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PubMedDate not supplied

Comparison of direct spreading and local recurrence of neoplasms.

Neoplastic progression proceeds most commonly with metastatic spreading but also with direct spreading and some minor forms of neoplastic distribution. The difference between metastatic spreading and direct tumor spreading is shown by the fact that metastatic cells are motile and separate from the primary tumor, whereas in direct spreading the progressing cells are less motile and connected with the primary tumor. This latter type of spreading is especially common in kidney cancers. In the case of local recurrence where portions of the primary tumor have been spared from destruction, regrowth of these portions may occur after different intervals. It is a precondition that the neoplastic metabolism has gained power again. Local recurrence is an offspring of growth from the primary tumor or from a not fully removed metastasis and should be considered as a growth comparable to direct spreading. It may switch during further progression to metastatic progression.

Female↗
PubMed1991

Imaging modalities in recurrent head and neck tumors.

Patients with recurrent neoplasms of the head and neck present perplexing management problems, and accurate preoperative assessment of their disease is crucial. Thirty-eight patients with suspected recurrent neoplasms comprise this study: 30 had computed tomography scans, 4 had magnetic resonance images, and 4 patients underwent both computed tomography and magnetic resonance imaging to assess the anatomical extent of pathology in 34 malignant and 4 benign tumors. Contrast enhancement was essential for detecting disease on computed tomography scan. Differentiation of recurrent tumor was more difficult when the patient had undergone radiation. Magnetic resonance imaging demonstrated superior visibility in recurrent parotid and paranasal sinus neoplasm, but was less helpful in laryngeal and pharyngeal recurrences. Computed tomography demonstration of a mass with infiltration of normal fat or tissue planes or lymphadenopathy correlated highly with recurrent disease. Imaging techniques and fine points for determining recurrent neoplasms are presented.

Adult↗
PubMed1985

Gastric interposition following transhiatal esophagectomy: CT evaluation.

Transhiatal esophagectomy without thoracotomy (THE) but with gastric interposition results in less morbidity and mortality than standard transpleural esophagectomy with thoracotomy. Barium examination has been the primary radiographic study following THE for detecting postoperative complications. We reviewed computed tomography (CT) scans of 21 patients who had undergone THE and correlated CT appearance with clinical status and with findings of the barium studies. Local mediastinal recurrent neoplasm was detected by CT in seven patients; barium study within 2 weeks of the CT scan failed to detect tumor recurrence in three of these patients. A mediastinal abscess well delineated by CT was percutaneously drained under CT guidance. Water-soluble contrast medium/barium study is preferable for the evaluation of certain postoperative complications such as anastomotic leak. However, CT is the modality of choice for detecting locally recurrent neoplasm and distant metastases following THE and may also be helpful in patients with postoperative mediastinal abscess. Normal mediastinal CT anatomy after esophagectomy is reviewed in order to warn against pitfalls in scan interpretation.

Abscess↗
PubMedDate not supplied

Diffusion-weighted imaging distinguishes recurrent epidermoid neoplasm from postoperative arachnoid cyst in the lumbosacral spine.

Diffusion-weighted imaging can be used to distinguish epidermoid tumor from arachnoid cyst in the intracranial compartment. We report the use of diffusion-weighted imaging in a postoperative spine to successfully distinguish a recurrent epidermoid tumor from arachnoid cyst in a noninvasive manner. Our case illustrates the value of this readily available sequence presently not generally used in the clinical evaluation of spinal pathology.

Adult↗
PubMed1992

Repeat mediastinoscopy in the assessment of new and recurrent lung neoplasm.

From 1976 to 1990, 140 patients (mean age, 66 years; 91% male) underwent repeat mediastinoscopy as a routine staging procedure. The mean interval between first and second mediastinoscopy was 56 months. Owing to adhesions, 26 repeat mediastinoscopies (18%) were considered incomplete. There was no mortality, and 10 complications did not require interventional therapy. The results were positive in 20 patients, thus avoiding an unnecessary thoracotomy. In 7 patients with negative findings, positive lymph nodes were found at thoracotomy or by transcarinal puncture biopsy. The sensitivity of repeat mediastinoscopy in this series is 74%, and the accuracy 94%. We consider repeat mediastinoscopy a safe and reliable preoperative staging procedure in new or recurrent lung cancer.

Adenocarcinoma↗
PubMed1993

Self-expanding stainless steel stent application in rectosigmoid stricture.

In recent years, several reports on the experimental and clinical applications of the Gianturco stent (self-expanding stainless steel stent) have been published. However, to our knowledge, the use of stents in rectosigmoid strictures has not been reported. We used self-expanding stainless steel stents to dilate rectosigmoid strictures caused by nonresectable recurrent neoplasm. Insertion and dilation (sigmoid colon and rectum) in two patients were successful. Accordingly, these patients were able to maintain bowel activity and avoid palliative loop colostomy. We believe that this procedure is effective for nonresectable rectosigmoid stricture due to recurrent neoplasm.

Colon, Sigmoid↗
PubMed2002

New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy.

OBJECTIVE: The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy. METHODS: The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1-5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI. RESULTS: Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occurrence of adenomas at baseline screening colonoscopy was the only factor associated with an increased risk for the recurrence of adenomas at follow-up (OR = 2.51, 95% CI = 1.77-3.55). Recurrence was associated with multiple baseline adenomas (4.45, 2.98-6.64) and baseline adenomas larger than 1 cm (2.62, 1.99-3.11). Recurrence was not associated with histology type or family history of colorectal cancer. There was a significant trend for adenomas to recur in the same proximal or distal segment as the baseline adenomas (p = 0.02). CONCLUSIONS: Colon adenomas tend to recur with greater frequency if the adenomas removed at baseline were either large or multiple. Although patients with large adenomas or multiple adenomas at baseline screening colonoscopy are at a 2.6- to 4.5-fold risk for recurrence of adenomas, the rate of de novo adenoma formation in patients without baseline adenomas may be large enough to warrant repeat colonoscopy at some time in the future. The exact timing of the follow-up colonoscopy needs to be determined.

Adenoma↗
PubMed1984

Utility of CT in detecting postpneumonectomy carcinoma recurrence.

After pneumonectomy for bronchogenic carcinoma, detection of recurrent disease in the ipsilateral hemithorax or mediastinum is often difficult. The authors discuss the utility of CT in the evaluation of 18 postpneumonectomy patients who had developed new clinical symptoms. In six patients without documented tumor recurrence, CT demonstrated a normal postpneumonectomy appearance. In the other 12, CT confirmed the clinical impression of recurrent neoplasm (10 prospectively, two retrospectively), which appeared either as enlarged mediastinal lymph nodes or as a soft-tissue mass projecting into the normal near-water-density postpneumonectomy space. In only five of these patients were plain chest radiographs suggestive of recurrence (two prospectively, three retrospectively). The accurate assessment of the presence and extent of recurrent neoplasm by CT was important in planning radiotherapy in eight patients.

Aged↗
PubMed1998

Imaging of oncologic patients: benefit of combined CT and FDG PET in the diagnosis of malignancy.

OBJECTIVE: The purpose of this study was to assess the benefit of combined CT and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in diagnosing malignancy. MATERIALS AND METHODS: The records of 26 patients with intraabdominal and intrathoracic neoplasms who underwent CT and FDG PET between January 1995 and September 1996 were retrospectively reviewed. Most of these patients had inconclusive findings on prior CT for the diagnosis of malignancy. Only sites of potential malignant disease were included in the data analysis. Presence or absence of malignancy was confirmed by histopathology or follow-up CT. Three observers experienced in abdominal imaging used CT findings alone to estimate level of suspicion (1 = definitely not malignant to 5 = definitely malignant) for primary or recurrent neoplasms (n = 21), distant metastases (n = 25), and neoplastic nodal involvement (n = 18). Six weeks later the three observers reviewed the same CT examinations supplemented with FDG PET and reestimated suspicion of malignancy. Receiver operating characteristic methodology was used to analyze the results. Sensitivity, specificity, positive and negative predictive values, and accuracy in diagnosis of malignant disease were calculated using level 4 (probable malignancy) as the cutoff for the presence of disease. RESULTS: The mean area under the receiver operating characteristic curve, indicating successful diagnosis of malignancy, was .82 for CT alone and .92 for CT with FDG PET (p < .05). The accuracies for diagnosis of primary or recurrent neoplasms, distant metastases, and neoplastic nodal involvement were 62%, 68%, and 83%, respectively, for CT alone and 81% (p = .06), 88% (p = .03), and 89% (p > .25), respectively, for CT with FDG PET. Also, supplemental FDG PET imaging improved observer confidence and accuracy in diagnosing recurrent neoplasm in four (36%) of 11 patients who had undergone surgery or chemoradiation and in diagnosing four (29%) of 14 extrahepatic sites that had potential metastases. CONCLUSION: Diagnosis of malignancy in oncologic patients is significantly improved when CT is supplemented with FDG PET. Combined imaging is particularly helpful in the evaluation of potential recurrence in previously treated patients and for diagnosing extrahepatic lesions that may be distant metastases.

Abdominal Neoplasms↗
PubMed1992

Long-term follow-up of serous ovarian tumors of low malignant potential.

The biologic behavior of serous tumors of low malignant potential (LMP) is of significant interest, yet most large series lack extended follow-up. This study consists of 200 patients: 106 patients were diagnosed with serous tumors of LMP at our institution between 1979 and 1984 and an additional 94 patients were identified in the referred tumor registry. The patients ranged in age from 6 to 98 years (median, 34 years). The stage distribution was Stage I in 135 patients (67.5%), Stage II in 24 patients (12%), and Stage III in 41 patients (20.5%). Follow-up information from 4 to 27 years (median, 10 years; mean, 11.2 years) revealed 155 patients (77.5%) were alive without further evidence of disease and 11 patients (5.5%) died of unrelated conditions without recurrent tumor. Thirty-four patients (17%) developed recurrent neoplasms at 6 to 145 months (median, 26 months). Patients with Stage III disease developed recurrent neoplasms more commonly (54%) than did patients with Stage I or II disease (6 and 17%, respectively). Following treatment of recurrence, 15 patients are free of disease, 6 patients are alive with disease, and 13 (6.5% overall) patients have died of disease 1 to 15 years (median, 5 years) after their initial diagnosis. Mortality was also stage dependent: 0.7, 4.2, and 26.8% of patients with Stages I, II, and III disease, respectively, died secondary to tumors of LMP. Clinical life table analysis demonstrated 5-, 10-, and 15-, and 20-year survival rates for all stages of 97, 95, 92, and 89%, respectively. These findings confirm the excellent prognosis for patients with serous tumors of LMP, even when long-term follow-up is extended to 20 years. Additionally, these data suggest that those with more advanced or recurrent disease can enjoy extended survival.

Adolescent↗
PubMed1999

Preventive health care, 1999 update: 3. Follow-up after breast cancer. Canadian Task Force on Preventive Health Care.

OBJECTIVE: To make recommendations to physicians who provide follow-up care for women who have been treated for early-stage breast cancer. OPTIONS: Combination of blood tests, bone scans, liver echography and chest radiography for detection of distant disease; physical examination with or without mammography for detection of contralateral breast cancer; and physical examination with or without mammography for detection of ipsilateral recurrent disease after breast-conserving therapy. OUTCOMES: Survival, disease recurrence and quality-of-life measures for distant disease, local recurrence of disease and disease in the contralateral breast. EVIDENCE: A MEDLINE search for relevant articles published between January 1966 and January 1998 with the MeSH terms "breast neoplasms" and "neoplasm recurrence" (local and distant) with limits to "human" was done. A subsequent MEDLINE search using the MeSH terms "breast neoplasms," "neoplasm recurrence," "local/diagnosis" and "mammography" was done to address issues of mammography. The literature search was reviewed by a medical librarian and 2 breast cancer specialists to ensure completeness. BENEFITS, HARMS AND COSTS: Breast cancer is the most common cancer in Canadian women and is the second leading cause of death after lung cancer. Even with early-stage breast cancer, recurrence after treatment for primary breast cancer is frequent. Traditionally, follow-up has been felt to facilitate early detection and improve survival. Randomized controlled trials (RCTs) have shown that routine screening (blood tests and diagnostic imaging) for distant disease does not alter survival or quality of life over routine physical examination. In an underpowered secondary analysis of RCT data, the detection of contralateral breast cancer did not affect survival. However, there have been no RCTs examining the role of mammography and physical examination and their effect on survival in the detection of contralateral breast cancer. The sensitivity and specificity of mammography after local excision and radiotherapy is unknown. There have been no RCTs examining the role of mammography or physical examination, or both, and their effect on survival in the detection of ipsilateral breast recurrence. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. A high value was placed on interventions that changed survival. When evidence was available, high value was also placed on interventions that affected quality of life. RECOMMENDATIONS: There is good evidence not to include blood work and diagnostic imaging as part of screening for distant disease (grade E recommendation). There is no evidence to suggest that mammography decreases mortality by detecting ipsilateral disease in the conservatively treated breast; however, there is indirect evidence that it may be beneficial (grade C recommendation). There is no direct evidence to suggest that physical examination or mammography, or both, should be used to detect contralateral breast cancer; however, there is indirect evidence that it may be beneficial (grade C recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care.

Breast Neoplasms↗