Symptomatology, localization and treatment of recurrent cervical carcinoma

1992 ◽  
Vol 2 (4) ◽  
pp. 179-188 ◽  
Author(s):  
D. J. Tinga ◽  
J. Bouma ◽  
H. Boonstra ◽  
J. G. Aalders
Keyword(s):  
Complete Remission ◽  
Tumor Recurrence ◽  
Lung Metastases ◽  
Distant Metastases ◽  
Primary Treatment ◽  
Vaginal Wall ◽  
Asymptomatic Stage ◽  
Permanent Remission ◽  
Vaginal Recurrence

In a group of 367 women treated for invasive carcinoma of the cervix tumor recurrence was discovered at an asymptomatic stage in 16 (23%) patients. The tumor recurrence was localized to the pelvis in 29 (41%) cases, in the vaginal wall in 3 (4%) cases, and 39 (55%) patients had distant metastases (with or without recurrent tumor in the pelvis). Curative treatment (surgery,n= 2; radiotherapy,n= 8) was applied in 5/29 (17%) patients whose recurrent disease was confined to the pelvis, in all 3 patients with vaginal recurrence and in 2/39 (5%) of the patients with distant metastases. Permanent remission (follow-up > 36 months) was observed in 2 patients with vaginal recurrence and in one with central recurrence. Temporary complete remission (mean 22 months, range 12–30 months) was observed in 3 patients (2 with central recurrence and one with vaginal recurrence). In 20 (69%) of the patients with central or locoregional recurrence, the primary treatment had been so radical (including adjuvant postoperative or full radiotherapy) that surgical treatment or radiotherapy of the recurrence was not considered possible or worthwhile; moreover, 4 of the patients were older than 80 years of age. In retrospect, exenterative treatment could have been considered in 14 patients (< 70 years) and based on 50% operability, could have led to a cure in 2 to 4 patients with tumor recurrence in the pelvis without distant metastases. Chemotherapy was applied to 10 patients, one of whom went into complete remission of lung metastases (follow-up 108 months).

CEA, CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): A prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS11627-TPS11627 ◽  
Author(s):  
Claudio Zamagni ◽  
Massimo Gion ◽  
Luigi Mariani ◽  
Petra Stieber ◽  
Daniela Rubino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Trial ◽  
Fdg Pet ◽  
Distant Metastases ◽  
Primary Treatment ◽  
Asymptomatic Patients ◽  
Clinical Scenarios ◽  
New Findings ◽  
The Impact

TPS11627 Background: Current recommendations for breast cancer (BC) surveillance in asymptomatic patients (pts) include only mammography and physical examination and arise from two trials conducted in the 80’s. Since then new findings about BC biology, treatment and the introduction of cutting-edge diagnostic technologies such as 18-FDG PET have deeply modified our clinical scenarios. The aim of this prospective randomized trial is to verify if the serial measurement of CEA and CA15-3 followed by 18-FDG PET can anticipate the diagnosis of BC recurrence compared to control arm by estimation of the difference of restricted mean survival time (RMST) between the two arms. If the end-point will be met a subsequent extension trial will investigate the impact of the earlier diagnosis of distant metastases on survival. Methods: Pts diagnosed with stage I-III BC, who underwent adequate surgery are eligible. Special histologies and low-risk cases according to St. Gallen criteria are excluded. The study includes pts at the beginning of the follow-up after the conclusion of primary treatment (cohort 1), and pts that have concluded without relapse the first 5 years of follow-up (cohort 2). Eligible pts will be randomized in a 1:1 ratio to follow-up according to local practice (control arm) or to three-monthly serial dosing of CEA and CA15-3 and subsequent 18 FDG-PET only in case of an increase of CEA and/or CA 15.3 greater than a critical difference compared to baseline (experimental arm). The following stratification factors will be used: node negative vs positive, HER2 negative vs positive, ER positive vs negative. Eight-hundred pts will be enrolled over 3 years. For such a calculation, we made the assumption of a 20% baseline 5-year incidence of relapse. The target reduction of three months in RMST implies a median time of diagnostic anticipation, conditional on having BC recurrence, of 10 months. The follow-up will continue until 10 years from surgery. Since 23rd October 2014 573 pts have been enrolled. The present trial was approved by the Ethical Committee of each participating centre and is registered on Clinical trial information: NCT02261389.

Thyroid Cancer in Childhood

1978 ◽  
Vol 64 (6) ◽  
pp. 649-657 ◽  
Author(s):  
Roberto Doc ◽  
Silvana Pilotti ◽  
Alberto Costa ◽  
Giancarlo Semeraro ◽  
Natale Cascinelli
Keyword(s):  
Thyroid Cancer ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Distant Metastases ◽  
Papillary Adenocarcinoma ◽  
The Other ◽  
External Irradiation ◽  
Radioiodine Treatment ◽  
Node Dissection

From 1956 to 1975 21 patients (13 females and 8 males) with thyroid cancer developed by age 14 have been observed at the Istituto Nazionale Tumori of Milan. Follicular adenocarcinoma was diagnosed in 4 cases and papillary adenocarcinoma in 17. Five patients (24%) had been given previous cervical irradiation for benign conditions. At admission lung metastases were evident in 2 patients (one affected by follicular and the other by papillary adenocarcinoma). All patients were submitted to surgical treatment, which in most cases consisted in total thyroidectomy plus elective lymph node dissection; serious postoperative complications were not observed. External irradiation was given to 4 patients, since surgery had not been radical. Radioiodine treatment was performed in the 2 patients with lung metastases: in the patient with follicular adenocarcinoma metastases disappeared after 131I treatment, whereas in the other one they still persist unmodified 10 years later. A local recurrence occurred in 3 cases and pulmonary metastases in one: all of them made an apparent recovery after surgical and/or radioiodine treatment. All patients are alive and, except one, without evidence of disease after a follow-up period from 14 months to 21 years. Although differences in evolution have been noted according to the histotype, the prognosis of thyroid cancer in childhood is good, evenif distant metastases are present.

scholarly journals A new functional parameter measured at the time of ablation that can be used to predict differentiated thyroid cancer recurrence during follow-up

2007 ◽  
Vol 156 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Robbert B T Verkooijen ◽  
Daphne Rietbergen ◽  
Jan W Smit ◽  
Johannes A Romijn ◽  
Marcel P M Stokkel
Keyword(s):  
Thyroid Cancer ◽  
Tumor Recurrence ◽  
Differentiated Thyroid Cancer ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Tumor Stage ◽  
Ablation Therapy ◽  
Initial Stage ◽  
Uptake Rates

Background: This study addresses the questions whether patients with a high risk for recurrent thyroid cancer can be identified at initial stage, i.e. at the time of ablation. Methods: We evaluated tumor recurrence in consecutive patients treated for differentiated thyroid cancer (DTC). Prognostic factors were statistically analyzed. We defined prognostic parameters based on thyroglobulin (Tg) levels, 24-h I-131 uptake rates and TSH values: (a) Tg/TSH, (b) Tg/24-h I-131 uptake value, and (c) Tg/(TSH×24-h I-131 uptake). Results: We included 190 patients (50 male, 140 female; mean age 47 years) with DTC for analysis, 146 without distant metastases and 44 with M1 tumor stage at initial presentation. The mean period of follow-up was 10.4 years (s.d. ± 3.7 years). In 18 out of the 146 DTC patients with M0 disease (12.4%), tumor recurrence was found during follow-up. Although tumor stage, age, and standard biochemical values significantly differ between patients with and without recurrent disease or between patients with M0 and M1 tumor stage, the newly defined parameter Tg/(TSH×24-h I-131 uptake) was the best independent significant prognostic parameter in the assessment whether patients will develop a tumor recurrence during follow-up or not. Conclusion: High Tg/(TSH×24-h I-131 uptake) ratios justify an adjustment of the I-131 activity for ablation therapy. To assess the optimal cut-off value for a dose adjustment, however, further studies are required in more patients, but the initial results are encouraging with respect to improving outcome in DTC patients.

Efficacy and safety of radioiodine in the treatment of disseminated differentiated thyroid cancer (DTC) in children

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10065-10065
Author(s):  
D. Handkiewicz-Junak ◽  
J. Roskosz ◽  
A. Kropinska ◽  
J. Kozielski ◽  
A. Krzywiecki ◽  
...  
Keyword(s):  
Lung Fibrosis ◽  
Radioiodine Therapy ◽  
Lung Metastases ◽  
Distant Metastases ◽  
Treatment Results ◽  
Increased Risk ◽  
Focal Fibrosis ◽  
Radioiodine Scan

10065 Background: Distant metastases, mainly to lung are diagnosed in about 20% of children with DTC. At present radioiodine is the treatment of choice in that case. However, it can results in massive lung fibrosis as was showed in historical groups of patients.The aim of this retrospective study was to evaluate results of radioiodine therapy in children and its long-term safety. Methods: From 235 children (median age 13.9) diagnosed either with papillary (82%) or follicular cancer (18%), 42 (17.9%) had lung, and 2 (9%) bone metastases (median time of observation 105 months). All were treated with radioiodine (accumulated activities 100 to 950 mCi). Treatment results were evaluated by means of scintigraphic, radiological, and biochemical examinations. 28 (67%) of the children were lately re-evaluated with high resolution CT, ultrasound, biochemistry, and spirometry. Results: In most children, 29/44 (66%), distant metastases were diagnosed in radioiodine scan while radiological examinations were normal. Complete scintigraphic and radiological remission was achieved in 38 (86%) children. In all children there was a decrease in thyroglobulin serum concentration after radioiodine therapy. However, it normalized at the last radioiodine treatment only in 13 (29%) cases. During follow-up Tg continued to decrease and at the last stimulated Tg evaluation it was < 10 ng/ml in 28 (64%) patients. In 5/28 (18%) of the children with lung metastases some small foci of focal lung fibrosis were diagnosed with CT. However, comparable percentage of focal fibrosis was observed in DTC children without lung metastases. Also the preliminary results didn't show an increased rate of abnormal spirometry results. Conclusions: Complete remission of distant metastases can be achieved in about 85% of children with DTC treated with radioiodine. This therapy is safe and does not cause any increased risk of lung fibrosis even in children treated with repeated courses of radioiodine. No significant financial relationships to disclose.

scholarly journals Surgical management of a case of recurrent carcinoma cervix: a case report

2020 ◽  
Vol 9 (4) ◽  
pp. 1721
Author(s):  
B. Kalpana ◽  
S. G. Balamurugan ◽  
Soumya Ranjan Panda
Keyword(s):  
Performance Status ◽  
Distant Metastases ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Pelvic Lymphadenectomy ◽  
Carcinoma Cervix ◽  
History Of

Worldwide cervical cancer is the fourth most common cancers among females. Pelvic recurrence, distant metastases, or a combination of both can occur in patients of carcinoma cervix. A 42-year-old P2L2 with a history of carcinoma cervix stage 3-b came to our OPD for routine follow up. Two year back she was managed with chemoradiation for her primary carcinoma which had parametrium extension. There was a 1 × 1 cm lesion on the anterior vaginal wall which was diagnosed to be cervical recurrence. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Patient is disease free till now. Treatment decisions should be individualised based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment.

scholarly journals Investigation of Recurrent Cases of Head and Neck Cancer after Initial Treatment

2019 ◽  
Vol 02 (01) ◽  
pp. e11-e17
Author(s):  
Ryosuke Kitoh ◽  
Kentaro Mori ◽  
Shin-ichi Usami
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Clinical Examination ◽  
Neck Cancer ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Primary Treatment ◽  
Regional Recurrence ◽  
Pet Ct

AbstractThe optimal follow-up strategy for patients with head and neck cancer after primary treatment is still under debate. This study aimed to review the data of patients with recurrence and evaluate our follow-up strategy. Patients with head and neck cancer who underwent surgery or chemoradiotherapy as the primary treatment between 2012 and 2016 were enrolled. All the patients were carefully followed up at our institution via intensive clinical examination and routine computed tomography (CT) and positron emission tomography (PET)/CT. Recurrence was detected in 20 of the patients treated by surgery and 25 of 96 patients treated by chemoradiotherapy. In more than 90% of the patients, recurrence occurred within 2 years of the primary treatment. Among the patients with recurrence, 11 showed local recurrence, 17 showed regional recurrence, and 17 others showed distant metastasis. In almost all patients with distant metastases, recurrence was detected using CT or PET/CT, whereas among the patients with local or regional recurrence, recurrence was detected based on the patients' complaints and their clinical examination results. Only salvage surgery was observed to be associated with disease-free survival after recurrence. Thus, analysis of the recurrence patterns and appropriate surveillance can result in improved salvage treatment for patients with recurrence.

scholarly journals Complete remission of Cdx-2 positive primary testicular carcinoid tumor: 10-years follow-up and literature review

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Eugen Widmeier ◽  
Hannah Füllgraf ◽  
Cornelius F. Waller
Keyword(s):  
Complete Remission ◽  
Literature Review ◽  
Carcinoid Tumor ◽  
Unknown Origin ◽  
Distant Metastases ◽  
Metastatic Tumor ◽  
Carcinoid Tumors ◽  
Neuroendocrine Cells ◽  
Significant Past Medical History

Abstract Background The neuroendocrine cells can cause a variety of malignancies throughout the human body known as the neuroendocrine tumors (NETs) or carcinoid tumors. The primary testicular carcinoid tumor (PTCT) accounts for less than 1% of the testicular neoplasms and for only 0.2% of all carcinoid tumors representing already a very rare neoplastic entity. Here, we present a patient with a history of an exceptionally rare primary testicular carcinoid tumor, staining positive for Cdx-2 along with a literature review. Case presentation A 44-year old patient without significant past medical history was diagnosed in September 2009 with primary testicular carcinoid tumor, which was surprisingly staining positively for Cdx-2, too. At the time of the initial diagnosis the tumor was already showing histopathological infiltration of veins. DOTA-TATE-PET/CT imaging and endoscopy studies did not show any signs of distant metastases and in particular no gastrointestinal manifestation following no further medical indication for systemic chemotherapy. The continuous and close follow-up of the patient has reached a total of over 10 years at the time of publication remaining in complete remission. Conclusion The diagnosis of primary testicular carcinoid is based on histopathology. The detailed histopathologic assessment of biomarkers based on immunohistochemistry is very important for the classification and the prognosis of the primary testicular carcinoid tumor. Primary testicular carcinoid tumor with Cdx-2 positive stain outlines an exceptionally rare neoplastic entity without a consensus about general follow-up guidelines, requiring close clinical and imaging aftercare and consideration in Cdx-2 positive metastatic tumor of unknown origin.

Adrenocortical carcinoma in children: a study of 40 cases.

1990 ◽  
Vol 8 (1) ◽  
pp. 67-74 ◽  
Author(s):  
R C Ribeiro ◽  
R S Sandrini Neto ◽  
M J Schell ◽  
L Lacerda ◽  
G A Sambaio ◽  
...  
Keyword(s):  
Complete Remission ◽  
Adrenocortical Carcinoma ◽  
Tumor Size ◽  
Abdominal Mass ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
The United States ◽  
Primary Treatment ◽  
Lost To Follow Up

Adrenocortical carcinoma (ACC), a very rare tumor in children in the United States, is apparently more common among Brazilian children. We reviewed the medical records of 40 children whose disease was diagnosed between 1966 and 1987. There were 12 boys and 28 girls; their median age was 3.9 years (range, 1 day to 15.7 years). Virilization was the most common clinical sign (37 of 40); other signs included abdominal mass, deepened voice, plethora, hypertension, seizures (seven patients) and, rarely, weight loss (two patients). The median time between first signs or symptoms and diagnosis was 1.4 years (range, 3 days to 5 years). Four of 33 tumors were classified as benign according to the Weiss, van Slooten, or Hough systems (tumor tissue was unavailable for seven patients). Tumors were completely resected in 26 of 38 patients; of those, 17 are in continuous complete remission, five relapsed, and four have been lost to follow-up. One patient, who had local recurrence, has been in a third complete remission for 18+ months after tumor resection and chemotherapy (cisplatin and etoposide). Of the remaining 14 patients, 11 died of progressive disease, the diagnosis was confirmed at autopsy in two, and one has been lost to follow-up. Univariate analysis disclosed that age greater than or equal to 3.5 years at diagnosis, interval of greater than or equal to 6 months between first symptoms and diagnosis, tumor weight greater than 100 g, tumor size greater than 200 cm3, and high levels of urinary 17-ketosteroids (17-KS) and 17-hydroxycorticosteroids (17-OH) were associated with an unfavorable outcome. Multivariate analysis disclosed that only a tumor size greater than 200 cm3 independently identifies those patients with an unfavorable prognosis. Among the variables known before surgery, age, and the interval between first symptoms and diagnosis were important predictors of outcome. Our data suggest that some children with ACC and certain clinical characteristics are at high risk of primary treatment failure and, therefore, are good candidates for investigational adjuvant therapy.

Who Actually Detects Relapse in Hodgkin Lymphoma: Patient or Physician?.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3124-3124 ◽  
Author(s):  
Lynda M. Foltz ◽  
Kevin W. Song ◽  
Joseph M. Connors
Keyword(s):  
Complete Remission ◽  
Hodgkin Lymphoma ◽  
Clinical Laboratory ◽  
Initial Therapy ◽  
Primary Treatment ◽  
Physical Exam ◽  
Limited Stage ◽  
Stage Disease ◽  
Therapy Completion

Abstract Background: Few studies have objectively assessed the value of routine clinical, laboratory and radiological evaluation to detect recurrence of Hodgkin lymphoma. The optimal follow up of patients (pts) in complete remission following initial therapy has not been defined. Methods: We identified 99 adult pts with Hodgkin lymphoma, who received treatment and follow up supervised by the British Columbia Cancer Agency and relapsed between Jan 1990 and April 2004. Pts who did not achieve complete remission or had a second hematological malignancy were excluded. Pts were followed with clinical assessment, chest radiograph, CBC and alk phos every 3 m for 2 y, then every 6 m for 3 y, then annually. Routine CT scans were recommended every 6 m for 3 y then annually for 2 y. Relapses were categorized as identified by pt (symptoms, new palpable disease) or by physician (routine physical examination or radiological or laboratory studies in asymptomatic pts). Results: Median age at original diagnosis was 28 y (range 14–73). 86 pts initally had advanced and 13 limited stage disease. Primary treatment was chemotherapy +/− radiation in 93 pts and radiation alone in 6 pts. 10 pts had autologous SCT for primary refractory disease. Median follow up from diagnosis was 82 months (range 12–241). Median time to first relapse from completion of treatment was 14 months (range 2–142). Of the 99 relapses, 75 (76%) were identified by the pt and 24 (24%) by the physician. Pt systemic symptoms of relapse were: fatigue 13 pts; alcohol induced pain 3; weight loss 11; pruritis 9; night sweats 19; fever 6. Local symptoms were shortness of breath 8; chest pain 8; back pain 9; abd pain 3. 29 pts had more than 1 symptom. 44 pts noted a new lymph node or mass and 1 pt had leg swelling. 24 relapses were detected by physician: 14 on CXR, 7 on CT scan, 1 on lymphangiogram and 2 on physical exam. No asymptomatic relapses were identified by laboratory abnormalities alone. 2 of the 13 relapses in pts with initially limited stage disease (18%) were detected by physician (1 CXR and 1 CT chest), vs 22 of 86 (26%) in advanced disease. 78% of relapses occurred within 36 months of completing initial treatment. Patient vs Physician Detected Relapses by Follow up Period Time from therapy completion Patient Detected Relapse Physician Detected Relapse Total # Relapses &lt; 12 months 37 (80%) 9 (20%) 46 12–35 months 19 (61%) 12 (39%) 31 ≥ 36 months 19 (86%) 3 (14%) 22 All Relapses 75 (76%) 24 (24%) 99 80% of relapses within 12 months of therapy completion were detected by pts despite more intensive physician surveillance in this period. The proportion of physician detected relapses was greatest 12–36 months after completion of treatment, possibly due to relapse with more slowly progressive disease amenable to detection on periodic routine testing while it is still being carried on relatively frequently. The 22% of relapses occurring in the period of less frequent surveillance, greater than 3 years after treatment, were primarily detected by pts. Conclusions: 76% of Hodgkin lymphoma relapses were detected by the pt and 78% of relapses occurred within 3 years of therapy completion. Asymptomatic relapse was detected on physical exam and radiological studies but not laboratory testing. The highest proportion of physician detected relapses occurred 12–35 months after treatment. Annual routine follow up beyond 36 months contributed minimally to relapse detection, identifying only 3% of total relapses.

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