bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic therapy in disseminated melanoma
Authors: Rümke Ph.
Published: February 2007

There is no standard treatment for advanced melanoma. As long as metastases are satellites or in‐transit metastases localized in a leg or arm, the prospects for curative treatment by isolation perfusion are good. But as soon as metastases have spread via the circulation, curative treatment with cytotoxic agents becomes virtually impossible. When the tumor burden is not too extensive, however, palliative treatment can be of clinical value. Some combinations of cytotoxic agents or combinations of biologic response modifiers have been shown to induce worthwhile remissions. Toxicity remains a problem, however. The advantages of the newer immunological approaches, especially with interleukin‐2 (IL‐2) and T‐cell lymphocytes, is that treatment for a short period may result in good remissions at an early stage. Much clinical research is still needed to improve these costly approaches.
Cutaneous melanoma: Prognosis and treatment results worldwide
Authors: Balch Charles M.
Published: February 2007

This first metanalysis of melanoma from treatment centers worldwide consisted of 15,798 patients with localized melanoma (stages I and II) and 2,116 stage II melanoma patients with nodal metastases. Comparisons of dominant prognostic variables showed consistent results from center to center, despite the heterogeneity of the patient population. Six of eight centers that performed a multivariate analysis ranked ulceration among the first three most dominant prognostic factors. Men had a higher proportion of ulcerated lesions than did women. There was a positive correlation between ulceration and thickness. Patients with melanoma of the scalp had a worse prognosis than did those with lesions of the face and neck; those with melanomas on the hands had a significantly worse prognosis than did those with lesions on the arms or legs. In this study, women had a statistically significant survival advantage over men. Their melanomas arose in more favorable sites, were thinner, and less ulcerative and had a lower stage of disease at presentation. Stage 111 melanomas were more common in males, thicker, and more ulcerated and had a nodular growth pattern. Patients with clinically occult nodal metastases detected by pathological examination and those with a single metastatic node fared the best. Five of six centers identified the number of metastatic nodes to be the most significant prognostic factor. Distant metastases (stage IV were analysed at only two centers, which found that the number and site of metastases appeared to be the dominant prognostic features of stage IV melanoma. When all factors were analyzed in a Cox regression analysis, the dominant factors for stage IV melanoma patients were (I) the number of metastatic sites, and (2) the remission duration. There were no histologic criteria of the primary melanomas that predicted the patient's clinical course once distant metastases had developed.
Will multimodality therapy solve the enigma of long‐term survival for squamous cell carcinoma of the esophagus?
Authors: Locicero Joseph
Published: February 2007

Squamous carcinoma of the esophagus is a disease with a poor prognosis which fortunately occurs seldom in the United States. Because patients present with more advanced disease here, surgical therapy has not equaled results reported from Asia. Although, claims of equality have appeared in the literature, radiation therapy alone has not been very effective for this disease. There are a myriad of small reports which extol a variety of combined approaches. Based upon a review of these series it is obvious that a Phase III trial is required to establish the best multimodality therapy for management of squamous carcinoma of the esophagus. Components of such a trial are reviewed and suggestions are made for design and reporting of such a trial.
Efficacy of multimodality therapy in gastric adenocarcinoma
Authors: Jessup J. M. , Posner M. , Huberman M. , Loclcero J. , Stone M. , Stele G.
Published: February 2007

Multimodality therapy has not reproducibly improved the survival of patients with gastric adenocarcinoma. This is largely because the staging of disease has been imprecise and because the current regimens have only limited efficacy against advanced disease. Until staging is improved and active regimens are found, it will be difficult to identify synergism between surgery and other treatment modalities.
Laparoscopy/thoracoscopy for staging: II. Pretherapy nodal evaluation in carcinoma of the esophagus
Authors: Locicero Joseph
Published: February 2007

Many surgical studies show a significant stratification of survival following resection of esophageal cancer based upon accurate pathologic staging. However, investigators are moving away from single modality therapy toward multimodality trials for the treatment of this disease. This presents a problem in staging of patients before therapy is begun. Chemotherapy and/or radiation therapy may alter the local tumor characteristics and nodal metastases, thus confounding evaluation of treatment results. Although CT scanning and transesophageal ultrasound help in assessing nodal status, they have not reached the precision necessary for study purposes. Pretherapy nodal staging using video‐assisted exploration may provide the same level of accuracy as mediastinoscopy does for lung cancer.
Laparoscopic surgery for colon and rectal cancer
Authors: Bleday Ronald , Babineau Timothy , Forse R. Armour
Published: February 2007

Laparoscopic techniques are now being applied to increasing numbers of general surgical procedures. Technical feasibility, margins, number of lymph nodes, and recurrence rates need to be assessed with the application of this new technique to colon or rectal malignancies.

Technically, the right colon, sigmoid, and proximal rectum appear to be the most amenable to laparoscopic assisted or complete laparoscopic resection. Early results from a registry of laparoscopic assisted colectomies shows that there is no significant difference in the number of lymph nodes in the lymphovascular bundle compared to conventional colon resections. Early retrospective reports indicate that there may be a significant decrease in post op length of stay.

We conclude that the technique of laparoscopic assisted colectomy for colon or rectal cancer needs to follow the same oncologic principles as that of conventional surgery, and ultimately a trial will be needed to compare conventional and laparoscopic cancer resections of the large bowel.
Relevance of quality of life assessment to the evaluation of combined‐modality therapy
Authors: Shapiro Charles L.
Published: February 2007

Quality of life (QOL) assessment is a research tool which is incorporated into clinical trials to provide information about the ways in which the treatment affects the individuals sense of well‐being and his physical, psychologic, and social functions. In the appropriate setting QOL assessment offers additional endpoints, beyond the traditional response rates and survival durations, to evaluate cancer treatments in ways which can be particularly meaningful to patients. Selected aspects of QOL methodology and the application of QOL assessment to the evaluation of combined‐modality therapies for gastrointestinal cancers are discussed.
Diagnostic imaging and staging of primary lung cancer
Authors: Rubin Eva , Sanders Colleen , Harvey James C. , Beattie Edward J.
Published: February 2007

Improved diagnostic imaging has the potential to guide the surgeon in choice of invasive procedures required for staging and treatment of lung cancer.

In the evaluation of a solitary pulmonary nodule, absence of growth for 2 years or certain typical calcifications are strong evidence of benignity, but we do not advocate following indeterminate nodules without a diagnosis because even small nodules may be carcinomas. In assessing chest wall invasion, computed tomography has no greater predictive value than a history of localized pain. The absence of nodes greater than 1.0 cm in short axis diameter on computed tomograms of the thorax is associated with low risk of tumor in mediastinal nodes, but tissue diagnosis is required for certainty. The finding of nodes larger than 1.0 cm may be useful in guiding the surgeon during staging procedures. Currently, there is no advantage of magnetic resonance imaging over computed tomography in evaluation of mediastinal nodes.

Complete history and physical examination with routine serum chemistries will identify patients at high risk for metastases and will guide selection of appropriate special studies.

It is emphasized that accurate staging requires histologic diagnosis and that CT and thorough surgical evaluation of the mediastinum are complementary procedures in staging of lung cancer.
Intraoperative brachytherapy in non‐small cell lung cancer
Authors: Nori Dattatreyudu
Published: February 2007

The lung cancer incidence and mortality rates have risen steadily each year. Survival rates during the same period have improved marginally even by the best treatment approaches. A small proportion of patients with limited disease can be offered surgical resection as the primary curative treatment. In a significant number of cases, complete resection of cancer is not possible either because the patient could not tolerate radical surgical approach or because the tumor is attached to important structures in the mediastinum precluding any surgical intervention. Intraoperative brachytherapy by various techniques offers the greatest advantage in these patients to deliver higher doses of radiation to the tumor without damage to the normal lung. Numerous intraoperative brachytherapy techniques are described to adapt to different clinical situations.

Experience over the past 30 years has shown that these procedures are safe and well tolerated and can be used alone or as a boost in conjunction with external beam radiation. Published data show encouraging local control rates and survival compared with treatment by external radiation to higher doses.
Multidisciplinary approach to the treatment of locally and regionally advanced non‐small cell lung cancer: University of Miami experience
Authors: Sridhar K. S. , Thurer R. J. , Markoe A. M. , Chatoor H. T. , Fountzilas G. , Raub W. J. , Savaraj N. , Beattie E. J.
Published: February 2007

An intensive multimodality therapy protocol incorporating neoadjuvant chemotherapy was initiated in July 1985 for patients with either borderline resectable or unresectable non‐small cell carcinoma of the lung. Thirty‐five patients, 21 men and 14 women were entered till March 1991. The median age was 58 years (27–74). Histology was squamous in 15, adenocarcinoma in 11, large cell in 6, and adenosqua‐mous carcinoma in 3. Initial stages were IIIA in 19 patients, IIIB in 14 and II in 2. All patients tolerated preoperative chemotherapy with 5‐FU, etoposide and cisplatin (FED). The response to chemotherapy was complete response in 2 (6%), and partial response in 22 (63%). Thirty‐two patients underwent surgery. 26 patients were rendered disease free including two found disease free at surgery. Fifteen underwent pneumonectomy, 14 lobectomy and 3 biopsy only. Interstitial radiation therapy was used in 7 patients. The median survival of all patients was 19 months, those who underwent incomplete surgical resection was 12 months and patients rendered disease free at operation 21 months. Thirteen patients are alive and free of disease, including 6 patients alive longer than 5 years. Only patients who responded to chemotherapy and also had compete resection survived more than 2 years. Aggressive neoadjuvant therapy with FED, followed by resection, brachytherapy, postoperative radiation therapy, and adjuvant chemotherapy can be safely accomplished with encouraging survival in Stage III patients.
Simultaneous chemoradiation in advanced non‐small cell lung cancer
Authors: Pisch Julianna , Malamud Stephen , Harvey James , Beattie Edward J.
Published: February 2007

We designed our study to evaluate the safety and efficacy of simultaneous chemoradiation therapy in an accelerated, twice‐a‐day schedule to improve local control and survival in advanced lung cancer patients. Forty‐one patients were entered into the study. Twenty‐three had stage IIIB and 18 had stage IIIA disease. They received cisplatin 30 mg/m2, VP‐16 80 mg/m2, and 5‐Fluorouracil (5‐FU) 900 mg/m2 in iv infusion. Radiation therapy consisted of 2G twice a day for 5 days, followed by a 2‐week rest. This cycle was repeated 3 times. Patients were evaluated for surgical resection after the second cycle.

Acute toxicity was acceptable: 3 patients expired (1 congestive heart failure, 1 sepsis, 1 pulmonary embolism). The 1‐year actuarial survival was 60.3%; the 2‐year actuarial survival was 55.3%. Our results show that this regimen is well tolerated and that the 2‐year actuarial survival appears to be comparable to that reported in the literature.
Small‐cell lung cancer: An overview of issues in therapy
Authors: Wittes Robert E.
Published: February 2007

As one of the few chemo‐ and radiosensitive neoplasms among the common epithelial solid tumors of adults, small‐cell lung cancer has long tantalized clinical investigators. Although for the last 15‐20 years therapy has yielded high remission rates, including substantial complete remission rates, results have not improved very much over nearly two decades of intensive therapeutic research, and long‐term disease‐free survival remains an elusive goal for the large majority of patients. At this point the number of promising untested hypotheses in therapy is quite small, and major advances will probably have to await either the serendipitous discovery of much more active drugs than we now possess, or else the purposeful development of new approaches based on insights into the nature of the transformed state and the biology of SCLC itself.
Initial and reoperative pulmonary metastasectomy: Indications, technique, and results
Authors: Pogrebniak Helen W. , Pass Harvey I.
Published: February 2007

The ability to predict which patients will derive a survival benefit from pulmonary metastasectomy is limited. Most patients remain asymptomatic until the disease becomes advanced, and therefore computerized tomography (CT) of the chest has become the standard of care for follow‐up of patients at risk for pulmonary metastases. The most important predictor of post‐thoracotomy survival in patients at the National Cancer Institute with soft tissue, osteogenic, and pediatric sarcomas as well as melanoma and renal cell carcinoma has been the ability to render the patient disease‐free. Tumor histology, disease‐free interval, and possibly number of nodules are also determinants of survival. Median sternotomy is the preferred approach for initial and repeat metastasectomies and every effort should be made to preserve pulmonary parenchyma. Resection of pulmonary metastases has become an accepted therapeutic modality, but selection of surgical candidates, and operative planning needs to be individualized.
Surgery for small liver cancers
Authors: Makuuchi Masatoshi , Kosuge Tomoo , Takayama Tadatoshi , Yamazaki Susumu , Kakazu Tohoru , Miyagawa Shinichi , Kawasaki Seiji
Published: February 2007

During the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5‐year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.
Postoperative chemoimmunotherapy for the treatment of liver cancer
Authors: Uchino Junichi , Une Yoshie , Kawata Akira , Wakisaka Yoshitaka , Hosokawa Masuo
Published: February 2007

A randomized study using spleen‐derived lymphokine‐activated killer (LAK) cells in hepatocellular carcinoma (HCC) is reported. We induced cytotoxic lymphocytes from resected spleen of HCC. The effect of recombinant interleukin‐2 (rIL‐2)‐activated spleen cells for prevention of recurrence of HCC after hepatic resection was studied. Enough mononuclear cells could be harvested from the resected spleens. The induction of activated spleen cells was carried out by culture in fresh medium containing 1,500 JU/ml of IL‐2. The cytotoxicity of the activated spleen cells maintained high levels during the culture period ranging from 3‐30 days. These autologous activated spleen cells were administered to patients 2 days after the intra‐arterial infusion of Adriamycin. A randomized study using these spleen LAK cells resulted in lower recurrence rates in the LAK IL‐2‐treated group. No severe side effects were observed.

The lymphocytes derived from resected spleens were useful as the source of effector cells in clinical adoptive immunochemotherapy for HCC, because of their higher cytotoxicity and the simplicity of gaining a large amount of Cells. 0 1993 Wiley‐Liss, Inc.
Molecular genetics of APUDomas
Authors: Decker Ruth A.
Published: February 2007

It is tempting to speculate that genetic studies of the human APUDomas, particularly those of a hereditary nature, may ultimately provide valuable clues to the molecular basis of malignant transformation in cells of all types, uncover the mechanisms responsible for tumor progression, and perhaps decipher the signals important in the differentiation of normal neural crest‐derived tissue. Generally, several strategies have been used in the genetic analysis of these tumors with success. These include (1) cytogenetic examination of recurring chromosomal abnormalities in hopes of pinpointing critical neighboring growth regulatory sequences important in tumor evolution, (2) identification of dominant acting oncogenes in tumor cells, (3) search for recessive inactivated suppressor genes that may regulate cell growth by analyzing tumors for loss of heterozygosity (LOH), and (4) genetic linkage studies of kindreds affected with familial APUDomas to identify and subsequently characterize the predisposition gene using a positional or functional cloning approach. The results of these strategies as they have been employed in the investigation of cutaneous malignant melanoma (CMM), the dysplastic nevus syndrome (DNS), and the multiple endocrine neoplasia (MEN) syndromes are summarized.
Central and autonomic nervous system links to the APUD system (and their APUDomas)
Authors: Baylis Barry W. , Tranmer Bruce I. , Ohtaki Masafumi
Published: February 2007

The concept of the APUD system and the APUDomas associated with it has evolved significantly since Pearse's description in the 1960s. Part of this evolution has been an understanding of the relationships between the APUD system and the central and autonomic nervous systems. The APUD system now referred to as the diffuse neuroendocrine system, can be linked to the central nervous system and autonomic nervous system by genetics, embryology, cellular characteristics, anatomy, interaction of the systems, and the immune system. Awareness of these relationships may enable clinicians to better understand APUDomas and lead to better methods of detection of these tumours and their treatment.
Diagnostic advances in APUDomas and other endocrine tumors: Imaging and localization
Authors: McLeod Michael K. , Few Julius W. , Shapiro Brahm
Published: February 2007

The different diagnostic imaging modalities available for determining the location of the various APUDomas are discussed with reference to their advantages and disadvantages. The ability to image these lesions, and to be confident in their role in the underlying pathophysiology, and clinical neuroendocrine syndrome causing symptomatology and illness, has proved to be the key to successful treatment. In many instances it is not the diagnosis that is in question, but it is the extent of disease, the location of the lesion, or whether the anatomical abnormality under study is responsible for the complicating symptoms being considered, that are the crucial questions. The ability to locate APUDomas by a variety of direct and indirect imaging or regionalizing modalities, represent a magnificent advance in the management of these tumors. It should, however, be kept in mind that no one modality or diagnostic method can uniformly be relied upon. It is evident that a multimodal, interactive medical team approach is essential to the successful overall management of patients afflicted with these fascinating tumors.
Supportive care of the paediatric cancer patient
Authors: Corbally Martin T.
Published: February 2007

Cytotoxic therapy for paediatric malignancy continues to be associated with significant mortality and morbidity. However, survival figures continue to improve despite increasingly toxic treatment protocols. Aggressive supportive care, more than any other modality, has produced a dramatic reduction in mortality during the past 30 years, and includes the appropriate management of infection, provision of adequate nutrition, and proper use of blood and blood products. The paediatric surgeon plays an integral role in the multidisciplinary team of cancer management and together with other team specialists is responsible for the planning of surgical intervention and also ensuring the safe passage of immunologically impaired patients through the additional stress of surgery. This paper details essential aspects of supportive care as commonly practiced in paediatric patients undergoing therapy and surgery.
Extremity rhabdomyosarcoma: Biological principles, staging, and treatment
Authors: Laquaglia Michael P.
Published: February 2007

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and adolescence with 20% of the primary tumors anatomically located on extremities. It is a complicated entity that requires careful planning and coordination between the surgical oncologist and other members of the therapeutic team for successful treatment. Even with the most effective regimens more than 50% of patients will die from progressive, usually distant disease. Further progress may require new therapeutic agents or techniques. The surgical oncologist is a necessary and often prominent member of the team. Elements of the biological behavior, histopathology, clinical staging, and treatment of extremity rhabdomyosarcomas occurring in children are discussed. In particular, the importance of the alveolar subtype in determination of prognostic risk as well as new findings regarding the molecular biologic determinants of phenotypic behavior are mentioned. Finally, innovative methods of local control like regional arterial perfusion and rapid intraoperative brachytherapy are addressed.
Bladder/prostate rhabdomyosarcoma: Results of the multi‐institutional trials of the intergroup rhabdomyosarcoma study
Authors: Hays Daniel M.
Published: February 2007

Rhabdomyosarcomas (RMS) occurring in pelvic sites are almost entirely of the embryonal histologic subtype and are relatively responsive to chemotherapeutic agents. When treated by radical surgery, pelvic irradiation, and intensive chemotherapy for 2 years, survival rates of higher than 85% have been achieved. However, the effects of such therapeutic approaches have resulted in major changes in the quality of life of survivors, because of the loss of pelvic organs, primarily the bladder. Current efforts are directed towards achieving long range survival with procedures that are less extensive than pelvic exenteration or total cystectomy and by regimens that eliminate or reduce the intensity of radiotherapy. Until the past 5 years, these efforts have been relatively unsuccessful in both North America and Europe. However, the most recent studies of the IRS and European cooperative groups suggest that a majority of these patients can survive with intact pelvic organs when treated with currently available chemotherapeutic agents in conjunction with radiotherapy and limited surgery.
Management of hepatic epithelial malignancy in childhood and adolescence
Authors: Wheatley Jennifer M. , Laquaglia Michael P.
Published: February 2007

This review addresses the management of epithelial liver tumors of childhood and adolescence (hepatoblastoma and hepatocellular carcinoma), which constitute approximately 90% of primary liver malignancy in this age group. The epidemiology, pathology, clinical presentation, and diagnosis are given in order to appreciate differences in biological behavior of these two neoplasms and the need for a distinct therapeutic approach to each.

The multidisciplinary treatment of hepatoblastoma has become increasingly refined and long‐term survival can be expected in approximately 80% of patients. Where survival once depended solely on complete surgical resection, it is now also possible in patients with initially unresectable tumors due to effective cytoreductive chemotherapy. The problem of systemic relapse following complete surgical resection has been reduced although not eliminated by adjuvant chemotherapy programs. To date, the biological behavior of hepatocellular carcinoma prohibits complete resection in the majority of children and chemotherapy has not been effective. Early detection, development of new agents and techniques such as monoclonal antibodies and total hepatectomy with autologous transplantation in selected cases may offer hope for the future.
Mortality rates by stage‐at‐diagnosis
Authors: Clinton Kenneth
Published: February 2007

Mortality rates by stage‐at‐diagnosis are not possible from usual mortality data. Normally, mortality data are based solely on information provided on death certificates, and stage‐at‐diagnosis is not generally reported on these documents. However, mortality rates by stage are possible when one can link diagnostic data with mortality data. Population‐based cancer registries collect these types of data routinely in determining the survival of cancers in their registry. Thus, using cancer registry data, mortality rates by stage‐at‐diagnosis can be calculated. We report stage‐specific mortality rates for the Surveillance, Epidemiology, and End Results Program, representing 10% of the cancers in the U.S. for the four sites with the largest mortality rates for females and for males. For an individual site, the stage‐specific mortality rates allow one to determine how the different stages are contributing to the trends in all stage mortality. For example, distant disease mortality is the largest contributor to all stage cancer mortality for female and male lung cancer, female colorectal cancer, ovarian cancer, prostatic cancer and male pancreatic cancer. In contrast, regional disease mortality is the largest contributor to all stage cancer mortality for breast cancer and male colorectal cancer. In addition, localized disease mortality is the second largest contributor to all stage mortality for breast cancer and prostate cancer. © 1994 Wiley‐Liss, Inc.

This article is a U.S. Government work, and, as such, is in the public domain in the United Statesof America
Figo stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: An analysis of 1973‐87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina
Authors: Kosary Carol L.
Published: February 2007

The prognostic impact of FIGO stage, histology, histologic grade, age and race in survival for cancers of the female gynecological (cervix, endometrium, ovary, vulva, vagina) were examined using cases obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that were diagnosed between 1973 and 1987. Utilizing Cox proportional hazards modeling and relative survival rates analysis of 17,119 cases of cervical cancer indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, histological grade, lymph node status, and age at diagnosis were all independently prognostic. No evidence was found of survival differences between squamous cell carcinoma and adenocarcinoma. Younger women were not found to have a poorer prognosis, survival declined with increased age. Analysis of 41,120 cases of endometrial cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnostic, and race were all prognostic factors. Clear cell adenocarcinoma, leiomyosarcoma, and mixed mullerian tumors were all found to have poorer prognosis. Analysis of 21,240 cases of ovarian cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnosis, presence of ascites, and race were all prognostically significant. Analysis of 2,575 cases of vulvar cancer indicated that FIGO stage, histology, histologic grade, age, and race were all prognostically significant. Analysis of 916 cases of vaginal cancer indicated that FIGO stage, histologic grade, lymph node status, and age are all prognostically significant. Additional analysis of the data by combinations of independent prognostic factors indicates that the interaction of factors may be more predictive of outcome than any one factor separately. © 1994 Wiley‐Liss, Inc.

This article is a U.S. Government work, and, as such, is in the public domain in the United States of America.
Staging of bladder cancer
Authors: Gospodarowicz Mary K.
Published: February 2007

The definitive diagnosis of bladder cancer is established at cystoscopic examination and confirmed by means of a transurethral biopsy. A careful bimanual palpation of the bladder under anesthesia is an integral part of the initial assessment of each patient. The most important part of the assessment of patients with bladder cancer is a thorough pathologic examination of the biopsy material establishing the histo‐logic type of tumor, histologic grade, tumor configuration, depth of invasion of the bladder wall, and depth of the bladder wall available for assessment. If possible, the size of the tumor and the presence of associated carcinoma in situ should also be reported. Imaging studies play a smaller role in the clinical staging of bladder cancer. However, when initial staging procedures point to invasion of the muscularis propria, chest X‐ray, bone scan, and computed tomography scan of the abdomen and pelvis may provide valuable information about possible metastases. Whereas the clinical staging is essential to select and evaluate therapy, the pathologic stage (pTNM) provides the most precise data with which to estimate prognosis and calculate end results. The pathologic assessment entails resection of the primary tumor or a biopsy adequate to evaluate the highest pT category, removal of lymph nodes adequate to validate the absence of regional lymph node metastasis, as well as biopsy and microscopic examination for assessment of distant metastases. Although numerous factors have an impact on the behaviour of the malignancy, in bladder cancer the anatomic extent of disease reflected in the current staging classification remains the most powerful indicator of outcome. © 1994 Wiley‐Liss, Inc.
Expression of p185erbb2 and p21ras in carcinoma, dysplasia, and intestinal metaplasia of the stomach: An immunohistochemical and in situ hybridization study
Authors: Li Jiyou , Zhao Ailian , Lu Youyong , Wang Ying
Published: February 2007

The expression of p185erbB2 and p21ras was determined immunohisto‐chemically in normal mucosa, intestinal metaplasia, dysplasia and in intestinal and diffuse type carcinoma of the stomach. The positive rates of p185erbB2 and p21ras in intestinal type were significantly higher than those of diffuse‐type carcinoma. The results indicate that there are differences not only in clinical and biologic features, but also in molecular abnormalities between the two types of stomach cancer. Positive staining of cell membrane for p185erbB2 was observed specifically in intestinal type cancer, but not in the other lesions. Positive expression of p185erbB2 on the cell membrane appears to be a useful marker in identification of malignant change of gastric mucosa, as well as a late event of gastrocarcinogenesis. The results of in situ hybridization analysis in cancer tissues were consistent with those obtained by immunohistochemistry and demonstrated amplification of erbB2 gene at the mRNA level. No significant difference of p21ras expression was found among intestinal metaplasia, dysplasia, and intestinal type carcinoma; therefore, it might not be a specific marker of malignancy in gastric mucosa. Expression of p21ras may be an early event in the development of lesions predisposing to carcinoma. © 1994 Wiley‐Liss, Inc.
Prognostic value of depth and pattern of stomach wall invasion in patients with an advanced gastric carcinoma
Authors: Haraguchi Masaru , Yamamoto Manabu , Saito Atsushi , Kakeji Yoshihiro , Orita Hiroyuki , Korenaga Daisuke , Sugimachi Keizo
Published: February 2007

We reviewed data on 467 patients with advanced gastric carcinoma, taking into consideration tumor size, shape and depth of invasion, and growth pattern, either expanding or infiltrative. Three patterns of penetration were identified: i.e., funnel, column, and mountain patterns. The funnel pattern was predominant in tumors extending into the muscularis propria (pm) or subserosa (ss), and were more widely distributed than the column pattern. The majority of the column type tumors were less than 8 cm in pm or ss, and the mountain type was found in only one case in ss, but their size was widely distributed once cancer cells penetrated the serosa. Patients with the funnel type had a better prognosis than the column or the mountain type, and the difference was significant when cancer invasion extended to the serosa. © 1994 Wiley‐Liss, Inc.
Expression of P‐glycoprotein influences resistance against anthracyclines in clinical gastric carcinomas
Authors: Orita Hiroyuki , Maehara Yoshihiko , Anai Hideaki , Baba Hideo , Kusumoto Hiroki , Korenaga Daisuke , Sugimachi Keizo
Published: February 2007

In 58 human gastric cancers, the expression of P‐glycoprotein (P‐gp) was evaluated immunohistochemically and chemosensitivity was determined using the in vitro succinate dehydrogenase inhibition (SDI) test. Tumors which contained over 75% stained cells were scored as positive, and 14 of 58 cases (24%) were positive. There was no significant correlation between P‐gp expression and clinicopathologic features. The succinate dehydrogenase (SD) activity for each drug of P‐gp positive and negative tumors was as follows: 81.8 ± 15.2% vs. 66.3 ± 16.1% for Adriamycin (ADM), 75.5 ± 14.2% vs. 59.1 ± 17.6% for aclacinomycin A (ACR), 71.7 ± 15.0% vs. 61.1 ± 14.0% for mitomycin C (MMC), and 57.5 ± 18.4% vs. 47.0 ± 16.7% for cisplatin (CDDP). The increase in SD activity was evident in P‐gp positive tumors compared with negative ones in cases of ADM (P = 0.0044), ACR (P = 0.0105), and MMC (P = 0.0353). We suggested that P‐gp expression is closely related to chemosensitivities of human gastric cancers to anthracyclines. © 1994 Wiley‐Liss, Inc.
Clinical value of SDI test for predicting effect of postoperative chemotherapy for patients with gastric cancer
Authors: Baba Hideo , Takeuchi Hideya , Inutsuka Sadaaki , Yamamoto Manabu , Endo Kazuya , Ohno Shinji , Maehara Yoshihiko , Sugimachi Keizo
Published: February 2007

We retrospectively evaluated the clinical usefulness of the succinate dehydrogenase inhibition (SDI) test as a chemosensitivity test, using 168 resected specimens of gastric cancer, with special reference to the correlation between the results of the SDI test and clinical effects of the corresponding chemotherapy. The rate of sensitivity of these tissues to DDP, CQ, ACR, MMC, ADM, and 5‐FU were 63.5%, 54.2%, 47.4%, 42.9%, 31.4%, and 10.8%, respectively. Survival rates for patients with a positive chemosensitivity to MMC and postoperatively prescribed more than 20 mg of MMC were significantly better than those without sensitivity to MMC, even when treated with MMC, although no statistical differences existed in clinicopathologic factors between the two groups. We conclude that the SDI test for human gastric cancer is a rapid, reliable, and useful assay to determine the compatibility between the results of assay and the clinical effects of corresponding chemotherapy. We propose that the regimen of postoperative adjuvant chemotherapy be tailored according to results of the SDI test, using tissues resected from individual patients. © 1994 Wiley‐Liss, Inc.
Aspirin and the prevention of colorectal cancer: A review of the evidence
Authors: Paganini‐Hill Annlia
Published: February 2007

In all but one of seven recent epidemiologic case‐control and cohort studies directly examining the association between aspirin and colorectal cancer and polyps, regular aspirin use reduced the risk of these diseases by about half. Although these studies show a biologically plausible relationship between aspirin and colorectal cancer, information regarding dose and duration and risk change after discontinuation of aspirin is limited and contradictory. Additionally, selection bias, recall bias, and confounding cannot be completed discounted. The one randomized trial of aspirin and placebo showed that aspirin at a dose adequate for preventing myocardial infarction (325 mg every other day) did not reduce colorectal cancer incidence during five years of randomized treatment and follow‐up. Further studies need to determine the biologic effects of aspirin, the minimum dose required, and whether other factors, such as age, illnesses, and reasons for aspirin use, modify or confound colorectal cancer development. © 1994 Wiley‐Liss, Inc.
Is there a role for clinical prognostic factors in staging patients with colorectal cancer?
Authors: Nathanson S. David
Published: February 2007

The clinician treating colorectal cancer (CRC) should be able to predict which patients will live and which will die from their tumor. Many prognostic variables, significant in retrospective analyses, are never formally used in staging. The resultant imperfection of clinical predictions of survival are probably directly related to the relative inaccuracy of the staging system, a system inevitably dependent entirely on pathologic criteria. Potentially valuable clinical variables, sometimes associated with better or worse outcome despite the pathologic stage of disease, could improve the accuracy of prediction. Evolution to better clinico‐pathologic staging systems would also help to better stratify patients in prospective randomized trials of new adjuvant therapeutic modalities. © 1994 Wiley‐Liss, Inc.
Nutritional assessment and the role of preoperative parenteral nutrition in the colon cancer patient
Authors: Vitello Joseph M.
Published: February 2007

Hospital‐based malnutrition is prevalent, especially among patients with gastrointestinal malignancy. Colorectal cancers produce malnutrition through impairment of gastrointestinal function and the liberation of cytokines. Malnourished patients who undergo operation have an increased likelihood of perioperative morbidity and mortality. The performance of a nutritional assessment will aid in the recognition of such patients and provide a risk assessment profile. Preoperative parenteral nutrition is a major expense and delays surgical intervention. Studies to document the efficacy of preoperative parenteral nutrition suffer from design flaws and small sample sizes. Studies that exclusively address patients with cancer of the colon and rectum are absent; therefore results must be extrapolated from the existing literature. Cumulative evidence suggests that a 7‐10 day period of parenteral nutrition repletion in the severely malnourished patient will diminish the incidence of postoperative septic complications and mortality. The preoperative treatment of lesser degrees of malnutrition remain controversial. Once the decision has been made to institute preoperative parenteral alimentation, attention to the details of protein requirements and caloric needs should be stressed. The endpoint of therapy is poorly defined. The role of glutamine, arginine, omega‐3 fatty acids, and growth hormone in the preoperative repletion process provide an exciting arena for future research. © 1994 Wiley‐Liss, Inc.
Technical considerations in the surgical treatment of colon and rectal cancer
Authors: Fengler Scott A. , Pearl Russell K.
Published: February 2007

Surgery is the primary mode of therapy for colorectal cancer. Advances beyond exteriorization began to appear at the end of the nineteenth century. The antibiotic era brought on more advances. Dogma abounds with respect to the technical aspects of surgery for colon and rectal cancer and few randomized, prospective trials have been done to evaluate the importance of these techniques. Firmly established are the techniques of resection of lymphatic drainage of tumors, en bloc resection of invaded structures, and obtaining at least 2 cm margins of rectal cancers. Radical lymph node dissection, luminal ligation, oophorec‐tomy, and the “No‐Touch Technique” are discussed. Despite the paucity of irrefutable scientific data to support many of the described surgical techniques, differences in outcome between surgeons suggest that technique is important. There is great need for randomized, prospective trials to evaluate the multitude of techniques described for the surgical treatment of colorectal cancer. © 1994 Wiley‐Liss, Inc.
Perineal reconstruction with continent colostomy after the miles operation
Authors: Santoro Emanuele , Santoro Roberto , Santoro Eugenio
Published: February 2007

Since the beginning of the century, different surgical procedures have been employed to create new anal sphincters for a continent perineal colostomy after abdominal perineal anorectal resection for cancer.

After a detailed review of all the currently employed surgical procedures, the authors present their experience with 15 cases treated by transposition of the gracilis muscles to the perineum.

More than 50% of the operated patients had good functional results with complete continence for solid stools and sufficient control of the stimulus. Poor results are related to surgical complications or unexpected postsurgical diseases and cancer recurrence or metastases. This surgical procedure seems to be an interesting possibility for selected patients in the case of a permanent abdominal incontinent colostomy after the Miles operation. © 1994 Wiley‐Liss, Inc.
Optimal follow‐up in colorectal cancer patients: What tests and how often?
Authors: Kronborg Ole
Published: February 2007

Patients' benefit from follow‐up examinations after curative surgery for colorectal cancer is unproven in spite of numerous different programs' having been designed for that purpose. Unfortunately, no final results from prospective randomized studies have been published yet and no ideal marker for recurrent cancer is available to identify patients in whom new curative treatment may be possible. So far, screening for metachronous neoplasia with intervals of several years may influence survival, whereas benefit from detecting recurrent colorectal cancer may be claimed only by using historical or other inappropriate controls. The tradition of follow‐up is expensive and prospective evidence for any cost benefit is needed to justify continuous use of our limited resources in this area of patient care. © 1994 Wiley‐Liss, Inc.
Etiology, biology, and epidemiology of ovarian cancer
Authors: Baker Trudy R. , Piver M. Steven
Published: February 2007

Epithelial ovarian cancer kills more women per year than all other gynecologic cancers combined. Pregnancy, oral contraceptive use, and tubal ligation decrease the risk of the disease, whereas risk is increased for women whose family history is consistent with one of the familial ovarian cancer syndromes. Several theories have been postulated concerning the etiology of ovarian cancer, including the incessant ovulation theory and that based on the model of hypergonadotropic hypogonadism. Chromosomal abnormalities and allele losses have been described in ovarian cancers. Involvement of oncogenes and tumor suppressor genes has been investigated as well. Genetic linkage studies are ongoing in families whose history is consistent with one of the familial ovarian cancer syndromes. © 1994 Wiley‐Liss, Inc.
Histopathology of ovarian cancer
Authors: Gore Hazel
Published: February 2007

Ovarian tumors which form a complex group due to the variety of tissues composing the ovary are classified according to world health organization criteria with minor variations. The histopathology of the most common ovarian carcinomas, common epithelial tumors and germ cell tumors is discussed in detail. © 1994 Wiley‐Liss, inc.
Surgical management of ovarian cancer
Authors: Farias‐Eisner Robin , Kim Young B. , Berek Jonathan S.
Published: February 2007

Although several surgical approaches to the diagnosis and management of epithelial ovarian cancer are now standard, surprisingly few prospective data exist to support many of these procedures. However, retrospective data have accumulated over the past decade, much of it very recent, which allow clinicians to make informed decisions regarding most of the commonly performed procedures. This review is an attempt to critically evaluate the best available data regarding the following procedures: primary surgical staging, primary cytoreductive surgery, second look laparotomy and secondary cytoreductive surgery, and palliative surgery for relief of bowel obstruction. We conclude that there is evidence to support the continued use of primary surgical staging and primary cytoreductive surgery. However, data in support of second look laparotomy and secondary cytoreductive surgery are lacking, and we recommend that these procedures not be performed on a routine basis. Finally, we conclude that palliative surgery is hazardous at best and results in questionable benefits for most patients. © 1994 Wiley‐Liss, Inc.
Second‐look laparotomy
Authors: Moore James L , Barter James F.
Published: February 2007

The second‐look laparotomy has become an important means of assessing therapy response in ovarian cancer patients. This procedure enables the gynecologic oncologist to diligently search for small volume persistent disease, which often escapes detection by less invasive means. Subsequent treatment, if required, may then be tailored to the initial biologic response to therapy. However, many patients with negative findings at second look will develop recurrent disease, dampening enthusiasm for the operation. Although controversial, this procedure remains the gold standard for the detection of disease status following chemotherapy for ovarian cancer. © 1994 Wiley‐Liss, Inc.