Prostate cancer detection and patient involvement in treatment.
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Humans↗
Biomedical subjects
R E Robins
Publications and source records attributed to R E Robins.
Efficacy of 131I ablation following thyroidectomy in patients with invasive follicular thyroid cancer.
The role of thyroid ablation following thyroidectomy for invasive follicular cancer remains controversial. The use of iodine 131 (131I) ablation as adjuvant therapy may facilitate follow-up of patients in whom serum thyroglobulin levels and 131I total body scans are used to detect metastatic disease. It is uncertain if 131I ablation improves survival of patients with follicular thyroid cancer. Thus, the purpose of this study was to determine if survival is enhanced following ablation, with particular reference to those patients with minimally invasive cancer. Between the years 1955 to 1988, 142 patients with invasive thyroid follicular cancer were treated at the British Columbia Cancer Agency, of whom 71 had minimal invasion and no extrathyroidal extension of tumor. In this group of patients, 46 underwent hormone suppression only, 17 had ablation, and 8 had neither. The average follow-up was 9 years and extended beyond 15 years in many patients. Data were entered in a mainframe computer, and Kaplan-Meier survival analysis was used, comparing crude survival, disease-specific survival, and disease-free survival. There was no significant difference between groups. In patients with follicular thyroid cancer and capsular invasion only, 131I ablation does not improve survival compared with patients treated with thyroid hormone suppression only.
Adenocarcinoma↗
Elective and therapeutic regional lymph node dissection for cutaneous malignant melanoma: experience of the British Columbia Cancer Agency, 1972 to 1981.
The authors present a 10-year review of patients registered at the British Columbia Cancer Agency (BCCA) who underwent lymph node dissection for malignant melanoma. Pathological findings in the regional lymph nodes were correlated with primary site, growth pattern, depth of invasion and Clark's level. Elective lymph node dissection (ELND) was performed in 223 patients, and the overall positivity rate (pathologically involved nodes) was 16%. Survival rates for patients who had ELND were compared with those for BCCA patients not having had ELND and patients from the University of Sydney, Sydney, Australia. Although patients who underwent ELND had thicker and more frequently ulcerated primary tumours than patients with stage I disease who did not undergo ELND, survival was better in the group who had ELND. However, when all potential prognostic factors were analysed by multivariate analysis, ELND was not a significant factor in prognosis. Therapeutic lymph node dissection (TLND) was performed in 50 patients at the time the primary tumour was diagnosed, and involvement of the lymph nodes was found in 36. Of 525 patients with clinical stage I disease who did not have ELND, disease recurred in the regional lymph nodes in 119; 86 of them had TLND for recurrence (RTLND). Median survival rates from the time of diagnosis of the primary lesion for ELND-positive, TLND-positive and RTLND patients were 4.2, 2.7 and 4.4 years respectively; the differences were not significant. New treatments are required for patients with involved regional lymph nodes.
British Columbia↗
A current analysis of primary lymphoma of the thyroid.
Over a 9-year period ending in May 1990, 27 patients with histologically proved thyroid lymphoma were assessed and treated. There were 24 female and three male patients with a median age of 67 years at the time of diagnosis (age range, 39 to 85 years). The usual presentation was that of a rapidly enlarging neck mass. Incisional biopsy was the diagnostic procedure of choice; however, nine of 27 patients underwent diagnostic partial or total thyroidectomy based on a preoperative impression of thyroid carcinoma. All 27 patients had non-Hodgkin's lymphomas of intermediate (77%) or high (23%) grade. Detailed staging was carried out in 25 patients; seven patients (28%) had disease confined to the thyroid gland (stage I), while 18 (73%) had accompanying disease in cervical lymph nodes or the mediastinum (stage II). Combined multiagent chemotherapy and irradiation was given to 19 of 25 staged patients (76%). Actuarial, overall 5-year survival for all patients was 70% with 48 months being the median follow-up for living patients (follow-up range, 3 to 102 months). Of a number of factors evaluated using log-rank survival tests, only the absence of dysphagia at the time of hospital admission, a primary tumor mass not greater than 10 cm, restriction of disease to the thyroid gland, and the absence of mediastinal lymph node involvement were statistically significant predictors of improved survival. Surgery should usually be restricted to diagnostic biopsy, as there is infrequently a role for resection in the management of thyroid lymphoma, given the effectiveness of combined multiagent chemotherapy and radiotherapy.
Actuarial Analysis↗
Clinical parameters predictive of malignancy of thyroid follicular neoplasms.
Needle aspiration biopsy is commonly employed in the evaluation of thyroid nodules. Unfortunately, the cytologic finding of a "follicular neoplasm" does not distinguish between a thyroid adenoma and a follicular cancer. The purpose of this study was to identify clinical parameters that characterize patients with an increased risk of having a thyroid follicular cancer who preoperatively have a "follicular neoplasm" identified by needle aspiration biopsy. A total of 395 patients initially treated at Vancouver General Hospital and the British Columbia Cancer Agency between the years of 1965 and 1985 were identified and their data were entered into a computer database. Patients with thyroid adenomas were compared to patients with follicular cancer using the chi-square test and Student's t-test. Statistically significant parameters that distinguished patients at risk of having a thyroid cancer (p less than 0.05) included age greater than 50 years, nodule size greater than 3 cm, and a history of neck irradiation. Sex, family history of goiter or neoplasm, alcohol and tobacco use, and use of exogenous estrogen were not significant parameters. Patients can be identified preoperatively to be at an increased risk of having a follicular cancer and accordingly appropriate surgical resection can be planned.
Adenocarcinoma↗
Surgical versus percutaneous drainage of intra-abdominal abscesses.
The records of 83 patients with intra-abdominal abscesses treated between 1986 and 1990 were reviewed to determine if there were significant differences in the outcome of patients treated by surgical drainage (n = 41) or percutaneous drainage (n = 42). The two groups were matched for age, abscess location, and etiology. Parametric statistical evaluations included the Student's t test as well as analysis of variance; nonparametric statistics used were chi-square and Wilcoxon rank sums. No significant difference was found in mortality (surgical 14% versus percutaneous 12%) or morbidity (surgical 26% versus percutaneous 29%). The duration of hospital stay was similar. Although there was no significant difference between the two groups in severity of illness as measured by APACHE II scores, these scores were significant in determining prognosis. APACHE II scores were significantly higher in non-survivors of both groups (23 versus 13) and also higher in those developing complications. A subgroup of patients with diverticular abscess was identified in whom percutaneous drainage enabled later resection with primary anastomosis without complication. This study indicates that percutaneous drainage of an intra-abdominal abscess is as efficacious as surgical drainage and that APACHE II scores are prognostic of both potential mortality and morbidity.
Abdomen↗
Recollections, responsibilities, and rewards of a senior surgeon.
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Canada↗
Carcinoma of the breast in women 80 years of age and older: still a lethal disease.
Cancer of the breast is a frequent and potentially lethal problem in women 80 years of age and older. In our experience, many present with advanced disease which indicates the continuing need for patient and doctor education concerning the significance of a breast lump in the elderly. Although many of these patients have other diseases, only a small number, if thoughtfully managed, will not be fit for appropriate standard methods of treatment. In the majority of patients who died, death was due to the breast cancer and many who did die from other causes had the added misery of persisting or metastatic breast cancer. In those patients with potentially curable cancer, we recommend either wide local excision, axillary node dissection and irradiation, or modified radical mastectomy. When simple mastectomy alone is used, there is a very high local recurrence rate. Although the patients studied were treated before the era of tamoxifen therapy, it is noteworthy that hormone manipulation would be of value in many of these patients and in selected cases, chemotherapy should also be considered.
Age Factors↗
Pelvic recurrence after anterior resection and EEA stapling anastomosis for potentially curable carcinoma of the rectum.
Rectal carcinoma can be treated by anterior resection with EEA anastomosis in order to preserve rectal continuity in those patients in whom anastomosis may be technically difficult. In our initial local experience however, the pelvic recurrence rate has been approximately three times as high as would be expected. The surgical results were good in those patients with Dukes' B lesions. The majority of failures occurred in those with Dukes' C lesions. When the preoperative assessment indicates the strong likelihood of a Dukes' C lesion, consideration of abdominoperineal resection must be given if cure is anticipated. Most surgeons will obtain a more complete pararectal tissue clearance with this procedure than with anterior resection. Those who wish to preserve rectal continuity with curative procedures for rectal carcinoma must become proficient at pararectal tissue clearance if a low rate of pelvic recurrence is to be achieved. The EEA stapler can enable safe anastomosis when these other factors have been accomplished. When cure is anticipated, it can only be provided for the majority of patients at initial surgical resection. The EEA stapler has a unique value in patients who have resectable rectal carcinoma, and yet have distal metastasis by the time initial surgery is performed. The preservation of rectal continuity in such patients is an excellent method of palliation.
Female↗
Squamous cell carcinoma of the tongue and lower oral cavity in patients under 40 years of age.
Squamous cell carcinoma of the tongue and lower oral cavity is uncommon in patients under the age of 40 years. The site distribution and male to female ratio of patients differed markedly from those of the overall squamous cell carcinoma group. The tongue was by far the most common site, and the majority of patients were women. There were no apparent etiologic or biologic factors noted. Lymph node metastases occurred in 38 percent of our patients and were present in six of seven tumor-related deaths. Those patients who died usually had a poor response to initial treatment, and most were dead within less than 2 years after diagnosis. The overall cure rate in our study patients was much better than that for the overall group of patients, and this was especially so in patients with tongue cancer (80 percent absolute cure rate). Aggressive treatment and careful follow-up for recurrence or metastases are necessary.
Adolescent↗
Role of ultrasonography, gallium scanning, and computed tomography in the diagnosis of intraabdominal abscess.
Ultrasonography is reasonable in cost and allows confirmatory needle aspiration. It is especially valuable when the clinical impression suggests a particular area where the abscess is probably located. Gallium scanning is useful to detect the abscess when examination suggests a septic process without clinical localization. Several false-positive findings were seen in postsplenectomy patients. Computed tomography should be reserved for patients in whom localization is by other means difficult. By correlating the results of these techniques with clinical findings, only one unnecessary operation resulted from false-positive studies, and no surgery was delayed due to improper reliance on negative findings.
Abdomen↗
Mucosal malignant melanomas.
Forty-seven cases of mucosal malignant melanomas and the recent literature are reviewed. Twenty patients had head and neck mucosal malignant melanomas; 14 had vulvar and 7 vaginal melanomas. Included are also isolated cases of urethral, anal and esophageal melanoma. Mucosal malignant melanomas are more aggressive and behave differently from cutaneous melanomas. The pathologic description and leveling system known from cutaneous melanomas are not applicable in mucosal melanomas, and other prognostic factors such as depth of invasion seem more important. Extensive surgical procedures is the favored treatment when cure is intended whereas radiation, chemotherapy and immunotherapy currently serve mainly as palliative measures. The prognosis is generally grave. In this review, 5 of the 20 patients with head and neck tumors and 3 of the patients with vulvar tumors had 5 years cures, but later recurrences are not infrequent. Two patients are alive with metastatic disease whereas the rest died from primary or recurrent disease. The main problem in head and neck tumors was gaining control over the local disease process, whereas metastatic disease was less ominous and less frequent. This was different in vulvar melanomas, in which disseminated metastatic disease made the disease difficult to control in the majority of cases. The course of the 47 patients, the poor treatment results and the rarity of the disease show the need for centralized registration and management of mucosal malignant melanomas.
Adult↗
The importance of recognizing malignant giant cell tumor of soft parts.
Four tumors in the extremities were initially diagnosed as extraskeletal osteogenic sarcoma. Recent review of these tumors had led to their reclassification. Three of these are now recognized as malignant giant cell tumors of soft tissue and one as a malignant fibrous histiocytoma. All four patients have been cured. Some special features of malignant giant cell tumors of soft parts are described. The importance of treatment planning is stressed.
Adult↗
Carcinoma of the parotid gland.
Sixty-nine patients with parotid gland cancer were studied at the Cancer Control Agency of British Columbia; half were treated successfully. Localized cancers should be treated by total parotidectomy with facial nerve preservation. Facial nerve sacrifice and radical neck dissection for metastatic lymph nodes may be required. If adequate surgery has been done, the histologic type of the tumor significantly determines the outcome. Postoperative radiation to the parotid bed in the more malignant types of tumor is advocated and appears to improve the results of treatment.
Adenocarcinoma↗
Leiomyosarcoma of the right ovarian vein a case report.
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Female↗
Submandibular and minor salivary gland carcinoma: a 15-year review.
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Adult↗
Analysis of mortality and morbidity in 100 composite resections for oral carcinoma.
The postoperative morbidity and mortality in one hundred patients who underwent composite resection for oral malignant disease are reviewed. Although there was a 7 per cent mortality and significant morbidity, the majority of patients did well. This procedure offers potential cure for life-threatening malignant disease.
Adult↗
Treatment of oral carcinoma with selective therapy for the individual patient.
A series of 121 patients with carcinoma of the lower oral cavity seen at the British Columbia Cancer Institute during the years 1963 to 1969 has been reviewed. We have evidence of improved treatment results over a previous series of patients treated between 1953 and 1962. The results are as satisfactory as other reported treatment policies in which either surgery or radiation is used exclusively. Careful follow-up of all patients is essential. When recurrence or metastatic disease is recognized early, further treatment can still result in cure. The criteria for case selection of the individual patients are outlined.
Adult↗