They are not asking about factors that affect oncologic prognosis and therefore imply a change in QT strategy. This question is straightforward. Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation. The T4s carry a much higher chance of recurrence, in fact there are ongoing studies that propose prophylactic HIPEC in T4 and second look surgery + HIPEC in perforated colon tumors.

They are not asking about factors that affect oncologic prognosis and therefore imply a change in QT strategy. This question is straightforward. Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation. The T4s carry a much higher chance of recurrence, [HIDDEN].

A 52-year-old man was referred to the gastroenterology department for hematochezia, tenesmus and reduction of stool diameter. A series of tests were performed and a diagnosis of adenocarcinoma of the sigma without distant metastasis was made. The patient underwent surgery and was referred to the medical oncology department for evaluation of complementary chemotherapy treatment. Which of the following is a poor prognostic factor after surgical resection and should be taken into account when planning chemotherapy treatment?

The existence of a family history of colorectal cancer.

The size of the primary lesion and histological differentiation.

Perforation or adhesion of the tumor to adjacent organs.

[The primary tumour resection with extended D3 lymph node dissection, metastases of synchronous metastatic colorectal cancer].

The progress in colorectal cancer treatment of IV stage that was shown in last decades was mainly due to modern chemotherapy schemes and aggressive surgical approach towards distant metastatic lesions. Meanwhile less attention is paid to primary tumour treatment - the questions of necessity and volume of its resection are still open. The AIM of this study was to evaluate safety and oncologic effectiveness of primary tumour resection with D3 lymph node dissection in synchronous metastatic colorectal cancer. Patients with colorectal cancer and synchronous metastatic lesion of distant organs who underwent surgical resection of primary tumour were chosen from prospectively collected department database. The analysis of short-term and long-term results of resections with and without extended D3 lymph node dissection and prognostic factors affecting overall survival was carried out. From 2006 to 2011 total of 190 patients underwent primary tumour resection, 157 (82.6%) among them - with extended D3 lymph node dissection. Twenty one patient (11%) developed postoperative complications that required reintervention, 30-days mortality rate was 2.6%. Three-year cumulative overall survival was 37%, median survival - 22 months (25 months with extended lymph node dissection and 4 months without, p<0.001). Univariate analysis revealed following statistically significant prognostic factors improving overall survival: metastatic lesions in one distant organ, solitary haematogenous nodes, extended D3 lymph node dissection, postoperative chemotherapy, resection of metastatic lesions. Removal of primary tumour with extended lymph node dissection in metastatic colorectal cancer doesn't increase the number of postoperative complications and mortality. Performing D3 lymph node dissection favours increase of median survival and is a significant prognostic factor influencing outcomes.

Metastatic liver disease

Diagnosis Hemoglobin decrease Liver function test: ALP elevated, bilirubin elevated, albumin decrease Carcinoembryonic antigen for colorectal secondaries Ultrasound scan CT scan Biopsy under ultrasound control Treatment Treatment can consist of surgery (hepatectomy), chemotherapy and/or therapies specifically aimed at the liver like radiofrequency ablation, transcatheter arterial chemoembolization, selective internal radiation therapy and irreversible electroporation. For most patients no effective treatment exists because both lobes are usually involved, making surgical resection impossible. Younger patients with metastases from colorectal cancer confined to one lobe of the liver and up to 4 in number may be treated by partial hepatectomy. In selected cases, chemotherapy may be given systemically or via hepatic artery.

Histopathology of colorectal adenocarcinoma

Grading Conventional adenocarcinoma may be graded as follows Staging Staging is typically made according to the TNM staging system from the WHO organization, the UICC and the AJCC. The Astler-Coller classification (1954) and the Dukes classification (1932) are now less used. T stands for tumor stage and ranges from 0, no evidence of primary tumor, to T4 when the tumor penetrates the surface of the peritoneum or directly invades other organs or structures. The N stage reflects the number of metastatic lymph nodes and ranges from 0 (no lymph node metastasis) to 2 (four or more lymph node metastasis), and the M stage gives information about distant metastasis (M0 stands for no distant metastasis, and M1 for the presence of distant metastasis). A clinical classification (cTNM) is done at diagnosis and is based on MRI and CT, and a pathological TNM (pTNM) classification is performed after surgery.

Adenocarcinoma of the lung

Adenocarcinoma is more common in patients with a history of cigarette smoking, and is the most common form of lung cancer in younger women and Asian populations. The pathophysiology of adenocarcinoma is complicated, but generally follows a histologic progression from cells found in healthy lungs to distinctly dysmorphic, or irregular cells. There are several distinct molecular and genetic pathways that contribute to this progression. Like many lung cancers, adenocarcinoma of the lung is often advanced by the time of diagnosis. Once a lesion or tumor is identified with various imaging modalities, such as computed tomography (CT) or X-ray, a biopsy is required to confirm the diagnosis. Treatment of this lung cancer is based upon the specific subtype and the extent of spread from the primary tumor. Surgical resection, chemotherapy, radiotherapy, targeted therapy and immunotherapy are used in attempt to eradicate the cancerous cells based upon these factors.

[Evaluation of the results of treatment of cancer of the large intestine based on our clinical data].

Results of the treatment of 225 patients operated between 1991-1995 on the colorectal carcinoma in the II Clinic of Surgery, Medical Academy Wroclaw are evaluated. The analysis of the own material covers the tumor site, age of the patients, histologic grade and clinical stage according to Dukes. The type of surgical procedure--curative or palliative and the evaluation of the survival, death and recurrence rate is presented. Curative procedures were possible only in approximately 60% of cases. The Dukes stage C and D was established in 55.5% of the operated patients. Authors believe that such a significant number of advanced cases was the reason of so poor results. In conclusion they suggest to introduce screening tests for early detection of colorectal carcinoma.

Primitive neuroectodermal tumor

Treatment The approach to management of a CNS PNET is first to obtain detailed imaging through MRI, as well as additional scans of the patient's body (X-ray, CT, PET, even bone marrow biopsies) to look for metastasis or other associated malignancies. The tumor will then need to be biopsied to confirm the diagnosis. After the diagnosis of a CNS PNET is confirmed, management includes neoadjuvant chemotherapy and radiation (to reduce tumor size burden), complete surgical resection with confirmed negative margins, and/or additional adjuvant post-surgical chemotherapy. CNS PNET is aggressive and must be managed as so. Palliative care services should also become involved in the patient's care team when the diagnosis is made. See also Medulloblastoma Ependymoma Ewing family of tumors References Pediatric cancers Rare cancers Nervous system neoplasia Small-blue-round-cell tumors

[Gastrocolic tumor progression--a possibility or mere supposition?].

The authors examined the five-years postoperative survival rate of fifty patients who suffered from colorectal cancer along with the fact that the large bowel one of the neighbouring organs were resected. The subjects were divided into four groups: the colorectal resection was associated with (1) stomach resection (13 patients); (2) liver metastasectomy (14 patients); (3) small bowel resection (10 patients); (4) the resection of other organs (13 patients). In the first two years of the study they were examined once in every three months, in the next two years once in every six months and then yearly. The following tests were carried out: chest X ray, abdominal sonography, irrigography or colonoscopy and CEA. On condition that the colonoscope reached the caecum and the result was negative, the test was repeated only a year later. The patients were operated on between 1985 and 1997. The statistical analysis was made with the help of the Kaplan-Meier method. During this period fifty-six complex resections were performed. Out of fifty-six patients fifty were followed. Compliance 89%. In group 1, where the average age of patients was sixty-two years, one patient died in the forty-first and the other in the fifty-second month after the surgery. Survival rate: 11/13 (83%). The survival rates for the other groups were as follows: group 2 (average age 64) twelve patients died within five years. Survival rate 2/14 (14%). The difference between the survival rates in the first two groups in significant (P = 0.0001). Group 3 (average age 67) seven died and only three survived. Survival rate: 3/10 (30%). The difference between group 1 and group 3 is significant (P = 0.0022). Group 4 (average age 64) seven patients died. Survival rate 6/13 (46%). Comparing this rate to that of the group 1, the difference is not significant (P > 0.01). Having analysed the results of the four groups it can be concluded that the patients of group 1 lived the longest (stomach resection) and those of group 2 (liver metastasectomy) died the earliest after the operation. It is surprising that the patients of group 3 lived significantly shorter than the ones of group 1 in spite of the fact that they belong by far the greatest number to stage Dukes B (group 1: 12/13 = 92%; group 3: 7/10 = 70%). The authors assume that the partial or the total absence of the stomach keeps back the growth of the tumour (gastro-colic tumour growing dependency). They think that in case of colon cancer which infiltrates the stomach surgeons experienced in gastric and colorectal surgery should be encouraged to take the risk of the double resection providing the fact that the operation is accomplishable.

Marginal zone B-cell lymphoma

Primary colonic EMZL, also termed primary colonic MALT lymphoma, usually presents at an early stage of disease with evidence of lower GI tract bleeding (e.g. tarry bowel movements and/or iron deficiency anemia), less commonly with lower abdominal pain, and rarely with bowel perforation or intussusception. Endoscopic examination most often reveals a single polyp or rarely multiple polyps, a mucosal ulcer, or a mucosal nodule. Diagnosis is passed on biopsy of the lesions showing a histology typical of EMZL, e.g. diffuse infiltrates composed of small to medium-sized lymphocytes that may show morphological features of monocytes and/or plasma cells. The lymphocytes in these lesions express B cell markers (e.g. CD19 and CD79a) typical of EMZL lesions. The best treatment regimen for this lymphoma is debated. Surgical resection, endoscopic resection, radiation, and chemotherapy have been employed. Surgery followed by chemotherapy (mitoxantrone + chlorambucil + prednisone or cyclophosphamide +

[Diagnosis and staging of colorectal cancers].

Early colorectal cancer produces no symptom, thus justifying efforts at detection in screening programs. Symptoms are usually secondary to obstruction, local invasion, perforation or bleeding. Any fecal bleeding must be investigated to rule out a colorectal cancer. The initial imaging study to identify a colorectal cancer is often colonoscopy, which is frequently supplemented with a double contrast barium enema. Once the presence of cancer is histologically proven, the preoperative evaluation includes detection of hepatic and extrahepatic spread, especially with ultrasound and CT scan. Endorectal ultrasonography has been shown to be a significant advance for staging rectal cancer. It provides the best staging in selecting patients for preservation of sphincter function and for adjuvant therapies. The most useful prognostic factors in tumors without distant metastases are the depth of tumor extension, the number of positive lymph nodes and the histologic grade. Preoperative CEA level, vascular invasion and ploidy are also important prognostic factors.

Malignant peripheral nerve sheath tumor

Prognosis Patient response to treatment will vary based on age, health, and the tolerance to medications and therapies. Metastasis occurs in about 39% of patients, most commonly to the lung. Features associated with poor prognosis include a large primary tumor (over 5 cm across), high grade disease, co-existent neurofibromatosis, and the presence of metastases. It is a rare tumor type, with a relatively poor prognosis in children. In addition, MPNSTs are extremely threatening in NF1. In a 10-year institutional review for the treatment of chemotherapy for MPNST in NF1, which followed the cases of 1 per 2,500 in 3,300 live births, chemotherapy did not seem to reduce mortality, and its effectiveness should be questioned. Although with recent approaches with the molecular biology of MPNSTs, new therapies and prognostic factors are being examined. See also Keratinizing metaplasia List of cutaneous conditions 50/50 (2011 film) References External links

[Clinicopathological analysis of 39 patients with multiple primary synchronous colorectal carcinoma].

To investigate the clinicopathologic characteristics and prognosis of multiple primary synchronous colorectal carcinoma (synchronous CRC) and single colorectal carcinoma (single CRC). Clinicopathological data of 39 patients with synchronous CRC and 528 patients with single CRC from May 1996 to June 2001 were reviewed retrospectively. The patients with synchronous CRC accounted for 6.9% of all the patients with colorectal carcinoma treated in our hospital during the same period. Compared with concurrent lesions, Dukes stage of the index lesions of synchronous CRC was more developed and the lymph node metastasis and vessel invasion occurred more frequently. In addition, it also had poorer differentiation. There were significant differences of Dukes stages and lymph node metastasis between the index lesions and single CRC. The incidence of adenomatous polyp in synchronous CRC was higher than that in single CRC(59.0% vs 25.0%,P<0.01). The sensitivity of preoperative colonoscopy examination was 76.9%, which was significantly higher than that of barium examination and exploration during operation. The total 5-year survival rate of synchronous CRC was significantly lower than that of single CRC (5.1% vs 28.2%,P=0.042), and no significant difference of total 5-year survival rate was found between single CRC patients and synchronous CRC patients undergone radical operation. Synchronous CRC patients undergone radical operation had longer survival as compared to those undergone palliative operation(P<0.01). Multivariate analysis indicated that Dukes stages, lymph node metastasis, vessel invasion and the type of operation were independent prognostic factors of synchronous CRC. Synchronous CRC and single CRC are not always similar in clinicopathologic characteristics and prognosis. Early finding, early diagnosis and radical operation are the keys to improve the survival rate of synchronous CRC.

Blastoma

Mortality during the first few years after diagnosis is around 15%, although current therapeutic approaches have reached cure rates of up to 60%. The most common forms of therapy are surgical resection, aided by radiation and chemotherapy (before or after surgery), and the survival rates that this yields are between 50% and 90%, a wide range that is influenced by the age at diagnosis, metastasis and histologic variants of the medulloblastoma of each patient. However, despite the long-term survival achieved with current treatments, the neurologic, endocrinologic and cognitive effects are still a great concern in the treatment of medulloblastoma. Nephroblastoma The most common type of renal cancer in children is nephroblastoma, also known as Wilms tumor. Nephroblastoma is also the fourth most common pediatric cancer form, and the most common pediatric abdominal cancer, typically diagnosed in children from zero to five years old.

[Treatment of colorectal cancer].

The large majority of colorectal cancers are well or moderately differentiated adenocarcinomas. Their biological behavior is not as malignant as that of stomach cancer, with a tendency of slow growth and limited spread. Surgery is therefore the first choice for management of these cancers even in cases where complete removal of the tumor is not expected, surgery is useful for the prolongation or improvement of the quality of life. However, the correct choice of operation for such cases is very important. The extent of resection and dissection must be decided based upon the degree of cancer spread. Both must be sufficient, but not excessive. In cases in the early stage where cancerous growth has not spread beyond the submucosal layer, local or segmental excision may be a good enough treatment. On the other hand, for far advanced rectal cancer involving adjacent organs, combined resection and pelvic evisceration is curatively effective. Several pathological findings of resected specimens influencing prognosis were investigated in the present study. In cases which appeared to be diffuse infiltrative spreading type in macroscopic appearance or poorly differentiated, undifferentiated, or mucinous types of cancer in their histological features, survival rates were low. However, these were uncommon and over half of them were much too far advanced to receive curative resection. Irradiation combined with hyperthermia or heavy chemotherapy were applied, but were mostly ineffective. For these uncommon types of cases as well as far advanced cases, we have no effective treatment other than surgery at this time.

Mediastinal germ cell tumor

Treatment Pure mediastinal seminomas are curable in the large majority of patients, even when metastatic at the time of diagnosis. These tumors are highly sensitive to radiation therapy and to combination chemotherapy. However, the cardiotoxicity of mediastinal radiation is substantial and the standard treatment of mediastinal seminomas is with chemotherapy using bleomycin, etoposide and cisplatin for either three or four 21-day treatment cycles depending on the location of any metastatic disease. Patients with small tumors (usually asymptomatic) that appear resectable usually undergo thoracotomy and attempted complete resection followed by chemotherapy. The treatment for mediastinal nonseminomatous germ cell tumors should follow guidelines for poor-prognosis testicular cancer. Initial treatment with four courses of bleomycin, etoposide, and cisplatin, followed by surgical resection of any residual disease, is considered standard therapy.

[Natural history of synchronous hepatic metastases from a non-treated colorectal cancer].

The authors present a retrospective study concerning 135 cases of untreated synchronous metastases from colorectal cancer. The median survival is 5.5 months and the natural history is depending on the percentage of liver replacement, on the "performance status" of each patient and on the stage of primary tumors classified according to Dukes. The seric levels of Alkaline Phosphatase and CEA are other useful prognostic factors. The age of patients and systemic chemotherapy (5-Fluorouracil) are not able to influence the evolution of the disease. At last different techniques, both curative and palliative, used in the current treatment of liver metastases from colorectal cancer are discussed and the reported survival improvements reaching with these forms of treatment are compared to the natural history of the disease.

Adamantinoma

Diagnosis Diagnosis is on plain radiography, or CT scan Treatment Treatment consists of wide resection or amputation. Metastases are rare at presentation but may occur in up to 30% of patients during the disease course. Prognosis is excellent, with overall survival of 85% at 10 years, but is lower when wide surgical margins cannot be obtained. This tumor is insensitive to radiation so chemotherapy is not typically used unless the cancer has metastasized to the lungs or other organs. History The typically benign odontogenic tumor known as ameloblastoma was first recognized in 1827 by Cusack but did not yet have any designation. In 1885, this kind of odontogenic neoplasm was designated as an adamantinoma by Malassez and was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill. Some authors still confusingly misuse the term adamantinoma to describe ameloblastomas, although they differ in histology and frequency of malignancy. References External links

Ultrasonography of liver tumors

US examination is required to detect liver metastases in patients with oncologic history. In addition, the method can incidentally detect metastases in asymptomatic patients. Early identification (small sizes, small number) is important to establish an optimal course of treatment which can be complex (chemotherapy, radiofrequency ablation, surgical resection) but welcomed. In addition, discrimination of synchronous lesions that have a different nature is also important knowing that up to 25–50% of liver lesions less than 2 cm detected in cancer patients may be benign . US sensitivity for metastases detection varies depending on the examiner's experience and the equipment used and ranges between 40–80% . Sensitivity is conditioned by the size and acoustic impedance of the nodules. For a lesion diameter below 10 mm US accuracy is greatly reduced, reaching approx. 20%. Other elements contributing to lower US

Pulmonary enteric adenocarcinoma

Pulmonary enteric adenocarcinoma is rare subtype of pulmonary adenocarcinoma. Presentation The presentation is similar to that of other lung cancers. There is nothing in the radiological appearances that would suggest this particular histology. Two-thirds of reported cases have occurred in the right lung. The reason for this difference is not known and may be due to chance. Histology The typical histological appearance of this tumour of tall columnar cells arranged in an irregular glandular cavity or cribriform pattern with extensive central necrosis. The cells resemble those of the intestinal epithelium and colorectal carcinomas. Diagnosis Diagnosis of this type of lung cancer is by biopsy, histology and special staining. CT and colonoscopy to rule out a colonic primary are recommended. Treatment Optimal treatment for this condition is not known. Surgery to remove the lesion is the usual form of treatment. Whether radiotherapy or chemotherapy can offer any advantage is not known.

[Evaluation of the number of patients likely to require surgical treatment of hepatic metastases. Based on a series of 180 colorectal cancers].

The spontaneous prognosis of patients with hepatic metastases from colo-rectal cancer is poor in the short term: less than 10 p. cent will be alive after 2 years. Over recent years, several teams have obtained encouraging results after surgical resection of hepatic metastases. The aim of the present study was to evaluate the number of patients likely to require resection of hepatic metastases in a serie of 180 cases of colo-rectal cancer. 57 patients (30 p. cent) already had hepatic metastases at the time of the gastro-intestinal resection and only 3 underwent a simultaneous metastasectomy. In the other cases, the extent of the disease or the general condition of the patients contra-indicated a 2-stage resection. Among the 126 patients free of metastases at the time of the operation, 40 p. cent would have been excluded from hepatic resection in the event of secondary development of metastases because of the general clinical state. 75 patients were suitable for post-operative surveillance of hepatic metastases. We calculated that 20 of them might develop a hepatic metastasis without local recurrence of the colo-rectal cancer in the 2 years following the colonic resection, although of course we were unable to predict the type of metastasis or its accessibility to surgery. These figures may be useful as a guide to the development of a surveillance strategy.

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report.

Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor's partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.

[Yield of diagnostic tests in neoplasms of unknown origin. A retrospective study].

A retrospective analysis of 54 patients diagnosed of neoplasia of unknown origin between January 1983 and December 1987 are presented. The patients's characteristics, histologic type, localization of metastasis, diagnostic procedures used and their cost-effectiveness, treatment, survival, and percentage of diagnosis of primary disease, are studied by clinical follow-up o necropsy studies. Our results are compared with those described in the literature. Adenocarcinoma was the predominant histologic type (48%). The cost-effectiveness of diagnostic tests was practically none in those performed without a clear clinical sign of suspicion, and very low in those performed with a clinical suspicion. The over all survival was 13 months with an actuarial survival probability at 24 months of 34%. We highlight the importance of an organized and predetermined clinical approach in this kind of patients, performing complementary tests only under the suspicion of a sign, or if a disease has to be discarded before initiating active oncologic treatment.

Chondroblastoma

Rarely, more aggressive chondroblastomas can metastasize. The most common location for metastases is the lung, with some cases also involving secondary bone sites, soft tissue, skin, or the liver. The prevalence of metastatic chondroblastoma, however, is quite low and is believed to be less than 1%. There is no relationship established between metastasis and previous surgery, non-surgical treatment, anatomical location, or patient age. Survival of patients with metastatic lesions is better when the metastases are surgically resectable, as chemotherapy has been shown to have little to no benefit. Prognosis is bleak for patients with malignant chondroblastomas that are resistant to surgery, radiation, and chemotherapy. However, patients with resectable metastases have survived for several years following diagnosis.

[Not Available].

F. Lacaine Lymph node metastasis carries enormous prognostic weight in the evaluation of colon cancer and raises the question of how extensive a lymph node dissection should be. Lymph node dissection has several goals: 1) staging of the cancer at the time of intervention; 2) improving the chances for complete resection and cure; 3) evaluating the thoroughness and quality of a particular surgical procedure. The prognostic value of lymphadenectomy is evident from the direct practical decisions it entails: evidence-based recommendations (Level A) have proposed adjuvant chemotherapy for all patients with Stage III colon cancer since 1990. Studies have shown a statistically significant correlation between the number of nodes examined in an operative specimen and long-term survival in patients with Stage II disease. The more closely lymph nodes are examined, the more metastasis is found; one can then see the aberrations of stage migration described as the "Will Rogers Phenomenon." Without randomized studies, it is impossible to say whether resection of a larger number of lymph nodes actually improves the prognosis or whether that number is simply a marker of better surgical management including the quality of the surgical gesture, the careful pathologic examination of the specimen, and subsequent choices for adjuvant chemotherapy. The recovery of 12 lymph nodes correlates with a better global prognosis. At the very least, it is an effective marker for the quality of the surgical resection and can be used in the evaluation of professional practice.

[Not Available].

Krukenberg tumor

Treatment and prognosis Since Krukenberg tumors are secondary (metastatic), management might logically be driven by identifying and treating the primary cancer. The optimal treatment of Krukenberg tumors is unclear. The role of surgical resection has not been adequately addressed but if metastasis is limited to the ovaries, surgery may improve survival. The role of chemotherapy and/or radiotherapy is uncertain but may sometimes be beneficial. History Krukenberg tumors are named after Friedrich Ernst Krukenberg (1871–1946), who reported what he thought was a new type of primary ovarian malignancy in 1896; six years later these were shown to be of metastatic gastrointestinal tract origin. However, Paget had described the process in 1854. References External links Gastrointestinal cancer Ovarian cancer

Sister Mary Joseph's nodule as a presenting sign of internal malignancy.

CASE 1: A 64-year-old, otherwise healthy woman was referred to the surgery clinic for a presumed umbilical hernia. On physical examination, a cutaneous nodule was noted on the umbilical region and the patient was referred to the dermatology clinic. The patient was reexamined and an erythematous nodule was observed in the umbilicus measuring 2.5 cm in diameter. The patient denied pain, change in bowel habits, or weight loss. There were no other abdominal masses, no sign of ascites, and no regional lymphadenopathy. A skin biopsy from the nodule showed mucinous adenocarcinoma. Immunohistochemical staining was positive for carcinoembryonic antigen, and negative for cytokeratin (CK)7 and CK20. These results were consistent with a Sister Mary Joseph's nodule and led to the diagnosis of an occult colon carcinoma. The patient had no risk factors for colorectal carcinoma. The patient underwent surgery in another hospital, and died 3 months after the initial diagnosis of Sister Mary Joseph's nodule. CASE 2: A 73-year-old woman was referred to the dermatology clinic for evaluation of a painful, ulcerated, 3-cm lesion in the umbilicus (Figure 1). She was otherwise asymptomatic. A skin biopsy showed neoplastic glandular cells infiltrating among collagen bundles (Figure 2). Stainings for mucin and for CK7 were positive, while staining for CK20 was negative. An abdominopelvic CT scan demonstrated a 3.5-cm space-occupying lesion in the liver. Results of gastroscopy, colonoscopy, chest computed tomographic (CT) scan, and mammography were normal. Serum levels of the tumor-associated protein CA125 were elevated to 164 units, while those of CA 19-9 and carcinoembryonic antigen were within normal range. A gynecologic examination and a transvaginal ultrasound were normal. The patient had no personal or family history of any malignancy or any risk factors for developing a carcinoma. The patient was scheduled for a palliative resection of the umbilical nodule, combined with a laparoscopic inspection in search of the undetected primary tumor. She refused surgery and was lost to follow-up. She died 4 months after the initial diagnosis of umbilical metastasis. CASE 3: A 51-year-old man was aware of a silent mass in his umbilicus for 2 years without seeking medical advice. Following 2 weeks of increasing pain in this area, he was referred to the emergency room for a suspected incarcerated umbilical hernia. Surgery revealed a mass attached to the fascia and peritoneal fat. The mass was removed and diagnosed as a poorly differentiated adenocarcinoma, staining positively for carcinoembryonic antigen, and negatively for CK20, CK7, prostate-specific antigen, and prostatic acid phosphatase. Both gastroscopy and colonoscopy failed to detect the primary tumor. An abdominopelvic CT scan was normal, but a CT scan of the chest disclosed a nodule measuring 2.5 x 1.5 cm in the lower lobe of the right lung. On bronchoscopy, it was found to be an invasive adenocarcinoma, consistent with a primary tumor of the lung. The patient was a heavy smoker (45 pack-years). The patient received 4 cycles of combined chemotherapy with carboplatine and gemcitabine, with no improvement. A month later, the patient complained of abdominal pain. Following demonstration of intra-abdominal spread of disease by CT scan, a second line chemotherapy was instituted with paclitaxel. A month later the patient's condition deteriorated and he complained of cough, sweating, and pain along the right leg. A bone scan revealed bone metastases in the right femur and left tibia. Two weeks later he was admitted to the hospital with intestinal obstruction and underwent laparotomy. He had massive intra-abdominal spread of cancer and ascites. Only a palliative colostomy was performed. The patient died 3 weeks later, 9 months after the diagnosis of adenocarcinoma of the lung. The clinical data on the three patients are summarized in Table I.

[Pulmonary metastases of colorectal origin].

From January 1979 to December 1988, 18 patients with pulmonary metastases from colorectal cancers were operated in our division. This series included 11 men and 7 women (average age 57 years). The primary cancer was colic in 6 cases and rectal in 12. In 3 cases, the metastases were synchronous and discovered during the initial assessment. In 15 cases, they were metachronous, without symptoms in 12 cases and symptomatic in 3. These metastases were single in 14 cases, multiple in 3, bilateral in 1. They were peripheral in 15 cases. The histological diagnosis was obtained preoperatively in 5 cases (27.7%). The procedures uses were lobectomy for 11 patients, segmentectomy for 1, wedge resection for 10. Postoperative chemotherapy was given to 7 patients. Benign complications occurred in 2 cases during the postoperative period. No perioperative death was noted. One patient was lost to follow-up without recurrence after 1 year, 6 patients died from neoplastic evolution 4, 8, 15, 17, 22 and 28 months after being operated. In May 1989, 11 patients were still living: -2 scheduled for the excision of a contralateral lesion, -2 with pulmonary recurrence. 7 patients were alive without recurrence 12, 14, 17, 46, 52, 68 and 108 months after being operated. The probability of occurrence of pulmonary metastases in the evolution of colorectal cancer is estimated between 20 and 50%. Only 1% of the patients can be treated surgically. When screening these lesions, one must bear in mind that their appearance is sometimes quite delayed, and often asymptomatic. The repeated use of tracers is necessary but not sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal intussusception in a young women: unusual cause and specific management.

Intussusception in adults is a rare cause of abdominal pain that is often associated with organic pathology. We describe a case of ileocolic intussusception revealing a cecal adenocarcinoma in a young woman successfully managed by laparoscopic-assisted surgery adhering to oncological principles. A 30-year-old woman with a family history of colon adenocarcinoma in a young brother presented to our emergency department with a 2-month history of intermittent colicky abdominal pain accompanied by nausea and vomiting. Physical examination showed a palpable mass in the right lower quadrant of the abdomen. Computed tomography showed a 3-layered structure giving the characteristic target-shaped appearance in the ascending colon, highly suggestive for an ileocolic intussusception associated with right colic parietal thickening and an adjacent lymphadenopathy. Patient was planned for laparoscopic exploration and eventually definitive surgery. Intra-operatively, we found an ileocolic intussusception with thickening of the colic wall and slight proximal intestinal dilation. Multiple lymphadenopathies along the ileocecal artery were observed. Laparoscopic right hemicolectomy was performed following strict oncologic principles with "en bloc resection" and lymphadenectomy given the risk of an underlying malignancy. Considering this risk, previous reduction of the invaginated segments was not attempted and primary extracorporeal anastomosis was performed using manual sutures. Macroscopic examination of the resected specimen revealed a tumor mass of the caecal wall .The histological analysis identified a moderately differentiated tubular adenocarcinoma invading the serosa (T3) without permeation of the lymphatic or venous capillaries. No lymphatic metastasis of 28 nodes removed was seen. Postoperative course was uneventful and patient was discharged 5 days after surgery. Postoperative chest, abdomen, and pelvis CT scan were normal. Therefore, tumor is classified as stage II A (T3N0 M0).There was loss of MLH2 and MSH6 protein expression on immunohistochemistry findings reflecting a microsatellite instability phenotype, and the patient was followed up without adjuvant chemotherapy. Ileocolic intussusception rarely revealed a cancer in young adults. Laparoscopic surgery has a special interest in the diagnosis and treatment in this pathology. Oncogenetic consultation should be required in malignant lesion.

[Preoperative evaluation of cancers of the rectum].

The diagnosis of colorectal cancer must be considered in the presence of suggestive symptoms and must be endoscopy. Assessment of operability, including chest x-ray, is completed by CEA determination and x-rays of the colon, looking for a synchronous lesion. Complementary assessments must answer 3 questions: what operation needs to be performed, is any preoperative adjuvant treatment indicated, do any prognostic factors need to be identified before the operation. The treatment of cancer of the colon is now clearly defined; intraoperative hepatic ultrasonography and histological examination of the resection specimen provide all of the necessary data in the majority of the cases. In the presence of a cancer of the rectum, various therapeutic alternatives are available according to the site and stage of the tumour. The complementary assessment includes biopsy to confirm the malignant nature of the lesion, and measurement of the distance of the lower pole from the anal margin (digital rectal examination, endoscopy). A more precise preoperative staging by ultrasonography, computed axial tomography or magnetic resonance is required when the clinician considers that the invasive nature of the lesion justifies preoperative radiotherapy. This precise staging is fully justified in the presence of a small rectal tumour amenable to local resection. Although infiltration of the rectal wall is now very clearly defined, formal identification of metastatic lymphadenopathy still remains hazardous. Finally, the search for distant metastases by invasive and/or expensive techniques is indicated when looking for contraindications to surgery (high-risk patients, surgery for recurrence and metastases). In other cases, the presence of metastases does not contraindicate a palliative colonic resection and intraoperative exploration allows reliable identification of any liver metastasis.

Oligoastrocytoma

Treatment If resected, the surgeon will remove as much of this tumor as possible, without disturbing eloquent regions of the brain (speech/motor cortex) and other critical brain structure. Thereafter, treatment may include chemotherapy and radiation therapy of doses and types ranging based upon the patient's needs. Subsequent MRI examination are often necessary to monitor the resection cavity. Prognosis Even after surgery, an oligoastrocytoma will often recur. The treatment for a recurring brain tumor may include surgical resection, chemotherapy and radiation therapy. Survival time of this brain tumor varies; younger age and low-grade initial diagnosis are factors in improved survival time. References External links Brain and Spinal Tumors: Hope Through Research from the U.S. (National Institute of Neurological Disorders and Stroke) Brain tumor

[Patient selection and efficacy of tumor after-care in surgically treated colorectal carcinoma].

Scheduled follow-up after surgically treated colorectal cancer remains controversial because eventually only about 5% of patients profit from it. Careful selection should therefore spare those patients unnecessary investigations who are least likely to benefit from follow-up. Only patients should be considered whose tumor was completely resected and who were found free of distant metastases. These patients should be fully informed about their disease and accept scheduled investigation even if asymptomatic. A questionable operability with regard to a second surgical intervention forbids formal entry into a follow-up program as well as a decreased life expectancy due to other disease. The family physician is most qualified to carry out or coordinate these investigations. For the first two postoperative years intervals of three and for the further three years of six months are recommended. Physical examination and determination of CEA titers are the essential measures; colonoscopy, sonography, CT scans, chest X-ray, and for rectal cancer, endoluminal sonography are undertaken periodically. In such a selected cohort one can expect a resectable recurrence in 25% of patients, of which 20% can be cured.

HOHMS

During this period, all malignant lung tumors were considered equivalent for treatment purposes. In the early 1960s, small cell lung carcinoma (SCLC) was recognized for its unique biological behavior, including a much higher frequency of widespread metastasis at diagnosis, and a higher frequency of sensitivity to chemotherapy and radiation therapy. Early studies suggested that patients with SCLC fared better when treated with chemotherapy and/or radiation than when treated surgically, while non-small cell lung carcinoma (NSCLC) patients generally did better after surgery, and usually did not respond well to chemoradiation. This "traditional" paradigm, wherein treatment options for lung cancer patients were based on histological stratification into two highly heterogeneous groups (i.e. SCLC vs. NSCLC), remained the standard for approximately 30–40 years.