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At least 433 records · Page 24Linked to original sources
PubMed1986

Massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases: report of two cases and review of the literature.

Two cases of massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases are presented. This devastating complication of hepatic malignant disease is difficult to diagnose preoperatively. However, the diagnosis should be considered in patients with known malignant disease who present with unexplained blood loss, shock, or signs consistent with an acute surgical abdomen. The presence of fever and leukocytosis with these signs and symptoms may also be part of the clinical picture. Treatment by hepatic resection is never curative. Review of the literature indicates that local control of the bleeding site by suture ligature, packing with topical hemostatic agents, or hepatic artery ligation offers the best chances of obtaining hemorrhage control and some degree of palliation in these desperately ill patients.

Adenocarcinoma↗
PubMed1986

Cholecystitis secondary to infusion chemotherapy.

This report centers on a patient with metastatic colorectal cancer who developed acute and chronic cholecystitis secondary to the infusion of FUDR (fluoro-deoxyuridine) into the hepatic artery. This was documented by sonography, cholescintigraphy, and, ultimately, pathologically on the surgically removed specimen. Undoubtedly, with increasing cumulative treatment days made possible through technological advances in delivery systems, this complication will be seen more frequently. Prophylactic removal of the gallbladder, at the time of pump placement, which does not significantly prolong the operative time nor increase the operative mortality, should be performed to prevent this complication from occurring.

Adult↗
PubMed1986

Home parenteral nutrition for patients with advanced intraperitoneal cancers and gastrointestinal dysfunction.

The use of total parenteral nutrition (TPN) in patients with advanced, untreatable cancer is controversial. Occasionally, however, damage to bowel by tumor, radiation, or surgery renders these patients unable to eat and TPN may be indicated to prevent premature death from starvation. We have used Home Parenteral Nutrition (HPN) to support three patients with advanced, untreatable abdominal cancer and inability to eat. Morbidity was minimal and survival times were 24, 6 and 1.5 months. Payment was covered by third party agencies. All patients and their families were gratified by the ability to return home with nutritional support. HPN can be used to support terminal cancer patients with bowel obstruction and may afford them longer survival. Ideally, patients considered for this should be well motivated, with good support systems, and with survival estimated to be at least months.

Abdominal Neoplasms↗
PubMed1987

Primary pulmonary angiosarcoma associated with multiple synchronous neoplasms.

A 60-year-old man presented with a 3-month history of shortness of breath. He was found to have a right thoracic mass involving the right middle and lower lobes, pulmonary hilum, and mediastinum. Diagnosis could not be established by pleural fluid cytology, pleural biopsies, bronchoscopy, and ultrasound-guided needle biopsies. A diagnostic exploratory thoracotomy was performed. Massive hemorrhage was encountered upon opening the pleura, and bleeding was controlled by performing a radical pneumonectomy. Histology revealed angiosarcoma, pulmonary primary. The patient survived for 68 days. At autopsy, he was found to have adenocarcinoma of the prostate, adenocarcinoma of the rectum, carcinoid of the ileum, and leiomyoblastoma of the stomach as well as diffuse metastases from the angiosarcoma. This represents the fourth reported case of primary pulmonary angiosarcoma.

Adenocarcinoma↗
PubMed1993

A cytoreductive approach to treatment of multiple liver metastases.

Modest benefits and extensive costs have occurred as a result of hepatic artery chemotherapy with fluorodeoxyuridine (FUDR). As a consequence, pump or port infusions of chemotherapy through the hepatic artery are rarely used today. A new cytoreductive approach to the treatment of multiple liver metastases isolated to the liver has been introduced. Induction chemotherapy is used to achieve a response or stabilize disease in the liver. Patients are then selected for surgery, at which time a complete response is achieved through the judicious use of a variety of cytoreductive techniques. In a limited number of patients treated to date the median survival greatly exceeds that reported for intraarterial chemotherapy alone. As experience accumulates, protocols are being modified to decrease the morbidity and maximize the number of complete responders.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Use of ileal urinary diversion in conjunction with intraoperative radiotherapy.

Intraoperative radiotherapy (IORT) was introduced in the 1970s as a new modality of cancer therapy. It has been especially useful after local irradiation or surgical failure. We report on the use of IORT in 13 patients with pelvic tumors requiring urinary diversion. All 13 were managed with ileal conduits. Despite the associated problems of prior abdominal procedures (11/13 patients), prior external beam radiation to the pelvis (11/13 patients), systemic chemotherapy (4/13 patients), and prolonged operative time (> 10 hours), perioperative mortality (1/13) and morbidity rates were low. We conclude that in cases of prior colonic resection and pelvic radiation, potentially irradiated ileum can be safely used for urinary diversion.

Aged↗
PubMed1986

A new technique for hepatic infusional chemotherapy.

Constant-infusion intra-arterial chemotherapy is associated with a significantly greater tumor response rate and perhaps an improved survival rate. Many intra-arterial drug delivery systems have been described, the most popular of which is the implanted Infusaid pump. Unfortunately, this is an expensive device that requires considerable experience in its implantation and maintenance. This paper describes a simplified, inexpensive technique, which can comfortably and reliably provide intra-arterial hepatic chemotherapy to patients treated in most moderate-size community hospitals. Implantation requires angiography and a minor surgical procedure. Maintenance of the system is easy and inexpensive. While use of the Infusaid pump is preferable, this technique is a reasonable alternative for the following: 1) patients with very poor hepatic function, 2) patients who cannot afford the implanted pump, 3) patients who have concomitant extrahepatic tumor, 4) patients with noncolorectal metastasis to the liver, and 5) patients treated at hospitals that do not have implanted pump capabilities.

Catheterization, Peripheral↗
PubMed1987

The role of the oncogene c-myc in sporadic large bowel cancer and familial polyposis coli.

The human myc gene is homologous to the v-myc gene, which was discovered in the avian oncogenic retrovirus MC29. Abnormally high expression of the cellular oncogenes is suspected to be involved in nonviral carcinogenesis. This article reviews the evidence that elevated expression of the human myc gene is involved in sporadic colon carcinoma and familial polyposis coli. The abundance of myc RNA and protein is frequently higher in colorectal cancer than in normal mucosa. The mechanism of this altered expression is obscure because the structure and quantity of myc DNA are very rarely disturbed. The COLO320 cell line is discussed as one unusual example of myc DNA rearrangement and amplification. There is a correlation between tumor-specific elevated myc RNA level and location in the bowel; tumors distal to the transverse colon are more likely to have elevated myc expression. The site distribution of unselected colorectal malignancies with an elevated myc RNA level is similar to the site distribution of familial polyposis coli tumors. With this observation it is suggested that elevated myc RNA may be a marker of a distinct type of colorectal cancer that involves the same genetic events as precede familial polyposis coli cancer.

Adenomatous Polyposis Coli↗
PubMed2001

Selective irradiation for the treatment of recurrent ovarian carcinoma involving the vagina or rectum.

OBJECTIVE: The aim of this study was to evaluate the role of selective irradiation in the management of recurrent or persistent ovarian carcinoma involving the vagina or rectum after initial surgery or surgery and chemotherapy. METHODS: Twenty-eight patients with recurrent or persistent vaginal and/or perirectal disease from ovarian carcinoma received selective irradiation and were evaluated for local control, survival, and quality of life. Seventy-nine percent had previously received various combinations of chemotherapy after initial surgery. At recurrence, 68% of the 28 patients were treated with external beam irradiation only, 7% with brachytherapy only, and 18% with both external beam irradiation and brachytherapy. In addition, 50% of the patients received various combinations of chemotherapy before or after radiotherapy and 3 patients received additional surgery. RESULTS: Vaginal bleeding was controlled in all patients and a complete symptomatic response was achieved in 79% of the symptomatic patients. Survival after recurrence at 2 years was 57% for patients who had no liver or extra-abdominal metastasis at the time of radiotherapy (21 patients) and 0% for patients who had liver or extra-abdominal metastases (7 patients). Median survival of 5 patients with abdominal and pelvic disease and 16 patients with no extrapelvic disease at the time of recurrence was 2.16 (0.16-10.67) and 2.08 (0.58-27) years, respectively, after recurrence. Fifty percent of the 16 patients without extrapelvic disease had a complete response to radiotherapy (CR group) and the remaining had a partial response or stable disease (non-CR group). The 1-year survival after salvage irradiation in this same group was 100% in the CR group and 37.5% in the non-CR group (P < 0.0001). There are 4 long-term survivors in the CR group who are still alive in excess of 5 years after salvage radiotherapy. Thirty-five percent (5/14) of the patients with pelvic disease only recurred in the unirradiated upper abdomen. CONCLUSIONS: Radiation can be considered an effective treatment option for patients with vaginal and/or perirectal recurrences of ovarian carcinoma. It offers excellent palliation to patients with disseminated disease and may result in both local control and long-term survival in patients with nondisseminated disease. This location may represent a sanctuary site from chemotherapy. Pelvic irradiation alone may be effective salvage and the addition of brachytherapy may improve local control, particularly in patients with disease confined to the pelvis who undergo debulking or chemotherapy.

Adult↗
PubMed1980

Clinical strategies in the chemotherapy of gastrointestinal cancer.

Clinical strategy in chemotherapy of gastrointestinal cancer depends on availability of drugs with single-agent activity. If active drugs are available, combination chemotherapy trials can be developed. In gastric cancer, combinations of 5-fluorouracil with chloroethyl nitrosoureas or adriamycin and mitomycin C are capable of producing responses in 40-50% of patients. Such active combinations may now be evaluated in patients with less advanced gastric carcinoma. The role of combination chemotherapy is now being defined in patients with locally unresectable cancer and in the surgical adjuvant situation. In pancreatic and colorectal cancer, combination chemotherapy regimens have been of marginal effectiveness. The major thrust of clinical investigation must be directed toward phase II evaluations of single agents in these diseases.

Antineoplastic Agents↗
PubMed1982

Chemotherapy of metastatic gastrointestinal cancers: prospects for future adjuvant systemic therapies.

Overall survival enhancement for patients with gastrointestinal malignancies is most likely to come from the integration of active systemic drug therapies into combined modality programs, applied in the surgical adjuvant or locoregional disease setting. Recent results of chemotherapy trials in advanced disease are discussed with emphasis placed on regimens that appear to be likely candidates for future early-stage disease studies. The ultimate success of this overall strategy depends heavily on identification of new active chemotherapeutic agents. meticulous disease-oriented phase II testing of all new agents in gastrointestinal cancers is critical to this effort.

Colonic Neoplasms↗