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Biomedical subjects

G W Morley

Publications and source records attributed to G W Morley.

At least 73 records · Page 4Linked to original sources
PubMed1985

Prognostic significance of groin lymph node metastases in squamous carcinoma of the vulva.

A retrospective review of the clinical and histologic findings in 48 cases of stages I, II, and III (excluding T3) squamous carcinoma of the vulva with positive groin nodes reveals the prognostic significance of the size and number of the nodal metastases. Other factors such as the morphology of the lymph nodes and the histologic features of the primary neoplasm are not nearly as significant. Patients with only one or two small nodal metastases have an excellent outlook for survival providing that adequate margins can be obtained around the primary tumor and that thorough groin node dissections can be performed. These patients do not appear to need adjuvant radiation or pelvic node dissection. A further finding is that patients with unilateral labial carcinomas do not have metastases to the opposite groin in the absence of ipsilateral groin metastases, although six of 21 patients had metastases to both groins.

Carcinoma, Squamous Cell↗
PubMed1984

The prognostic significance of tumor emboli in lymphatic or vascular spaces of the cervical stroma in Stage IB squamous cell carcinoma of the cervix.

The presence of tumor emboli in lymphatic or vascular spaces within the cervical stroma in squamous cell carcinoma of the cervix has been reported by several authors to be associated with a decrease in 5-year survival. In a 10-year review of 124 radical hysterectomies for Stage IB squamous cell carcinoma of the cervix at the University of Michigan from 1970 to 1980 the presence of tumor emboli in the cervical stroma without other known risk factors did not significantly alter the 3- and 5-year survival. With the potential risks and lack of proved benefit the use of adjuvant radiotherapy or chemotherapy in this setting is not recommended.

Adult↗
PubMed1984

Presidential panel. The gynecologic oncologist in academic departments.

Now that the subspecialty of gynecologic oncology is well established within the specialty of obstetrics and gynecology, it seems timely to evaluate the pros and cons, the strengths and weaknesses of such a program as it interrelates with other programs in an academic department. A survey is presented which reflects the beliefs of both members and candidate members of the Society of Gynecologic Oncologists on such issues as gynecologic oncologists as chairmen of departments; teaching demands; time commitments to patient care and research in an academic institution; and surgical privileges for gastro-intestinal and urologic procedures in various hospitals. Financial and budgetary items are also discussed. Perspectives from three different points of view are presented as a discussion of the report of the survey.

Academic Medical Centers↗
PubMed1984

Autopsy findings in patients with uterine sarcoma.

Autopsy findings were reviewed in 22 patients treated for uterine sarcoma at the University of Michigan Hospitals. Included are 11 mixed mesodermal tumors, 6 endometrial stromal sarcomas, and 5 leiomyosarcomas. Only one patient died with disease limited to the pelvis. Forty-five percent of the patients died with disease limited to the pelvis and abdomen. The most common site of the disease above the diaphragm was the lung. Lymph nodes were involved in 59% of our patients. There were no obvious differences in the patterns of spread between the tumor types.

Combined Modality Therapy↗
PubMed1984

Combination cisplatin and dichloromethotrexate in patients with advanced or recurrent cervical cancer: a preliminary report.

The chemotherapy combination of cisplatin and dichloromethotrexate was administered to 14 patients with measurable cervical cancer. Six (46%) have had a complete response for 6+, 7, 11, 14, 15, and 21 months. Four (30%) have had a partial response for 1, 6, 10, and 11 months. Two patients (15%) have had stable disease for 6 and 11 months. Only one patient failed to respond to this combination. In six of these patients, the measurable mass was located in a previously radiated area. This combination was well tolerated with only three instances of severe toxicity. No irreversible renal dysfunction was seen in any patient.

Adult↗
PubMed1984

Prognostic features of sarcomas and mixed tumors of the endometrium.

A retrospective study of 103 patients with endometrial sarcomas treated at the University of Michigan Hospital includes 47 mixed homologous tumors, 32 mixed heterologous tumors, 21 pure homologous sarcomas (endometrial stromal sarcoma), and three pure heterologous sarcomas (rhabdomyosarcomas). Clinical characteristics appeared similar among the four patient groups. Fourteen percent of the patients had received previous pelvic irradiation. Twenty-nine percent of the patients with a clinical stage I or II tumor had extrauterine disease discovered at surgery. Extent of the tumor at the time of surgery strongly correlated with outcome, and only two patients with extrauterine disease were long-term survivors. Life table survival probability at five years was 58% with surgical stage I, 33% with surgical stage II, 13% with surgical stage III, 0 with surgical stage IV, and 5% in patients referred with recurrence. Risk factors predicting treatment failure were analyzed separately in surgical stages I and II using Cox model analysis. There was no difference in risk for treatment failure between pure endometrial stromal sarcoma, mixed homologous sarcoma, or mixed heterologous sarcoma. The strongest factor correlating with a poor outcome was deep myometrial invasion (P less than .001). An adverse trend was detected in those patients with previous pelvic irradiation, with advancing patient age, and with increasing uterine size, although these differences did not reach statistical significance. Neither the presence of heterologous tumor elements nor cervical involvement were found to be adverse prognostic factors.

Actuarial Analysis↗
PubMed1983

The selective use of vaginal hysterectomy in the management of adenocarcinoma of the endometrium.

Vaginal hysterectomy was performed in 56 patients with Stage I adenocarcinoma of the endometrium who were selected because of obesity or major medical problems that placed the patient at high risk for morbidity and death with an abdominal operation. Seventy percent of the patients were hypertensive and 29% were diabetic. The median weight for the 56 patients was 211 pounds. Ten patients who were age 40 or younger were included, and all showed signs of polycystic ovary syndrome. This subgroup of patients was significantly more obese, with a median weight of 331 pounds. Adjuvant radiation therapy was used in 32 of the 56 patients. There was one postoperative death from a pulmonary embolus, but there were few other major complications. The actuarial survival probability was 94% for all patients. With grade 1 tumors, the 5-year survival rate was 98%; with grade 2 tumors, it was 78%; and with grade 3 tumors, it was 84%. Although we do not recommend that vaginal hysterectomy become routine, it has cure rates comparable to those with abdominal hysterectomy and should be considered in patients who are a poor surgical risk, particularly patients with grade 1 tumors.

Adenocarcinoma↗
PubMed1983

Radiotherapeutic alternatives to standard management of adenocarcinoma of the endometrium.

Primary radiotherapy as an alternative management for adenocarcinoma of the endometrium was chosen for 117 patients treated at the University of Michigan Medical Center and University of Virginia Medical Center. Cases were selected for radiation because of contraindications to surgery (52.2%) or by protocol for disease outside the endometrium (47.8%). An overall 5-year actuarial survival rate of 49.6% was attained for all stages, with 55% 5-year survival for disease limited to the uterus or cervix. Stage and grade were the most significant risk factors. The addition of external-beam irradiation did not improve local failure rates or survival. Heyman's uterine packing technique was slightly more successful than uterine "line sources" in controlling local disease (P = 0.08). Treatment-related mortality (0.8%) and morbidity (6.8%) were minimal. Surgery, whenever possible, remains the "best standard therapy" but the radiotherapeutic alternative is of significant benefit for those deemed nonsurgical candidates.

Actuarial Analysis↗
PubMed1983

Adenocarcinoma of the fallopian tube.

Carcinoma of the fallopian tube is the least frequent tumor of the female genital tract. During a 27 year period, 34 patients with adenocarcinoma of the fallopian tube were treated at the University of Michigan Medical Center. Eight of 34 of the patients were found to have early second primary tumors during the work-up. The over-all two year and five year survival rates were 52 and 20 per cent, respectively. Results of our review of this group of patients would indicate that postoperative irradiation of the pelvis with more than 50 Grey in five weeks increased the five year survival rate of patients with disease confined to the fallopian tube.

Adenocarcinoma↗
PubMed1983

Fine needle aspiration of para-aortic and pelvic lymph nodes showing lymphangiographic abnormalities.

Fifty-six fine needle aspirations of lymphangiographically abnormal pelvic and para-aortic lymph nodes were performed in 50 patients at The University of Michigan between January 1, 1977, and May 31, 1980. Fine needle aspiration was used both in the initial evaluation of patients with gynecologic malignancies and in the investigation of persistent and recurrent malignant disease. The overall diagnostic accuracy of fine needle aspiration was 74.0%. Fine needle aspiration yielded diagnostic cytologic specimens; it was safe and well tolerated, and in some instances it permitted the diagnosis of lymph node metastasis without laparotomy.

Biopsy, Needle↗
PubMed1983

Microinvasive squamous carcinoma of the vulva: search for a definition.

All cases of stage I squamous cell carcinoma of the vulva from the University of Michigan Tumor Registry from 1935 to 1981 were reviewed. Seventeen of 90 (19%) patients had nodal metastases. All had a depth of invasion of more than 2 mm and all exhibited histologic confluence. The risk of nodal metastases varied with depth of invasion, size of lesion, and histologic grade, although the association with grade was not statistically significant. The size of the lesion influenced the incidence of nodal metastases only in that it was associated with the depth of invasion. Lymphovascular invasion was present in only four patients, but three of them had nodal metastases, including one patient with only 3 mm depth of invasion.

Carcinoma, Squamous Cell↗
PubMed1981

Cancer of the vulva: a review.

Localized carcinoma of the vulva in situ can be treated by wide local excision and continued close observation. Skinning vulvectomy, with or without subsequent skin grafting, is now well accepted as a treatment of Multifocal preinvasive disease. Microinvasive carcinoma of the vulva, on the other hand, is not treated with vulvectomy alone since the regional lymph nodes must be accurately assessed. The currently accepted treatment of invasive carcinoma of the vulva is radical vulvectomy and bilateral groin lymph node dissection. No longer is pelvic lymph node dissection to be considered a routine part of this therapy but is included only under specific circumstances. On rare occasion a more radical procedure such as anterior or posterior pelvic exenteration is considered appropriate therapy when the geographic location of the tumor requires this approach. The treatment of recurrent disease is influenced by its extent and location and must be tailored for the individual patient. Palliative vulvectomy is still used as a treatment of the far advanced disease in an attempt to improve personal and social hygiene, as well as to control serious infection and to prevent localized hemorrhage. The role of x-ray therapy in the treatment of carcinoma of the vulva is discussed.

Carcinoma in Situ↗
PubMed1980

Multiple primary neoplasms of the anogenital region.

The anogenital region, comprising the cervix, vagina, vulva, perineum, and anus, has the potential for the development of multicentric and multiple primary malignancies. Fifteen patients with 3 or more primary neoplasms in this region are presented. Awareness of the existence of these tumors as a regional disease and the possible long intervals between successive malignancies are emphasized. The presence of a vulvar neoplasm should arouse suspicion of a synchronous primary tumor elsewhere in the region. Conversely, sequential neoplasms occur more commonly after an initial cervical primary neoplasm and should be anticipated.

Adult↗
PubMed1979

Endometrial carcinoma: causes of death and sites of treatment failure.

A retrospective analysis of causes of death in 398 patients with endometrial carcinoma and sites of treatment failure in 105 cases, all seen at the University of Michigan Medical Center between 1930 and 1971, is the subject of this report. Of 398 patients (337 with Stage I, 61 with Stage II disease), 183 (46%) died with endometrial carcinoma, and 122 (31%) died free of cancer. The cause of death in 35 cases (9%) was a known or unknown maligancy, and remained undetermined in 58 patients (14%). The exact site of treatment failure was identified in 105 cases. Forty-one (40%) failures were considered local, 32 (30%) geographic, and 32 (30%) both local and distant. The uterus and lungs were the most common sites of local failure and distant metastasis, respectively. Of patients who died free of cancer, 88% survived 5 or more years, and 32% survived 20 years or longer. It is concluded that 1) Hematogenous dissemination of endometrial carcinoma may occur early and with appreciable frequency. Thorough pretreatment investigative workup, preferably including chest laminograms and liver scans and consideration of adjuvant systemic therapy in advanced cases (i.e. those with positive nodes) is recommended. 2) The uterus, a common site of local failure, must be removed whenever feasible. 3) A realistically aggressive approach to the treatment of patients with endometrial cancer is justifiable despite their older age and coexistent medical problems.

Adolescent↗
PubMed1979

Pelvic exenteration for advanced rectal carcinoma.

Twelve patients with advanced rectal cancer and no evidence of extrapelvic metastases underwent pelvic exenteration. The operative mortality rate was 8.3 per cent. Determinate 3 and 5 year survival rates of 54 and 37 per cent were achieved. Criteria for the selection of patients and techniques of supravesical urinary diversion are discussed.

Aged↗