all patients, with lead times up to more then 1 year, surpassing the CT-scan in cheapness and accuracy. (v) Diagnosis and differential diagnosis. Only when used in combination with other markers, do CA 125 determinations have a value as a diagnostic adjunct in the discrimination of ovarian cancer patients from those with benign ovarian tumors and from those with advanced colon cancer. Today, optimal management of ovarian cancer patients can only be provided using the CA 125 serum test.
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PMID:CA 125 in gynecological pathology--a review. 836 5

From 1960 to 1993, a total of 1.766 patients with liver metastases from colorectal carcinoma was recorded. Five-hundred-and-eight patients (28.8%) underwent hepatic resection which was performed with curative intent in 473 patients (26.8%). 30-day mortality in this group was 4.5%, being 2.6% (4 out of 155) since 1990. Significant morbidity was observed in 16% of patients with a decrease to 7% for the last 4 years. A 99.5 percent follow-up until January 1, 1996, was achieved. Excluding operative mortality there are 376 patients with "potentially curative" initial liver resection, and 65 corresponding patients with minimal macroscopic (n = 19) or microscopic (n = 46) residual disease. The latter group demonstrated a poor prognosis with median and maximum survival times of 14.8 and 56 months, respectively. Among the 376 patients having potentially curative resection the actuarial five, ten, and twenty year survival was 39 +/- 3, 26 +/- 5 and 21 +/- 13 percent, respectively. Tumor-free survival was 34 +/- 3 percent at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: Presence and extent of mesenteric lymph node involvement (p = 0.0001), poor grading of the primary tumor (p = 0.008), synchronous diagnosis of metastases (p = 0.004), satellite metastases (p < 0.0001), an increasing metastasis diameter (p < 0.0001), preoperative CEA elevation (p = 0.0002), a resection margin of less than 1 cm (p = 0.018), extrahepatic disease (p = 0.02), non-anatomical procedures (p = 0.008), and an operative blood loss exceeding 2.000 ml (p = 0.02). With respect to disease-free survival, extrahepatic disease (p = 0.09) failed to achieve statistical significance, while patients with colon cancer and with delayed resection of synchronous metastases did significantly better than those with rectal cancer (p = 0.02) and with a simultaneous procedure (p = 0.04), respectively. Multiplicity and bilobar involvement did not affect prognosis. Similarly, no significant predictive value of an increasing number of metastases (1-3 vs > or = 4) on either overall (p = 0.35) or disease free survival (p = 0.55) was found after a radical excision of all detectable disease. Using Cox's multivariate regression analysis, presence of satellite metastases, anatomical vs non-anatomical approach, primary tumor grade and diameter of the largest metastasis all independently affected both crude and tumor-free survival (p < 0.05). With respect to survival, this was complemented by the margin of clearance (0.05 < p < 0.1), while for disease-free survival primary tumor site and time of metastasis diagnosis had some additional influence. Twenty-six patients with R0-reresection of the liver, and 32 patients with radical excision of extrahepatic recurrent disease had a subsequent 5-year survival of 57 +/- 15 percent and 32 +/- 12 percent, respectively. This confirms the effectiveness of a close follow-up policy.
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PMID:[Surgical resection of colorectal liver metastases: Gold standard for solitary and radically resectable lesions]. 896 36

In a total of 1073 unradically resected patients (R1/R2) surprisingly we found a group of 31 with a more than 5-year-survival and seven patients living more than 10 years. The prognosis in patients presenting rectal carcinoma was significantly better compared to colon cancer, with a 5-year-survival of 5 +/- 2% compared to 1 +/- 1%. For a long local control of tumor growth in the residual tumor patients, the possibility of irradiation probably in combination with chemotherapy seems to explain these data; but half of our longterm survivors had no additional therapy. The influence of tumorbiological and immunological factors in such patients are of further interest.
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PMID:[Long-term survival after non-curative therapy of colorectal carcinomas]. 910 12

Adjuvant chemotherapy with fluorouracil (FU) and levamisole or FU/leucovorin (LV) has been established as effective adjuvant treatment for patients with stage III colon cancer. Among several other promising treatment strategies in resected colon cancer, intraperitoneal anti-cancer drug administration with its appealing rationale of counteracting microscopic residual disease on peritoneal surfaces and occult metachronous liver metastases by achieving high intraportal drug concentrations has not yet undergone sufficient clinical evaluation. To determine whether a combination of this locoregional therapeutic concept with systemic intravenous administration of FU/LV would yield better results than conventional adjuvant chemoimmunotherapy with FU/levamisole, the present randomized study was initiated. A total of 241 patients with resected stage III or high-risk stage II (T4N0M0) colon cancer were randomly assigned to 'standard therapy' with FU and levamisole, given for a duration of 6 months, or to an investigational arm, consisting of LV 200 mg m(-2) plus FU 350 mg m(-2), both administered intravenously (days 1-4) and intraperitoneally (days 1 and 3) every 4 weeks for a total of six courses. In patients with stage II disease, no significant difference was noted between the two arms after a median follow-up time of 4 years (range 2.5-6 years). Among 196 eligible patients with stage III disease, however, a comparative analysis of the two treatment groups suggested both an improvement in disease-free survival (P = 0.0014) and a survival advantage (P = 0.0005), with an estimated 43% reduction in mortality rate (95% confidence interval 26-70%) in favour of the investigational arm. In agreement with its theoretical rationale, combined intraperitoneal and intravenous FU/LV was particularly effective in reducing locoregional tumour recurrences with or without liver or other organ site involvement (9 vs 25 patients in the FU/levamisole arm; P = 0.005). Treatment-associated side-effects were infrequent and generally mild in both arms, although a lower rate of severe (WHO grade 3) adverse reactions was noted in patients receiving locoregional plus intravenous chemotherapy (3% vs 12%; P = 0.01). The results of this trial suggest that combined intraperitoneal plus systemic intravenous chemotherapy with FU/LV is a promising adjuvant treatment strategy in patients with surgically resected stage III colon carcinoma.
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PMID:Combined intravenous and intraperitoneal chemotherapy with fluorouracil + leucovorin vs fluorouracil + levamisole for adjuvant therapy of resected colon carcinoma. 957 45

A 58 year-old woman underwent radical nephrectomy, thrombectomy and ileo-cecal resection for renal tumor with thrombus involving the inferior vena cava and ascending colon cancer. In a patient having tumor thrombus extending to the vena cava, recognition of the position of the thrombus is important for surgical and anesthetic management in pre- and intra-operative periods. Transesophageal echocardiography (TEE) enabled us to visualize the real-time movement and deformity of thrombus by surgical manipulation and compression during operation. TEE seemed also very useful not only in understanding the hemodynamics during operation but also in detecting the residual tumor and the blood flow in liver and the inferior vena cava after operation.
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PMID:[Anesthetic management for renal tumor extending to the inferior vena cava]. 962 72

We report an 89-year-old man with colon cancer that developed rapidly after an incomplete endoscopic mucosal resection (EMR), and discuss the adverse effect of this maneuver on the tumor biology. A sessile polyp, 15 mm in size, was detected at the hepatic flexure. EMR was performed immediately. Histological examination showed well differentiated adenocarcinoma with an adenomatous component invading the submucosal layer. There was vascular invasion (positive on elastica van Gieson staining) and the surgical margin was positive for cancer. A right hemicolectomy was performed. The surgical specimen showed the residual tumor, 22 mm in diameter. The relevant histopathological findings of the surgical specimen were: well differentiated adenocarcinoma, with partly mucinous carcinoma and a tubular adenomatous component, depth muscularis propria (mp), lymph node (LN) (0/9). Most of the submucosally invasive cancer was resected by the initial EMR, but the small residual tumor showed rapid growth within only 3 months after the EMR. It was assumed that the residual tumor cells had acquired more malignant characteristics after EMR. In regard to EMR we propose that: (1) except for patients who are at high risk for a major operation, EMR should be avoided for carcinoma with massive submucosal invasion, (2) colonic resection should be performed immediately when histology shows a positive surgical margin for carcinoma, and (3) patients operated after an incomplete EMR should be watched very carefully for the detection of recurrence.
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PMID:Rapid growth of residual colonic tumor after incomplete mucosal resection. 1021 29

Although cancer surgery has been of great benefit to patients with large bowel cancer, a flaw that has caused the death of countless patients has gone unrecognized. Although surgeons have dealt successfully with the primary tumor, they have neglected to treat microscopic residual disease. Persistent cancer cells within the abdomen and pelvis are responsible for the death of 30-50% of the patients who die with this disease and for quality of life consequences that result from intestinal obstruction caused by cancer recurrence at the resected site and on peritoneal surfaces. New surgical techniques for large bowel cancer resection minimize the surgery-induced microscopic residual disease that may result from surgical trauma. New developments in exposure, hemostasis, adequate lymphadenectomy, and qualitatively superior margins of excision have occurred. Clinical data show that a 40% improvement in survival with an optimization of surgical technique is possible. Not only should the surgical event for primary colon and rectal cancer be optimized, but also the successful treatment of peritoneal carcinomatosis should be pursued. Resected site disease and peritoneal carcinomatosis can be prevented through the use of perioperative intraperitoneal chemotherapy in patients at high risk of persistent microscopic residual disease. These are patients with perforated cancer, positive peritoneal cytology, ovarian involvement, tumor spill during surgery, and adjacent organ involvement. Patients with established peritoneal carcinomatosis can be salvaged with an approximate 50% long-term survival rate if the timely use of peritonectomy procedures, intraperitoneal chemotherapy, and knowledgeable patient selection are utilized. Peritonectomy procedures allow the removal of all visible peritoneal carcinomatosis with acceptable surgical morbidity (25%) and mortality (1.5%) rates. Heated intraoperative intraperitoneal chemotherapy using mitomycin C, in addition to early postoperative intraperitoneal 5-fluorouracil, can eradicate microscopic residual disease in the majority of patients. The peritoneal cancer index, which quantitates colon cancer peritoneal carcinomatosis by distribution and by lesion size, must be used in the selection of patients who may benefit from these advanced oncologic surgical treatment strategies. The completeness of the cytoreduction score is the most powerful prognostic indicator in this group of patients. The surgeon must be aware that there are no long-term survivors unless complete cytoreduction occurs. With a combination of proper techniques for the resection of primary disease, peritonectomy procedures for the removal of all visible peritoneal implants, intraoperative and early postoperative chemotherapy for the eradication of microscopic residual disease, and quantitative tools for proper patient selection, one can optimize the surgical treatment of patients with large bowel cancer.
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PMID:Successful management of microscopic residual disease in large bowel cancer. 1035 54

Hepatectomy provides the highest rates of cure among the methods for treating colon cancer liver metastases, but it cannot be performed in many cases. Hepatectomy is the treatment of choice for colon cancer liver metastases in our department, but we conduct transcatheter arterial embolization alone or in combination with MCT on patients in whom hepatectomy cannot be performed or those with residual tumor following hepatectomy. Transcatheter arterial embolization is conducted on patients shown to have tumor vessels, following a single intra-arterial shot of an anticancer drug. MCT is performed under general anesthetic percutaneously or by abdominal section in patients who have not responded well to transcatheter arterial embolization, in order to improve the effectiveness of treatment on the tumor overall. We consider the combination of transcatheter arterial embolization and MCT to be an effective treatment for patients with a colon cancer liver metastasis who present with tumor vessels.
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PMID:[Treatment policy for colon cancer liver metastases]. 1056 Mar 87

We report two cases affected by neoplasia after colectomy with ileo-rectal anastomosis (IRA) with a positive family history of colon cancer. Case 1, a 41-year-old ulcerative colitis (UC) patient, underwent IRA in 1977. In 1986, biopsies showed high-grade dysplasia. She underwent resection of the rectal stump in 1986. Submucosal invasive carcinoma was found in the surgical specimen. The immunohistological study demonstrated p53 protein overexpression in the neoplastic lesion. Her family history fulfilled the Amsterdam criteria of hereditary non-polyposis colorectal cancer (HNPCC). Case 2, a 47-year-old UC patient, underwent ascending colostomy in 1975 and the following year IRA. Endoscopic mucosal resection (EMR) for a sessile adenoma was performed in 1995 and subsequently polypectomy was performed for the residual tumor. Recurrent adenoma and dysplasia in another area were detected. The immunohistological study demonstrated p53 protein overexpression only in dysplasia. Renal cancer in the right kidney was detected. Resection of the rectal stump with ileal pouch-anal anastomosis (IAA), loop ileostomy and right nephrectomy were performed in 1998. Her mother and her mother's sister had been diagnosed with colon cancer. Only in the dysplastic lesion did we detect microsatellite instability at D5S644. Both cases with neoplasia had two relatives with colorectal carcinoma. In 33 cases with UC who had been followed up, 30 cases (96.8%) without neoplasia had no family history of colorectal carcinoma. These findings suggest that UC patients with a family history of colon cancer should be put under close surveillance. It should also be emphasized that IAA is the procedure of choice for UC patients with this particular condition.
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PMID:Ulcerative colitis patients with a family history of colorectal cancer should be subjected to close and careful surveillance. 1056 1

Treatment for peritonitis carcinomatosa in gastrointestinal cancer remains to be established though it is one of the commonest causes of cancer death. Subtotal peritonectomy (SP) with chemohyperthermic peritoneal perfusion (CHPP) was developed for the new therapeutic strategy for peritoneal dissemination in gastrointestinal cancer in our department. SP includes resection of stomach, colon, small bowel, spleen, gall bladder, and parietal peritoneum. CHPP was carried out by heated saline containing 25 mg/l cisplatin, 10 mg/l mitomycin C, and 20 mg/l etoposide. Intraperitoneal temperature was maintained at 42 degrees C for 60 min. Fifteen gastric cancer and three colon cancer patients with severe peritoneal dissemination underwent these procedures. The averages of operating time, intraoperative bleeding volume, and total perioperative transfused blood volume were 9 h, 4400 ml, and 5600 ml, respectively. The patients estimated as complete resection and residual disease by histopathological study numbered 11 and 7. There was no treatment-related deaths though bleeding occurred in 5 patients; perforation in 2 patients; and abscesses in 2 patients. The 1-year survival rate (1ysr) and the 2-year survival rate (2-ysr) of all the patients were 57% and 21%, respectively. The 1-ysr and the 2-ysr of the patients who underwent complete resection were 67% and 40% significantly greater than the 43% and 0% of the patients who had residual tumors (p=0.02). The combination therapy of SP and CHPP is feasible in spite of its morbidity and has great possibilities in complete resection of peritoneal dissemination and prolongation of patient's survival.
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PMID:Subtotal peritonectomy with chemohyperthermic peritoneal perfusion for peritonitis carcinomatosa in gastrointestinal cancer. 1085 49


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