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PubMed2005

Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial.

OBJECTIVE: Ovarian cancer screening with transvaginal ultrasound (TVU) and CA-125 was evaluated in the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial. STUDY DESIGN: This was a randomized controlled trial of screening versus usual care. Baseline screening results are reported. RESULTS: Of 39,115 women randomized to receive screening, 28,816 received at least 1 test. Abnormal TVU was found in 1338 (4.7%), and abnormal CA-125 in 402 (1.4%). Twenty-nine neoplasms were identified (26 ovarian, 2 fallopian, and 1 primary peritoneal neoplasm). Nine were tumors of low malignant potential and 20 were invasive. The positive predictive value for invasive cancer was 3.7% for an abnormal CA-125, 1.0% for an abnormal TVU, and 23.5% if both tests were abnormal. CONCLUSION: The effect of screening on ovarian cancer mortality in the PLCO cohort has yet to be evaluated and will require longer follow-up. Screening identified both early- and late-stage neoplasms, and the predictive value of both tests was relatively low.

Aged↗
PubMed1977

Renal adenocarcinoma: prognostics and treatment reflected by survival.

A retrospective study of 164 patients with renal adenocarcinoma has reconfirmed the highly malignant potential of this neoplasm. Stage and size of the tumor appear to be the best prognostic parameters. Radical surgery appears to have improved survival statistics. Follow-up must be indefinite since late metastases are not uncommon.

Adenocarcinoma↗
PubMed1998

[Proliferative activity of stage I testicular neoplasms: evaluation by image analysis of immunoreactive MIB-1].

The proliferative activity has been evaluated in 55 cases of seminoma and 36 cases of non-seminomatous germ cell tumors of the testis (NSGCT) in clinical stage I from patients alive and well within 5 years, by a semi-quantitative image analysis method of determination of the percent MIB-1 positive nuclear areas, using a Leica Quantimet 500+ analyzer. Significant differences of growth fraction have been detected between classical seminomas and seminomas showing more than 3 mitoses/1HPF (anaplastic seminoma)-mean of MIB-1 positivity in classic seminoma 23.8%, versus 43.9% in anaplastic seminoma; confirming this value of cut-off in distinguishing two classes of cases with different growth fractions, but without any difference as far as prognosis is concerned. The non seminoma- germ cell tumours (NSGCT) in toto display a growth fraction significantly higher than that of seminomas (mean value of MIB-1 positivity: 26.3% in seminoma versus 40.4% in NSGCT), but absolute values of positivity as high as those obtained by others by subjective evaluation have not been observed. A higher growth fraction in NSGCT is positively correlated with an embryonal carcinoma component as high as 80% of the tumor mass and/or with vascular invasion, but not with different histotypes. The proliferative activity doesn't stratify subgroups with different prognosis within the two groups of germinal tumours of the testis (seminomas and NSGCT) in our cases of clinical stage I testicular tumours.

Antigens, Nuclear↗
PubMed1996

[Video-thoracoscopic pulmonary lobectomy. Our experience].

Video-endoscopic surgery developed from laparoscopic removal of the gallbladder and can be used for treatment of certain disease processes of the chest. The major application of this technique is the performance of pulmonary resections (lobectomies and pneumonectomies). Video-thoracoscopic lobectomy requires general anesthesia with a double lumen intubation. After collapse of the involved lung, two intercostal incisions are performed (the first one in seventh space, mid axillary and the second one in fifth space, below the angle of the scapula) and an additional mini-thoracotomy (submammillary in the fifth space) is made. The lobar arteries, veins and bronchus are occluded with an automatic endoscopic stapling device. Seven cases of pulmonary neoplasms (stage I) have been treated by video pulmonary lobectomy (3 right lower lobectomies, 2 right upper lobectomies, 2 left lower lobectomies). Two procedures have been converted for an advanced neoplastic stage that required a radical pneumonectomy and an uncontrolled bleeding. This new procedure has the advantage of greatly reducing the pain and ventilatory disability associated with conventional open thoracic surgery.

Aged↗
PubMed1995

Transformation of ovarian dysgerminoma to yolk sac tumor: evidence for a histogenetic continuum.

Dysgerminoma has traditionally been considered an end-stage neoplasm without potential for further differentiation. Although there have been several reports of transformation of testicular seminoma to yolk sac tumor, a similar event has not been previously reported in dysgerminoma of the ovary. Three cases of ovarian germ cell tumor (two pure dysgerminomas and one mixed germ cell tumor with dysgerminoma and yolk sac components) that revealed histologic changes compatible with early transformation to yolk sac tumor are described. In general, the areas of transformation were located at the periphery of the tumor lobules which otherwise had features of typical dysgerminoma. They were characterized by the presence of microcysts and small glandular structures, which though not readily identified on H&E became more evident with stains for keratins, alpha-fetoprotein, and blood group-related antigen. The small size and focal nature of change, and the apparent transition favor the interpretation that this change represents transformation rather than admixture of two germ cell components. The relationship of dysgerminoma to the solid variant of yolk sac tumor is discussed and an alternate histogenetic scheme in which dysgerminoma represents the stage of earliest differentiation from which other non dysgerminomatous tumors may arise is presented. Although previously proposed for testicular germ cell neoplasia, this scheme has not yet been applied to their ovarian counterparts.

Adolescent↗
PubMed1988

Detection and staging of renal neoplasms: a reassessment of MR imaging.

The use of magnetic resonance (MR) imaging in the detection and staging of renal neoplasms was investigated in 104 patients with 106 renal cell carcinomas confirmed at surgery or autopsy. Overall, MR imaging demonstrated 101 of 106 lesions (95%), including all 93 tumors that were larger than 3 cm in diameter but only eight of the 13 smaller tumors (62%). MR imaging enabled accurate staging of 82% of all detected lesions but led to the understaging of nine lesions and the overstaging of nine. At present, MR imaging cannot be used as a screening modality for renal tumors. However, its negative predictive values of 98% and 99%, respectively, for the evaluation of tumor vascular extension and tumor spread to adjacent structures makes it an excellent staging modality that should be used when the CT findings are equivocal. MR imaging is not accurate in indicating bowel and mesentery involvement, but rapid technical advances and the introduction of bowel contrast medium may improve this present limitation.

Adult↗
PubMed1997

[Chemotherapy of head and neck carcinomas].

In most cases head and neck tumors manifest themselves on a local-regional level giving rise to highly mutilating pathologies with psycho-social repercussions. Surgery and radiotherapy are effective treatments for limited neoplasms (stage I-II). On the other hand, after surgery and/or radiotherapy, the treatment of locally advanced tumors (stage III-IV) or local recurrences and/or distant metastases is still problematic. For this reason chemotherapy, initially used only as a palliative, is today associated with other treatments to achieve better results both in terms of survival and disease-free time spans. Hence chemotherapy must be considered part of any multimodal primary treatment for advanced squamous cell carcinoma of the head and neck. In fact, numerous clinical studies have clearly demonstrated that adjuvant or neoadjuvant chemotherapy has a highly relative affect on survival in locally advanced diseases and that the incidence of distant metastases is reduced. This is not, however, followed by a similar reduction in local recurrences which are often the cause of death in such patients. It would, on the other hand, appear that survival is improved with integrated radio-chemotherapy. Immunochemotherapy, which has not as yet provided significant clinical results in cases of advanced tumors and/or metastases, must still be evaluated in the treatment of locally limited neoplasms. Organ preservation, which proves feasible in the larynx, leads one to hope it can be applied in other head and neck sites. The future balance leans in favor of the multidisciplinary approach and multi-center studies must be performed so that an adequate number of cases can be gathered over a brief period. This will make it possible to answer those questions and, at times, illusions which accompany chemotherapy in the treatment of advanced head and neck tumors.

Adult↗
PubMed1999

The effect of granulocyte colony-stimulating factor on oral mucositis in head and neck cancer patients treated with hyperfractionated radiotherapy.

We investigated the effect of granulocyte colony-stimulating factor (G-CSF) administration on radiotherapy (RT)-induced oral mucositis in 26 consecutive patients with head and neck neoplasms, stages III and IV, treated with hyperfractionated RT. The first 13 patients were treated with RT alone and the remainder with RT + G-CSF. The two groups of patients were similar in age, sex, PS, primary site, stage, RT schedule and RT volume. Daily mucositis, median mucositis score, day of highest mucositis, requirement of parenteral nutrition, weight loss, treatment break, number of days of RT interruption were analyzed during RT treatment. No statistically significant differences were found between the two groups except for the number of patients who interrupted the treatment: 9/13 patients (69%) in the RT alone group versus 3/13 (23%) in the RT + G-CSF group (p < 0.05). Our observations indicate that G-CSF did not appear to have influenced the objective mucositis although it reduced the number of treatment breaks. In consideration of the cost of G-CSF, its prophylactic administration should be reserved only for patients at high risk of RT interruption.

Adult↗
PubMedDate not supplied

[The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

Endosonography↗
PubMed2006

[Intracranial menigioma manifested after delivery in a patient with Hodgkin's disease].

BACKGROUND: Intracranial meningioma is rerely reported in the patients treated for Hodgkin's disease (HD), known to mainly occur in the area of radiation therapy. CASE REPORT: A 26-year-old woman with HD, and intracranial meningioma following the delivery, was presented. As we knew, a similar case had not been reported in the literature before. Three years prior the surgery for intracranial tumor, the patient had been started to be treated for HD of neoplasm stage I (NS I) type, by the use of the standard (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) BEA-COPP protocol. The remission of HD, achieved after 7 cycles, persisted over a 27-month-period up to the delivery. Within this period, the patient was without neurologic disorder, but with the obvious psychotic behavior, for which the patient was treated with haloperidol. Two days following the normal delivery, during the acute disorder of the consciousness, intracranial tumor was found. A complete bilateral meningioma (11.7 x 8.3 x 8.1 cm) of the frontal parietal zone was removed. CONCLUSION: there were no reliable signs of the use of an intensive hemotherapy in the reported case (alkylating cytostatics and topoisomerases inhibitors) which might have caused the proliferation of a benign solid tumor. The pregnancy was supposed to be the possible second risk factor for causing the growth of a meningioma. On the basis of the significant psychic disorders before the pregnancy, as well as upon the size of the operated on tumor, we concluded that the occurrence of intracranial meningioma could be regarded the parallel neoplastic disease or the second primary tumor.

Adult↗
PubMed1995

Free forearm flap in oral reconstruction. Functional outcome.

OBJECTIVE: To examine functional outcome associated with free radical forearm flap reconstruction of oral cavity and oropharyngeal defects. DESIGN AND SETTING: Case series obtained from a head and neck clinic conducted at a regional cancer center. Patients underwent surgery at the associated tertiary care center. PATIENTS: Thirty consecutive patients treated for oral and oropharyngeal malignant neoplasms staged from T1 to T4 were studied. Subjects were assigned to five groups based on the site and extent of their surgical resections, as specified on a resection template. INTERVENTION: All patients had undergone free radial forearm flap reconstruction of their surgical defects. OUTCOME MEASURES: Ten factors reflecting functional properties and processes of the upper aerodigestive tract were evaluated clinically or with videofluoroscopy or both. RESULTS: Near-normal and fair oral and oropharyngeal function wholly characterized the sample. Patients who underwent reconstruction of unilateral tongue, floor of mouth-ventral tongue, and retromolar trigone-buccal defects functioned well on most measures; the function of patients with anterior tongue-jaw and tongue base-tonsil defects varied. CONCLUSIONS: Functional outcome with free radial forearm flap reconstruction was favorable for three of five subgroups of oral and oropharyngeal cancer patients. Qualitatively different functional profiles emerged for subgroups based on resection site. Methodologic issues for research on surgical reconstruction and functional outcome include the need for a meaningful, reliable system of classifying oral and oropharyngeal resections, and the development of standardized procedures for evaluating functional outcome.

Adult↗
PubMed2004

Decrease of signal intensity of myometrium and cervical stroma after ultrasmall superparamagnetic iron oxide (USPIO) particles administration: an MR finding with potential benefits in T staging of uterine neoplasms.

OBJECTIVES: Following the empiric observation of a significant decrease of signal intensity of both myometrium and cervical stroma on ultrasmall superparamagnetic iron oxide (USPIO)-enhanced images, the aim of our study was to evaluate whether USPIO-enhanced T2*-weighted gradient echo (GRE) images might provide any potential advantage on T-staging of uterine malignancies having surgery and histology as standard of reference MATERIALS AND METHODS: Seventeen female patients with known uterine malignancies underwent magnetic resonance (MR) imaging before and 24 hours after the intravenous administration of the USPIO agent. Imaging protocol included proton density-weighted turbo spin echo and T2*-weighted GRE sequences. Each patient underwent surgery within 14 days from the first MR examination, and histologic confirmation of tumor T-stage was obtained. Quantitative (calculation of signal-to-noise and contrast-to-noise ratios) and qualitative (visual assessment of T staging) analyses were performed on unenhanced and USPIO-enhanced images. RESULTS: Quantitative analysis showed a significantly lower (P < 0.05) signal-to-noise ratio of myometrium and cervical stroma on USPIO-enhanced compared with unenhanced images. In 15 of 17 patients (88.2%), the contrast-to-noise ratio between tumor and myometrium and between tumor and cervical stroma was higher on USPIO-enhanced compared with unenhanced images (P < 0.001). Qualitative analysis demonstrated that the GRE T2* USPIO-enhanced MR offers a better definition of the depth of tumor infiltration rather than the unenhanced GRE T2* images. CONCLUSION: The decrease of signal intensity of myometrium and cervical stroma on T2*-weighted GRE images after the intravenous administration of USPIO should be considered a constant and physiologic finding that improves tumor conspicuity in the majority of the cases, allowing more accurate T-staging of neoplastic lesions.

Adult↗
PubMed2004

Surgical management of epithelial parotid tumours.

OBJECTIVE: To describe the clinicopathological presentation and treatment options in epithelial parotid tumours with emphasis on surgery. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: ENT Departments of Pakistan Institute of Medical Sciences, Islamabad and Holy Family Hospital, Rawalpindi and Surgical Units at Rawalpindi General Hospital and DHQ Teaching Hospital, Rawalpindi, during a ten year period 1993-2003. SUBJECTS AND METHODS: Epithelial parotid tumours diagnosed and operated by an ENT surgeon and a general surgeon in 10 years during their posting in different teaching hospitals were included in the study. Clinical presentation, preoperative investigations, operative procedure, histopathology report, postoperative complications and further management were recorded. The data was collected and reviewed from the records of all the patients maintained by the authors. RESULTS: Fifty-two patients presented with parotid tumour. Average age was 38 years. Commonest presentation was a painless lump over the parotid region (85%), pain (15%), facial palsy, and enlarged neck nodes. Majority of tumours were benign, only two were recurrent. Parotid pleomorphic Adenoma (PPA) was the commonest benign tumour, others being Warthin's tumour and monomorphic adenoma. Adenoid cystic carcinoma was the commonest malignant tumour 29% followed by mucoepidermoid carcinoma. Others were carcinoma in PPA, squamous cell carcinoma, malignant mixed tumour, malignant lymphoepithelioma and undifferentiated carcinoma. Superficial parotidectomy (SP) was the commonest operation performed in 69%. Other procedures were total conservative parotidectomy in 11%, total radical surgery in 9% and enucleation in only one patient earliest in the series. Neck node dissection was done in 2 patients. Except for one child, rest of the 13 patients received postoperative radiotherapy and one patient of lymphoepithelioma received chemotherapy in addition. Commonest postoperative complication was temporary facial weakness in 35% (18/52). Permanent facial palsy occurred in 08 patients. Of these 07 had a malignant process and only one patient had excision biopsy. CONCLUSION: Benign and malignant epithelial parotid tumours can be diagnosed by their clinical presentation supplemented with FNAC. Superficial parotidectomy (SP) was the operation of choice. Facial nerve can be saved in total conservative parotidectomy for benign tumour in deep lobe and early malignant tumour. Radical parotidectomy followed by radiotherapy and in selected cases neck node dissection are the recommended procedures for advanced malignant parotid tumours.

Adenoma, Pleomorphic↗
PubMed2006

Association between circulating white blood cell count and cancer mortality: a population-based cohort study.

BACKGROUND: Inflammatory processes are implicated in the development and progression of cancer. However, it is not clear whether systemic markers of inflammation predict cancer. We examined the prospective relationship between circulating white blood cell (WBC) count and cancer mortality. METHODS: Population-based cohort study of 3189 individuals, aged 49 to 84 years and free of cancer at the baseline examination (January 1, 1992, to December 31, 1994), in the Blue Mountains region, west of Sydney, Australia. The main outcome of interest was all cancer mortality ascertained from vital status as of December 31, 2001. RESULTS: Higher WBC count was found to be associated with all cancer mortality. In proportional hazards models adjusting for age, sex, education, body mass index, hematocrit level, alcohol consumption, physical inactivity, smoking, weekly aspirin use, diabetes mellitus or fasting hyperglycemia status, and fasting glucose levels, the multivariable relative risk of all cancer mortality comparing quartile 4 of WBC count ( > or = 7400 cells/microL) with quartile 1 (< or = 5300 cells/microL) was 1.73 (95% confidence interval [CI], 1.18-2.55). In subgroup analyses, the relative risk of cancer mortality comparing quartile 4 of WBC count with quartile 1 was higher among those with diabetes or fasting hyperglycemia (3.03 [95% CI, 1.01-9.15]) than among those with normoglycemia (1.68 [95% CI, 1.12-2.52]). Also, the relative risk of cancer mortality associated with joint exposure to quartile 4 of WBC count and aspirin nonuse was 2.42 (95% CI, 1.46-4.01) compared with their absence. CONCLUSION: These data provide new epidemiological evidence of an association between circulating WBC count, a widely available marker of inflammation, and subsequent cancer mortality.

Aged↗
PubMed2005

Chemoprevention of head and neck cancer with retinoids: a negative result.

OBJECTIVE: To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. PATIENTS: One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. INTERVENTIONS: Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. MAIN OUTCOME MEASURES: The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. RESULTS: There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P = .80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. CONCLUSION: With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.

Administration, Oral↗
PubMed1980

Primary tumors of the external and middle ear. Benign and malignant glandular neoplasms.

Glandular neoplasms represented 14% of primary tumors of the external and middle ear at the University of Minnesota. Although the collective term "ceruminoma" has been used in the past, four distinctive histopathologic patterns were recognized among our 12 cases: adenoma (four cases), pleomorphic adenoma (one case), adenoid cystic carcinoma (two cases) and adenocarcinoma (five cases). The prognosis correlated with these subgroups. A thorough review of the English literature also tended to support the rationale for the subclassification of so-called ceruminomas. The prevailing histogenetic view is that these tumors are derived from the modified apocrine glands of the auditory canal, the ceruminous glands. In some instances, these tumors may originate from ectopic salivary gland tissue.

Adenocarcinoma↗