Higher Rate Of Metastatic Disease Research Articles

Resection of Small Bowel Adenocarcinoma Liver Metastasis Combined with Neoadjuvant and Adjuvant Chemotherapy Results in Extended Disease-Free Period—A Case Report

Small bowel adenocarcinoma (SBA) is a very rare tumor entity but occurs in up to 5% of patients suffering from familiar adenomatous polyposis (FAP). Because of nonspecific symptoms, diagnosis is usually made with delay, which contributes to high rates of metastatic disease at the time of diagnosis. The overall prognosis of SBA is poor with 5-year survival rates of 15-35%. For localized disease, complete surgical resection is the treatment of choice, whereas systemic chemotherapy is deemed indicated in tumors with metastatic spread. The optimal regimen has not been defined as yet. In October 2001, a 51-year-old woman with attenuated FAP, that had total proctocolectomy in 1994 was diagnosed with a jejunal adenocarcinoma. She subsequently underwent small bowel resection. Because a computed tomography (CT) scan in April 2002 revealed multiple liver metastases, chemotherapy with nine cycles FOLFOX6 was initiated. Afterwards, a small residual lesion in segment VIII was seen in CT scan but could not be identified by PET and at laparotomy in November 2002. In December 2003, again, a lesion was detected in S VIII. This solitary residual liver metastasis was resected in January 2004. Postoperatively, the patient received adjuvant chemotherapy with three cycles (with six applications in each cycle) 5-fluorouracil/folinic acid/irinotecan according to the AIO protocol. To date, more than 3 years after liver resection, the patient is still in complete remission and undergoes regular restaging investigations. Resection of liver metastases from SBA combined with neoadjuvant and adjuvant chemotherapy can result in extended disease-free survival and should undergo further investigation.

Adiponectin, ghrelin, and leptin in cancer cachexia in breast and colon cancer patients

The hormone ghrelin and the adipocytokines leptin and adiponectin participate in body weight regulation. In response to weight loss, ghrelin and adiponectin levels increase and leptin decreases. Cancer cachexia is a complex metabolic state, characterized by loss of muscle mass and adipose tissue together with anorexia. The authors hypothesized that responses of these hormones may be attenuated in cancer cachexia. Fasting plasma ghrelin, adiponectin, and leptin levels, as well as weight loss, were determined in 40 cancer patients: 18 of them suffered from cancer-induced cachexia, and 22 served as a comparison group. Hormone levels were measured before administration of cancer therapy. A similar distribution of age, gender, and diagnosis was observed in both study groups, but the cachectic patients had higher rates of metastatic disease and lower albumin levels. No significant correlation was observed between plasma adiponectin levels and weight loss. Mean plasma ghrelin levels were higher among cachectic compared with noncachectic patients. Notably, the association between ghrelin levels and weight loss was only modest, and in a third of the cachectic patients, ghrelin levels were equal to or lower than those in the noncachectic group. Plasma leptin levels showed gender-dependent associations, and significantly lower levels were found among cachectic women but not among cachectic men. Results suggested a gender-dependent attenuation of expected physiologic responses to weight loss among cancer cachexia patients. Thus, impaired response of adiponectin, ghrelin, and leptin may play a role in the pathogenesis of cancer cachexia syndrome.

Ghrelin, adiponectin and leptin in cancer cachexia

8113 Background: The hormone ghrelin and the adipocytokines leptin and adiponectin participate in body weight regulation. In response to severe weight loss, ghrelin and adiponectin levels increase and leptin decreases. Here we studied the association between plasma levels of these mediators and cancer cachexia. Methods: Study population included breast (n=14) and colon (n=26) cancer patients. The mean age was 65±14. Fasting plasma ghrelin, adiponectin and leptin levels, as well as weight loss, were determined prior to administration of cancer therapy. Patients who had other acute or chronic cachectic states were excluded. Results: Patients were classified as either cachectics (defined as ≥5% loss of body mass index, n=18) or non-cachectics (n=22). Similar distribution of age, gender and diagnosis was observed in both study groups, but the cachectic patients had higher rates of metastatic disease and lower albumin levels (p<0.02 for both variables). Mean plasma ghrelin levels (pg/ml) were higher among cachectic compared to non-cachectic patients, for all categories examined (table). Yet, statistical significance was not reached for the differences between cachectic and non-cachectic men and colon cancer patients (table). Notably, the association between ghrelin levels and weight loss was only modest (r=-0.49) and in a third of the cachectic patients, ghrelin levels were equal or lower than the mean levels of the non-cachectic group. Mean plasma adiponectin levels were higher among cachectic patients compared to the control (12.3±5.2 ng/ml vs. 9.6±3.6 ng/ml respectively, p=0.06). Mean leptin levels were similar in both study groups. No correlation was found between ghrelin, adiponectin and leptin levels. Conclusions: Baseline plasma ghrelin and adiponectin levels are high among cancer cachexia patients. Yet, these expected physiologic responses are absent in a significant proportion of these patients and seem be gender and tumor type dependent. No significant financial relationships to disclose.

Findings at Esophagectomy After Endoscopic Mucosal Resection (EMR) of Neoplastic Lesions in Barrett's Esophagus

Rationale: Although the correlation of EMR histology and depth of invasion of early squamous cell cancers to possibility of metastasis is well known, this information has not been established for adenocarcinomas. Aim: To determine the relationship of histology and depth of invasion found on EMR to pathology at surgical resection. Methods: Patients who underwent EMR for esophageal cancer and/or high-grade dysplasia (HGD) in BE followed by esophagectomy, were assessed by record review. EMR data was abstracted from a prospectively maintained database. EUS was performed in all patients with radial scanning at 7.5 and 12 MHz and suspicious lymph nodes were aspirated using the linear EUS instrument. A single experienced endoscopist performed all EMRs. Pathology was confirmed by two experienced GI pathologists. Results: 32 patients with a mean age of 67 years were identified. 25 (78%) patients were males. 20 patients (62%) had a diagnosis of HGD on prior pathology; 11 (34%) had carcinoma and 1 had low-grade dysplasia (LGD). Findings on upper endoscopy included nodules in 25 patients (75%). EMR pathology revealed carcinoma in 24 patients (70%), HGD in 6 (20%), and LGD (1) and nondysplastic BE (1) in others. 5 patients (21%) had mucosal cancer on EMR and at surgery 1 had no cancer and 4 had mucosal cancers. Of these 5 with mucosal cancer, 1 patient had a single metastatic lymph node. 19 (81%) had submucosal cancer on EMR and at surgery 8 had no cancer (3 had PDT before surgery), 6 had T1 cancer, 4 had T2 cancer and 1 had T3 cancer on esophagectomy. Of the 8 patients without cancer at surgery, 2 had positive lymph nodes. Of the remaining 11 patients 4 had positive lymph nodes. EUS did not visualize a lesion (uT0) in 18 patients of whom 8 had lesions on surgery. Of the 15 patients where EUS visualized a lesion (uT1, 2, 3), only 8 had cancer at surgery. 8 patients had FNA of lymph nodes on EUS and all had negative cytology. The overall correlation of EUS T staging to surgical staging was poor (k statistic 0.06). Conclusions: Submucosal involvement on EMR was associated with a high prevalence of positive margins (75%) with residual disease at surgery in 55%. Lymph node metastasis was present in 30% of submucosal cancers. Preoperative EUS findings did not predict residual or advanced stage disease at esophagectomy. Submucosal cancer found on EMR of Barrett's cancers is associated with a high rate of metastatic disease.

1 The role of laparoscopic surgery in gynaecological oncology

Minimal access surgery is here to stay in gynaecological oncology. Within the last three years, rapid strides have been made in applying minimal access surgical techniques to a wide range of gynaecological oncology procedures. The re-assessment of radical vaginal surgery has come largely because of the ease of accessing the pelvic lymph nodes using retroperitoneal and intraperitoneal techniques. An ability to assess the lymph nodes of the pelvis and the para-aortic region prior to definitive therapy is making management of many oncological conditions more logical. Question marks still arise over the place of minimal access surgery in ovarian cancer. A recent study by Professor Gunther Kinderman (Munich) in which, following a postal questionnaire, he identified an unacceptably high rate of laparoscopic interventions in invasive cancer with a parallel unacceptably high rate of metastatic disease, particularly in the port sites, has demonstrated a need for constant vigilance and careful assessment of the application of minimal access surgery in certain areas of oncology. Even while this chapter was in press, Professor Daniel Dargent has shown the possibility of carrying out assessment laparoscopically of the groin lymph nodes using a combination of minimal access surgery and plastic surgical techniques to remove fat. This technique when applied to sentinel node identification may revolutionize our assessment of the groin. Clearly this is an exciting time in gynaecological oncology and many and new inventive applications are being visualized by surgeons throughout the world. When this chapter is rewritten in two years time, inevitably, a considerable part of it will be altered. A glimpse of the future has been seen and we await the full vision with bated breath.

Ciliary body melanoma treated with helium particle irradiation

Melanoma involving the ciliary body is a rare tumor which carries a poor prognosis when compared to all uveal melanoma. We have treated 54 patients with ciliary body melanoma using helium ions from 1978 to 1985. Because of the high rate of metastatic disease, the 5-year disease specific survival rate is only 59% despite a 5-year local control rate of 98%. The greatest diameter of the tumor was predictive of loss of vision and enucleation ( p = .05, p = .04, respectively). Multivariate analysis showed that the greatest diameter of the tumor was the most important predictor of death from metastases. The incidence of neovascular glaucoma at 5 years is 43%. The 5-year actuarial rate of enucleation is 26%. Enucleation was done for pain and/or neovascular glaucoma. Univariate analysis showed treatment volume to be a statistically significant predictor for the development of neovascular glaucoma ( p = .0017) and enucleation ( p = .0078). Seventy percent of neovascular glaucoma occurred in patients with treatment volume > 5.5 cc. Seventy-four percent occurred in patients with an initial ultrasound height > 9.2 mm. Using this information, patients at high risk for neovascular glaucoma could be considered for prophylactic treatment with panretinal photocoagulation.

Zyklische Nukleotide und Östrogenrezeptoren als biologische Marker bei hormonabhängigen Neoplasien

The estrogen and progesterone receptor assay is presently carried out in five Swiss laboratories (Basel, Geneva, Lausanne, Locarno, Zürich). A regular quality control of the method applied allows clinical comparisons. Estrogen receptor contents were found to be higher in postmenopausal women. Mammary carcinomas exhibited a relative decrease of type II cAMP-dependent protein kinase as compared to mammary dysplasias. Type II protein kinase is implied in the control of the cell proliferation. Two significantly different groups with high and low cAMP-binding affinities (high > 5 pmol, low < 5 pmol) were found in the carcinoma tissues. A new therapy with DBcAMP is suggested in carcinoma patients with high levels of cAMP binding resulting in an improved prognosis rate of the endocrine therapy (60%). Low specific activity levels (< 200) of cAMP-dependent protein kinase within the carcinoma group (n = 51) caused a significantly higher rate of metastatic disease raising the possibility to use this enzyme as a biological marker for the prediction of metastasis.