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At least 19 recordsLinked to original sources

A study in general practice of the symptoms and delay patterns in the diagnosis of gastrointestinal cancer.

GASTROINTESTINAL CANCER WAS CLASSIFIED INTO FOUR GROUPS ACCORDING TO THE SITE: stomach, caecum and ascending and transverse colon, sigmoid colon and rectum. The incidence of these cancers in general practice is as rare as three per 10,000 consultations. I report on a study in general practice of the symptoms and delays in diagnosis in 150 patients with gastrointestinal cancer. There was an interval of many weeks between the onset of symptoms and diagnosis in the majority of cases. In approximately 50 per cent of cases there was an interval of weeks between the patient consulting the general practitioner and being referred for hospital investigation. No association was demonstrated between delay and social class, age, physical isolation, or the regular consulting rate of the patient. There was evidence that the consulting rate of some patients with gastrointestinal cancer increased in the 12 months before diagnosis because of the presence of symptoms not specific to the gastrointestinal tract.Much more knowledge of the early symptoms of these cancers is required if the general practitioner is to be able to identify those patients with a high probability of early cancer from others who have symptoms which are common both to non life-threatening conditions and to cancer lesions.

Family Practice

Dietary factors in the aetiology of gastrointestinal cancer.

Gastrointestinal cancers, mainly oesophageal, gastric, pancreatic and large bowel cancer, account for about 40,000 deaths annually in England and Wales which is 32% of all cancer deaths. Nutritional factors have been implicated in the cause of each cancer and probably act by promoting the effect of carcinogenic substances taken in the diet or produced in the gut. Gastric cancer for example may be due to nitrosamine production in the stomach. This is enhanced by readily available sources of dietary nitrite and nitrate whilst the reaction is inhibited by vitamin C and low temperatures (2 degrees C). By contrast large bowel cancer can be related to high fat and meat intakes whilst a protective role for dietary fibre has been suggested. Dietary factors in the aetiology of oesophageal cancer differ from one high incidence area to another.

Animals

Numbers of asbestos bodies in urban patients with lung cancer and gastrointestinal cancer and in matched controls.

We compared the numbers of asbestos bodies extracted from the lungs of 103 patients with lung cancer and 50 patients with gastrointestinal malignant neoplasms to the numbers of bodies extracted from lungs of control patients matched for age, sex, smoking habits, and, in some cases, occupation. All patients were urban dwellers over the age of 40 years, and none was a primary asbestos worker. No differences in the counts of asbestos bodies were observed between the tested and control populations. The numbers of asbestos bodies did correlate well with occupation; the highest counts were found in male manual laborers. We conclude that in the urban population studied herein, the numbers of asbestos bodies alone do not correlate with the presence of pulmonary or gastrointestinal carcinoma; however, uncoated asbestos fibers are also known to be present in the lung, and the possibility that such tumors may be related to the numbers of these fibers in lungs remains to be explored.

Adult

Clinical management of advanced gastrointestinal cancer.

Although advanced gastrointestinal cancer is the most commonplace problem encountered by the medical oncologist, this group of diseases has proved exceedingly resistant to past chemotherapy efforts. 5-Fluorouracil (5-FU), accepted by some as standard treatment, had provided only infrequent, incomplete, and fleeting antitumor effects, which are probably more than counterbalanced by its gastrointestinal, mucocutaneous, and hematologic antihost effects. There is no evidence that any manipulation of route or schedule of administration provides any improvement in the therapeutic ratio of 5-FU. There is no evidence that this drug contributes to patient survival when used at any stage of any type of gastrointestinal carcinoma. The search for alternative single drugs to 5-FU has been disappointing. The nitrosoureas and Mitomycin C produce occasional regressions, but they do not match the meager effectiveness of 5-FU; and they, in addition, present the difficult problem of cumulative bone marrow suppression. Recent trials with combination regimens have given some indication that the long stalemate in chemotherapy of gastrointestinal cancer may be breaking. Substantial improvements in frequency of tumor regression have been recorded for gastric carcinoma with combinations of 5-FU and BCNU, 5-FU and methyl CCNU, and 5-FU, Mitomycin C, and cytosine arabinoside; for colorectal carcinoma, with the combination of 5-FU, methyl CCNU, and vincristine; and for carcinoid tumors and islet cell carcinomas, with the combination of 5-FU and Streptozotocin. There are also suggestion that such combination chemotherapy with response rates in the 30 to 50% range may produce increased survival when compared to the untreated patient and patients treated with single-drug regimens. While the accomplishments of chemotherapy for the gastrointestinal cancer patient remain less than spectacular there is nevertheless realistic hope that a respectable contribution can now be made to multidisciplinary efforts applied at a stage of disease with minimal tumor burden.

Adenoma, Islet Cell

A study of pancreatic secretory and intracellular enzymes in pancreatic cancer tissue, other gastrointestinal cancers, normal pancreas and serum.

Serum and tumour tissue extracts from patients with pancreatic exocrine adenocarcinoma and a number of other gastrointestinal tumours were examined for digestive and intracellular enzymes or tumour associated variants by cellogel electrophoresis. Enzymes were identified within the gel by their specific catalytic activities. Normal serum and extracts of normal pancreas were also studied. All the pancreatic secretory enzymes were present in extracts of normal pancreas; their levels were markedly reduced in tumour extracts and no characteristic isozymes were found. Alkaline phosphatase, carbonic anhydrase and a number of carbohydrate metabolising enzymes were present in all extracts; tumour associated isozymes were not consistently identified. These findings suggest that most human pancreatic exocrine cancers do not produce pancreatic secretory enzymes or intracellular isozyme variants, and that the identification of these enzymes or their isozymes is unlikely to be of practical diagnostic value.

Adenocarcinoma

Effect of immunochemotherapy on lymphocyte response of patients with gastrointestinal cancer.

Patients with gastrointestinal cancer were treated with 5-fluorouracil (5-FU) in combination with a streptococcal preparation, OK-432, or without OK-432 before operation, and lymphocyte response to PHA was examined. Oral administration of 5-FU with or without intramuscular injection of OK-432 did not affect the response. However, treatment with cytostatic drugs in combination with OK-432 markedly augmented the lymphocyte response to PHA, but the cytotoxic activity of lymphocytes was not elevated.

Biological Products

Nucleoli of lymphocytes in the peripheral blood of patients with bronchogenic lung and gastrointestinal cancer.

Patients suffering from bronchogenic and gastrointestinal cancer without, as well as with metastases, were investigated to provide more information on the number of morphology of lymphocytes in their peripheral blood particularly in respect to the frequency of various nucleolar types in these cells. The decreased number of lymphocytes in the peripheral blood of the cancer patients was due to the decline of lymphocytes with ringshaped nucleoli representing resting cells which can be stimulated in respect to the RNA synthesis and blastic transformation. The decreased number of such cells was apparently more pronounced in the peripheral blood of the patients suffering from gastrointestinal cancer with metastases. The increased frequency of lymphocytes with compact nucleoli or nucleoli with nucleolonemas representing immature or stimulated cells was noted in most patients suffering from bronchogenic cancer without, and with metastases in lymph nodes, as well as in some patients with gastrointestinal cancer and, without metastases. On the contrary, the decreased number of these cells was observed in the peripheral blood of patients suffering from gastrointestinal cancer with metastases. All these changes provide further information on the changes of the lymphocytes in the peripheral blood of the patients suffering from malignant disease. The possible interpretation of these changes presented in the discussion is in accordance with the present conception on the relationship between the malignant growth and lymphocytes.

Cell Nucleolus

Integrated landscape of salivary metagenome and multi-biofluid metabolome characterizes a microbial-metabolic axis in upper gastrointestinal cancer progression.

BACKGROUND: Upper gastrointestinal cancer (UGIC) imposes a major global health burden, yet the stage-specific molecular changes along the microbial-metabolic axis remain limited understood. We aimed to delineate this molecular landscape across UGIC progression and evaluate its potential as non-invasive methods for precision screening. RESULTS: Derived from a multi-center population-based UGIC screening program, we enrolled 420 individuals, stratified into normal, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and UGIC (n = 105 per group). Integrated salivary metagenomics and paired salivary/plasma metabolomics were performed to capture local and systemic dysregulation. We uncovered distinct stage-specific divergence during UGIC progression: profound remodeling of the salivary microbiota (104 differential species) and salivary metabolomics (80 differential metabolites) initiated early at the LGIN stage, whereas plasma metabolic dysregulation (40 differential metabolites) peaked significantly later at the HGIN stage. Integrative analysis revealed salivary microbiota related more closely with salivary metabolome than plasma metabolome. Moreover, statistical evidence suggested that dysbiotic salivary microbiota was associated with altered lysine- and tryptophan-related catabolic pathways converging on Acetyl-CoA-related metabolic nodes, supporting a potential metabolic mechanism in precancerous lesions. Finally, the discriminative model integrating metagenomic and metabolomic markers demonstrated promising diagnostic performance in distinguishing these precancerous lesions (LGIN: area under the curve [AUC] = 0.83; HGIN: AUC = 0.77) and UGIC (AUC = 0.76) from normal. CONCLUSION: This study characterizes a stage-specific microbial-metabolic axis that facilitates the comprehensive understanding of UGIC pathogenesis. These multi-biofluid signatures offer a promising non-invasive triage strategy for detecting precancerous lesions and optimizing endoscopic resource allocation. Video Abstract.

Female

[Chemotherapy of gastrointestinal cancer (author's transl)].

Gastrointestinal cancer has proved exceedingly resistant to chemotherapy efforts. 5-Fluorouracil (5-FU) accepted as standard treatment, has provided only infrequent and incomplete antitumor effects. Other drugs as the nitrosoureas BCNU and CCNU or Mitomycin C do not match the effectiveness of 5-FU. Improvement in frequency of tumor regression have been recorded for gastric carcinoma with combinations of 5-FU and BCNU and 5-FU, adriamycin and Mitomycin C and for colorectal carcinoma with combination of 5-FU, methyl-CCNU and vincristine. There are also suggestions that such combination chemotherapy may produce increased survival when compared to untreated patients. The combination of 5-FU and streptozotocin in carcinoid tumors or adriamycin in primary hepatoma may be of some effectiveness.

Carcinoid Tumor

Correlation between postoperative prognosis in gastrointestinal cancer patients and blastformation rate of lymphocytes.

Gastrointestinal cancer patients were followed up for up to 30 months postoperatively and their clinical status related to a parameter of nonspecific immunity, the blastformation rate of peripheral blood lymphocytes against phytohemagglutinin. By the fourth postoperative week, the blastformation rate had recovered from the effect of the operation. In patients who had undergone curative resection, the postoperative level rose to exceed the preoperative level, whereas whereas in those in whom resection had not been possible, the blastformation rate failed to show this rise by the fourth week, and continued at the decreased immediate postoperative level. Results for long-term follow-up (30 months postoperatively) showed that the blastformation rate continued at high levels (almost all over 40%) in cases of curative resection without recurrence, but remained low (under 40%) in those in which the tumor could not be removed. The 40% level of the blastformation rate test thus correlated well with the prognosis. The blastformation rate, therefore, proved a very good parameter for following the pre-and post-operative clinical course of gastrointestinal cancer patients.

Gastrointestinal Neoplasms

Combination chemotherapy with 5-fluorouracil and methyl-CCNU for the treatment of advanced gastrointestinal cancer.

Sixteen patients with advanced gastrointestinal cancer (colorectal 12/16, gastric 4/16) were treated with a combination of 5-fluorouracil (5-FU) plus 1-(2-chlorethyl)-3(4-methyl-cycloexyl)-1-nitrosourea (Me-CCNU). The therapeutic program consisted of orally administered Me-CCNU (140 mg/m2) and intravenous 5-FU (9.5 mg/kg by bolus injection for 5 days). The cycles were repeated at 6-week intervals. At the beginning of the therapy, 11/16 patients were in performance status (PS) 0-1 and 5 patients in PS 2-3. Eight patients developed early progressive disease between the 1st and 2nd course of therapy. Only a minor tumor response was observed in the remaining 50% of the patients. However, the patients with stabilized disease lived longer (11.8 months) than non-responders (3.5 months).

Adult

Presidential address: Gastrointestinal cancer. Surgical survey of abdominal tragedy.

The experience with gastrointestinal cancer at a single large hospital has been utilized as a "micro-model" of the experience for the country at large, and the reasons why such a comparison might be possible have been presented. The incidence of various lesions has been discussed in terms of sex, age, and race. The changing incidence of various lesions has been pointed out. Survival results have been determined for total series, for various types of operative procedures, and for various extents of disease. The comparability of survival results from this one institution and those collected from the literature have been discussed. The emergence of newer diagnostic and therapeutic measures has been highlighted. The importance of education of both patients and physicians is emphasized repeatedly by the late stage at which so many of the patients with any gastrointestinal cancer present to and are diagnosed by the physician. The educational task for all of medicine is apparent and must be faced in some effective fashion.

Adenocarcinoma

Gastrointestinal cancer studies in the human to nude mouse heterotransplant system.

Human gastrointestinal cancer xenografts were established in the nude mouse. Grafts were accomplished with gastric adenocarcinomas, gastric leiomyosarcoma, histiocytic lymphoma of the stomach and gallbladder, pancreatic tumors, colonic cancers and cell lines of duodenal (HUTU-80) and pancreatic (HS-766-T) cancers, melanoma (SK-Mel-5), and murine metastasizing Lewis lung carcinoma. The rate of successful xenografting of these tumors varied from virtually 100% with colon and duodenal cancer, 50% for a pancreatic cancer (P-1), to only 17% for gastric adenocarcinoma. Pancreas and colon adenocarcinomas have been maintained by successive xenotransplantation over 16 and 19 months, respectively. Human xenografts retained morphological identity with tissues of origin through several transplant generations and shared some of their ultrastructural characteristics but did not metastasize. Rodent xenografts, of heterogenous origin were characterized by differences in the duration of the latent period and in the rate of their initial development as described by the average doubling times and average slopes (B) of their growth curves. Differences between B of the Lewis lung carcinoma and all of the human xenografts and between B of a pancreatic adenocarcinoma and three other neoplasms were significant (P less than 0.05 to 0.04). Labeling indices determined for 14 cancer transplants were in the range of previously reported data for similar neoplasms in patients or other xenograft systems. These findings suggest that the nude mouse model can be used to evaluate endogenous properties of gastrointestinal cancers and their responses to exogenous agents.

Adenocarcinoma

Reactivating effect of levamisole on cell-mediated immunity in gastrointestinal cancer patients.

Cell-mediated immunity was studied in 23 cases of advanced gastrointestinal cancer. The patients received levamisole at 150 mg/day for three consecutive days each week for four weeks. In cases at the terminal stage of gastrointestinal cancer, the blastformation rate of peripheral blood lymphocytes against phytohemagglutinin (PHA) after the administration of levamisole showed a slight increase, but cases with blastformation rates over 40% increased markedly three or four weeks after the initial administration of levamisole. The peripheral blood lymphocyte count showed little change in these cases.

Gastrointestinal Neoplasms

Nitrosoureas: useful agents for the treatment of advanced gastrointestinal cancer.

Patients with a wide range of gastrointestinal cancers have been treated with nitrosoureas by the Eastern Cooperative Oncology Group. Methyl-CCNU, CCNU, and streptozotocin have been evaluated as single agents in the treatment of colorectal carcinoma. Methyl-CCNU has had an extensive trial in gastric carcinoma as a single agent and in combination with 5-fluorouracil (5-FU). It has also been used to treat pancreatic carcinoma and, in a few patients, carcinoma of the biliary tract. In gastric cancer it would appear that a synergistic effect on response rates has resulted from the combination of methyl-CCNU and 5-FU. The addition of cyclophosphamide to this combination as an induction agent detracted significantly.

Clinical Trials as Topic

Significance of tumour mass on T-lymphocyte levels in patients with gastrointestinal cancer.

The relationship between tumour load and immunity in gastrointestinal cancer has been studied by sequential comparison in patients whose tumour has been removed and those whose tumour was found to be inoperable. Total lymphocyte count, absolute and percentage T- and B-lymphocyte counts, effect of papain on E-rosetting cell levels, and inhibitory effect of cancer sera on E-rosette formation by normal lymphocytes have been studied in 30 patients with stomach or colorectal cancer, and 10 control patients with benign gastrointestinal disease. The examination was done on each patient before and at regular intervals after operation up to 24 weeks. Operable cases, with removal of tumour load, showed a temporary fall in total lymphocyte count and T cell counts, which returned to normal by four weeks postoperatively. Inoperable cases (15 patients) showed a progressive fall in total lymphocyte count and a relatively greater depression of T cell counts, in parallel with increasing tumour mass. E-receptor blocking factor was demonstrated in the sera of cancer patients. This factor was related to tumour mass and presumably was of tumour origin, as it persisted in the inoperable group but disappeared by 12 weeks after tumour removal. The factor explained the excess depresion of T cells over total lymphocytes, but does not explain the continuing depression of total lymphocyte count in the cancer patients.

Aged

Phase III comparison of the treatment of advanced gastrointestinal cancer with bolus weekly 5-FU vs. methyl-CCNU plus bolus weekly 5-FU. A Southwest Oncology Group study.

In a randomized and stratified study, 294 patients with advanced gastrointestinal cancer were treated either with 5-fluorouracil (5-FU) 400 mg/m2 weekly intravenously (i.v.) or 5-FU 400 mg/m2 i.v. weekly plus methyl-CCNU 175 mg/m2 orally (p.o.) every 6 weeks. The response rate in colorectal cancer with 5-FU was 9.5% while the two-drug treatment produced a response of 31.8% (p=.009). The response in all gastrointestinal cancers to 5-FU was 10.6% as compared with29.3% for the combination (p=.012). All responses were partial. The two-drug regimen is more effective and more toxic than weekly 5-FU therapy.

Adolescent