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PubMed1998

Intraoperative and laparoscopic ultrasound.

Intraoperative ultrasound, whether during celiotomy or laparoscopy, plays an important role in assisting the surgeon in directing appropriate therapy for intra-abdominal diseases, particularly primary or metastatic malignancies involving the liver and primary malignancies of the pancreas and upper gastrointestinal tract. It is the most sensitive imaging technique for detecting small intraparenchymal lesions of the liver, pancreas, and other solid organs. Owing to its increased sensitivity over all commonly used preoperative imaging studies, it is responsible for changing the intraoperative treatment plan of these tumors in a significant percentage of cases. This is particularly true with respect to resectability. In the era of laparoscopic surgery, it replaces the surgeon's inability to palpate the liver and other organs during surgery. As surgeons use a laparoscopic approach with increasing frequency to treat intra-abdominal disease, they will have an increasing need to master the use of intraoperative ultrasound in order to render optimal care to their patients.

Biliary Tract Neoplasms↗
PubMed2001

Patients with urologic cancer and other nonurologic malignancies: analysis of a sample and review of the literature.

OBJECTIVES: To describe our experience with patients with urologic cancers who also have malignancies of nonurologic origin, before, after, or simultaneously, to review the literature, and to suggest treatment options. METHODS: We reviewed our institutions' tumor registry from 1995 to 2000 to discover how many patients had a urologic malignancy and another nonurologic cancer (antecedent, subsequent, or synchronous). We reviewed Medline from 1966 to 2000 and also questioned several urologists at major centers in the United States concerning this clinical dilemma. RESULTS: We encountered 18 patients during a 6-year period with a urologic cancer and another primary malignancy. Thirteen patients had their second cancer detected during the workup of their primary urologic tumor. Two patients developed a second tumor within 1 year of treatment of the primary urologic tumor. Another patient was referred with two primaries already diagnosed, and another had renal carcinoma detected during her colon cancer workup. We found that multiple tumors, although very rare, are usually detected during the preoperative workup of the primary tumor, usually by physical examination and improved radiologic imaging, or during the follow-up examinations. Most reports suggest that treatment should be performed simultaneously, especially if the lesions are relatively small and require a single incision, and the patient's medical condition allows longer anesthesia exposure. If these prerequisites are not met, most investigators agree that treatment should be directed at the more aggressive lesion first, which may improve the condition and/or survival, and thus, if a second operation is warranted, it will be possible. CONCLUSIONS: Although patients with multiple malignancies are rare, the urologist and/or other specialist should be alerted to this possibility when evaluating patients for the initially presenting symptoms and/or detected tumor, as well as during the follow-up evaluations.

Aged↗
PubMed1985

Tumors of the alimentary tract.

Neoplasms of the canine and feline alimentary tract represent diagnostic and therapeutic challenges for the veterinarian in practice. Careful attention to historical details and thorough and repeated examination are of paramount importance in evaluating animals with chronic digestive disturbances. By judicious use of ancillary studies such as plain and contrast radiography, endoscopy, and exploratory surgery, the clinician may arrive at a diagnosis earlier in the course of a neoplasm. This in turn may facilitate more efficacious treatment. A particularly interesting aspect of tumors of the gastrointestinal tract is their frequent association with environmental carcinogens. By being aware of these relationships, veterinarians stand a better chance of reaching the ultimate goal of cancer therapists--the prevention of malignant disease.

Animals↗
PubMed2005

[Mixed endocrine tumors].

Mixed endocrine tumors are tumors composed of at least two distinct tumor populations, one of which is endocrine. Because of their rarity and unusual presentation, endocrine mixed tumors raise many problems of diagnosis, management and therapy. Three main types of endocrine mixed tumors are recognized: The existence of these various types has been confirmed by recent molecular studies, even if the same studies have also shown that the histogenesis of a mixed endocrine tumor cannot be predicted from its histological features. Composite tumors are the less rare mixed tumors. The recent WHO classification recommends to restrict the term of composite endocrine tumor to the epithelial tumors containing at least 30% of obviously tumoral endocrine cells; some authors recommend to use higher thresholds, of at least 50%, in order to avoid overdiagnosis. The endocrine component is usually well differentiated, easily identified by its suggestive histological features; the endocrine nature of tumor cells is confirmed by the immunodetection of specific endocrine and neuro-endocrine markers (such as chromogranin A and synaptophysin). In some cases, the endocrine component is poorly differentiated: the demonstration of neuro-endocrine markers is necessary to confirm the diagnosis. Mixed tumors can occur in every anatomical site; they are more frequent in organs containing endocrine cells in the normal state (especially the digestive tract and the pancreas), but they can also be observed in organs devoid of endocrine cells (such as the mammary gland). The management of mixed endocrine tumors must take into account the more aggressive component. Mixed tumors containing a well differentiated endocrine component and an adenocarcinomatous component are to be treated like adenocarcinomas. Mixed tumors containing a poorly differentiated endocrine component must be considered as poorly differentiated endocrine carcinomas.

Colonic Neoplasms↗
PubMed2005

[Five-year survival of Ile-de-France cancer patients diagnosed in 1994].

BACKGROUND: This study aimed to estimate survival at 5 years by localization, sex and stage of the patients who presented a new cancer in 1994 in the Ile-de-France area. METHODS: A cohort study began in 1994 by an exhaustive collection of the incidental cancers notified in the Ile-de-France area at the health insurance (27,080 patients). A stratified random sample based on tumor localization was followed at 1 year, 3 years and 5 years. The analysis of the observed survival was carried out according to Kaplan-Meier method. Relative survival was calculated according to Ederer II method. RESULTS: The follow-up sample concerned 4,166 patients. For all cancers, relative survival at 5 years was 65% for the women and 51% for the men. Relative survival rate at 5 years was 82% for the women with a breast cancer (98% for the patients in stage I) and 66% for those with a cancer of the cervix. Relative survival at 5 years for colonic cancer was 67% for men and 54% for women. For lung cancer, the relative survival rate fell from 47% for patients in stage I to 5% for those in stage IV. CONCLUSION: Our study produces population-based survival data for a entire geographical area covering 20% of the French population. Survival improves with earlier diagnosis but depends also on quality of care and availability of care: access to medical care can be a favouring factor. While in terms of incidence the situation in the Ile-de-France area is close to the national situation, survival at 5 years for a set of tumors appears to be better in this area than the nationwide figures. Besides providing information useful to determine mortality and incidence, the health insurance data offer additional insight to cancer epidemiology and contribute to better knowledge of this disease.

Breast Neoplasms↗
PubMed1996

Malignant ascites: a 2-year review from a teaching hospital.

In this retrospective review of 164 consecutive patients with malignant ascites it has been shown that ovarian ascites accounts for 28% of the total and is associated with a significantly improved survival compared with other groups (P<0.001). Non-ovarian ascites is associated with a very poor prognosis and many patients in this group are unsuitable for aggressive treatment. In 49% of patients, ascites will be the presenting feature requiring further investigation to ascertain the primary tumour. Thorough investigation of female patients should be performed in order to identify all patients with an ovarian primary so that appropriate chemotherapy can be given. However, thorough investigation in male patients is not justifiable.

Adult↗
PubMed1999

Raltitrexed (Tomudex) in combination with platinum-based agents and/or anthracyclines: preliminary results of phase I clinical trials.

Three ongoing, dose-escalation, phase I studies are evaluating the combination of raltitrexed with oxaliplatin or anthracyclines (with and without cisplatin). In study 1, patients with advanced solid tumours received 2.0-3.75 mg/m2 raltitrexed, followed 45 min later by 85-130 mg/m2 oxaliplatin (2-h infusion) every 3 weeks. In study 2, patients with advanced oesophageal or gastric adenocarcinoma received 2.0-3.0 mg/m2 raltitrexed with 50 mg/m2 intravenous (i.v.) epirubicin and 60 mg/m2 i.v. cisplatin every 3 weeks. In study 3, patients with advanced or metastatic gastric cancer received 2.5-3.5 mg/m2 raltitrexed followed by 30-60 mg/m2 i.v. doxorubicin every 3 weeks. In all studies, raltitrexed was given as a 15-min infusion. All the combinations evaluated were administered in convenient 3-weekly schedules and were generally well tolerated. Recommended doses for raltitrexed and oxaliplatin are the same in combination as for single-agent use, i.e. 3.0 mg/m2 raltitrexed and 130 mg/m2 oxaliplatin. The recommended dose of raltitrexed in combination with cisplatin and epirubicin is 2.5 mg/m2. No dose-limiting toxicities were observed during co-administration of the full single-agent doses of raltitrexed and doxorubicin (3.0 mg/m2 and 60 mg/m2, respectively); dose escalation is continuing. Preliminary efficacy results were encouraging, particularly for the combination of raltitrexed and oxaliplatin in patients with mesothelioma and advanced colorectal cancer. Preliminary data from these phase I studies suggest that the combination of raltitrexed with platinum-based agents and/or anthracyclines may represent useful regimens for the treatment of patients with advanced cancer. Further studies are required to identify the most effective combinations of raltitrexed with both established and new anticancer agents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction.

PURPOSE: The aim of this study was to analyze the patency of percutaneously inserted metallic stents in malignant biliary obstruction and to evaluate all the complications associated with the stents and the reinterventions needed. MATERIALS AND METHODS: Thirty-nine patients with 42 malignant strictures were treated percutaneously with 55 metallic self-expandable stents. Forty-eight were Wallstents and seven were Memotherm stents. Twenty-five strictures were hilar, 16 were in the common bile duct, and one was in the hepaticojejunal anastomosis. The patients were followed until death and the mean follow-up was 6.4 months. RESULTS: Stent insertion was successful in 97% of the patients. Thirty percent had early complications (<30 days), and as many as 66% had late complications, including stent occlusions, which were seen in 10 patients. The patency rates of patients with cholangio-carcinoma were significantly lower than those of the patients with other diagnoses. There was also a tendency toward obstruction with less dilation of the stents, Y, T or tandem-style stent placement, an increasing number of stents, longer strictures, and hilar strictures. Thirty-one percent of the patients alive after the first 30 days had late reinterventions. CONCLUSIONS: Although metallic stents offer an alternative in the palliation of malignant bile duct obstruction, there seem to be numerous early and late complications.

Aged↗
PubMedDate not supplied

Mortality trends of malignant tumours of digestive organs in Belgrade, Yugoslavia, 1975-1997.

AIM: To analyse mortality trends of malignant digestive tract tumours. MATERIAL AND METHODS: Population of Belgrade (Yugoslavia) in the period 1975-1997. Mortality rates were standardized by direct method using world population as the standard. For time series, exponential trends were calculated by the use of three-year moving average rates. RESULTS: In males, the highest mortality rate was for stomach cancer: 14. 6 per 100,000 (average for the period 1975-1997), followed by cancer of liver and cancer of colon: 8.4/100,000, cancer of rectum: 8.1/100,000, cancer of pancreas: 7.3/100,000, oesophageal cancer: 2.8/100,000 and gallbladder cancer: 2.0/100,000. In males, upward mortality trends for carcinomas of colon, rectum, pancreas, oesophagus, gallbladder and bile ducts were observed. The mortality rates series for stomach cancer and liver cancer did not fit any usual trend function. In females, the highest mortality rate was also for stomach cancer 7.7 per 100,000, then for cancer of colon: 6.0/100,000, cancer of rectum: 5.3/100,000, cancer of liver: 4.4/100,000, cancer of pancreas: 4.4/100,000, gallbladder cancer 3.4/100,000 and oesophageal cancer: 0.8/100,000. In females, upward mortality trends were observed for colon and rectal cancer, cancer of pancreas, and gallbladder and bile duct cancer. Downward mortality trends were present for stomach cancer and liver cancer. Mortality rates series for oesophageal cancer did not fit any usual trend function. CONCLUSIONS: In the majority of digestive tracts cancers, an upward mortality trend was observed which is in keeping with the mortality trends of these malignant tumours in many other countries.

Colonic Neoplasms↗
PubMed2002

Symptom-to-diagnosis interval and survival in cancers of the digestive tract.

The objective was to identify the main correlates of the symptom-to-diagnosis interval (SDI) and to analyze their influence upon the survival in patients with cancers of the digestive tract. Two hundred forty-eight symptomatic patients with cancer of the esophagus (N = 31), stomach (N = 70), colon (N = 84), and rectum (N = 66) were interviewed and prospectively followed (median follow-up of 77 months). Cox's regression was used to assess the relative risk (RR) of death according to SDI. The median SDI was about 4 months, with nonsignificant differences by sex, age, social class, family history of cancer, or tumor site. The RR of death varied significantly by age (P = 0.012), tumor site (P < 0.01), tumor stage (P < 0.01), and type of hospital admission (P < 0.01). After adjustment for known and potential predictors of survival and as compared to an SDI < 2.5 months, the RR of death was 0.89 (95% CI: 0.61-1.32) for an SDI of 2.5-6 months, 0.78 (95% CI: 0.49-1.26) for SDI > 6-12 months, and 0.81 (95% CI: 0.44-1.49) for SDI > 12 months. These results do not imply that specific actions to hasten diagnosis must of necessity be ineffective, but underscore what a challenging task the secondary prevention of cancer remains.

Aged↗