RESUMO
A 53-year-old man who complained of dyspnea and prolonged cough visited to our hospital. Computed tomography (CT)revealed massive tumors of right lung and small intestine. CT-guided fine-needle aspiration(FNA)on lung lesion was performed and the lung tumor was diagnosed as small cell carcinoma. We subsequently performed surgical resection for the tumor of small intestine, but part of tumor lesion remained due to pelvic wall invasion. The resected tumor was diagnosed as metastasis from lung carcinoma by histopathological examination. After surgery the patient was treated with atezolizumab and carboplatin-etoposide chemotherapy, but the remnant metastasis caused intestinal fistula. Treatment was continued carefully with fistula management using pouches. Although the fistula was closed during chemotherapy response, it recurred after discontinuation of treatment due to severe adverse events. The patient died 325 days after the surgery.
Assuntos
Fístula Intestinal , Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Masculino , Humanos , Pessoa de Meia-Idade , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/cirurgia , Recidiva Local de Neoplasia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Intestino Delgado/cirurgia , Intestino Delgado/patologia , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgiaRESUMO
A 69-year-old man on hemodialysis for chronic renal failure was diagnosed with ascending colon cancer, and received surgical resection. Multiple liver metastases were detected after surgery. He was administered modified FOLFOX6 therapy (reducing the dose to 50%), and showed severe disturbance of consciousness due to hyperammonemia on treatment day 6. After treatment with daily hemodialysis, branched-chain amino acid solutions, lactulose and rifaximin, his conscious level improved on day 9. Intensive chemotherapy in dialysis patients should be carefully performed considering the serious adverse events including hyperammonemia.
Assuntos
Encefalopatias , Hiperamonemia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Fluoruracila/efeitos adversos , Humanos , Hiperamonemia/induzido quimicamente , Hiperamonemia/tratamento farmacológico , Masculino , Diálise RenalRESUMO
We examined the occurrence of complications following gastric cancer surgery in the elderly and its influence on the prognosis of reduction surgery.The study included 805 surgical cases of gastric cancer; elderly, middle-aged, and young patients were examined.In the elderly patients, there was a tendency to undergo reduction surgery.According to the gastric cancer treatment guidelines, 28.9% of the elderly patients, 5.3% of the middle-aged patients, and 0% of the young patients did not satisfy the criteria for lymph node dissection. The incidences of postoperative complications were 25.6%, 23.0%, and 13.4%in the elderly, middle-aged, and young patients, respectively, with a higher tendency seen in elderly patients.In elderly patients, the survival rate was examined separately for each postoperative complication, but no significant difference was noted.Additionally, the survival rate was assessed for the limited surgery and standard surgery groups; however, no significant difference was noted.Therefore, it is recommended that the optimal lymph node dissection range be determined in the elderly with respect to the general condition.
Assuntos
Neoplasias Gástricas , Idoso , Gastrectomia , Humanos , Excisão de Linfonodo , Estadiamento de Neoplasias , Taxa de SobrevidaRESUMO
A 33-year-old man was diagnosed with bowel obstruction due to advanced sigmoid colon cancer and underwent an emergency laparotomy. The sigmoid colon cancer turned out to be unresectable because of firm invasion to the retroperitoneum with severe adhesions and diffuse dissemination. Therefore, unplanned jejunostomy was performed, which was complicated by high-output stoma and short bowel syndrome. His condition was stable enough to receive chemotherapy via parenteral nutrition and parenteral electrolyte solution infusion added to the diet. mFOLFOX6 plus cetuximab therapy was started 4 weeks postoperatively. Although oxaliplatin was discontinued because of worsening numbness, he was sustained without cancer progression by receiving chemotherapy for a year. Chemotherapy was interrupted by a Candida fungemia 13months postoperatively, and he died 4 months later. Patients with jejunostomy may have difficulty absorbing enough water and nutrients in the intestine; therefore, they are at risk of dehydration and electrolyte depletions due to high stomal output, and malnutrition due to the short bowel. These complications may prevent colorectal cancer patients with jejunostomy to be indicated for chemotherapy.
Assuntos
Neoplasias Peritoneais/secundário , Síndrome do Intestino Curto , Neoplasias do Colo Sigmoide , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab , Fluoruracila , Humanos , Jejunostomia , Leucovorina , Masculino , Compostos Organoplatínicos , Neoplasias Peritoneais/tratamento farmacológico , Síndrome do Intestino Curto/complicações , Neoplasias do Colo Sigmoide/tratamento farmacológicoRESUMO
We report a case of breast cancer(T4b[skin], N1, M1[lung], ER-, PR-, HER2 3+)in a 63-year-old woman with liver dysfunction of unknown cause(T-Bil 3.6mg/dL, ALP 3,483 U/L, AST 214 U/L, ALT 320 U/L, g / -GTP 1,943 U/L). Further- more, serum CA19-9(4,670 U/mL)and HbA1c(8.8%)levels were both elevated. First, she underwent chemotherapy with trastuzumab and capecitabine. Subsequently, liver dysfunction relieved gradually. CA19-9 and HbA1c levels were also decreased, but the tumor size was NC. Subsequently, trastuzumab, pertuzumab, and docetaxel were administered, as liver function became normal. The tumor shrank significantly after this treatment. Finally, she underwent mastectomy. Five years after the first visit, she has continued chemotherapy, with lung metastases almost scarred(CR).
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Capecitabina , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor ErbB-2 , TrastuzumabRESUMO
The is a case involving a 55-year-old man with advanced rectal cancer(type 3). MRI showed urinary tract and regional lymph node metastases without distant metastasis. The tumor was reduced(PR)after neoadjuvant chemotherapy(mFOL FOX6 plus Bmab, 4 courses). The patient underwent an abdominoperineal resection. Because infiltration of the tumor into the lower urinary tract was deep, it was also resected and repaired. The clip was placed to mark the repaired region. Pathological examination revealed that excision stump at the anterior wall of the urethra was cancer positive without lymph node metastasis. He was then administered chemotherapy(mFOLFOX6 4 courses)and irradiated 60 Gy in both sides of the inguinal lymph node to prevent metastasis to the pelvicdomain. One year and 6 months postoperatively, as the left inguinal lymph node swelled at 3.7 cm irregularly, he further received chemotherapy(FOLFIRI 8 courses). The size of the lymph node became normal with a good response to FOLFIRI. Six years postoperatively, he remains alive and well with no evidence of recurrence.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgiaRESUMO
We report 2 cases of lung metastasis from breast cancer that were successfully treated with endocrine therapy.Case 1 is a 69-year-old woman with cirrhosis of the liver caused by hepatitis C.She underwent surgery for left breast cancer at the age of 58, and surgery for right breast cancer at the age of 65.Four years later, she was diagnosed with lung metastasis of breast cancer.She received letrozole and the treatment was effective.Because the severity of the pleural effusion increased 3 years later, fulvestrant was subsequently administered.As a result, the patient remained in good health for 1 year.She died 5 years later.Case 2 is a 72-year-old woman who underwent right breast cancer surgery 12 years previously.She complained of respiratory discomfort as a result of right pleural effusion from lung metastasis.She was hospitalized for cancer lymphangitis that had deteriorated.The patient was immediately treated with fulvestrant and her symptoms improved significantly; the pleural effusion also disappeared.Sixteen months later, no recurrence has been observed.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Estradiol/análogos & derivados , Antagonistas do Receptor de Estrogênio/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Idoso , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Estradiol/uso terapêutico , Feminino , Fulvestranto , Humanos , Letrozol , Neoplasias Pulmonares/secundário , Nitrilas/uso terapêutico , Resultado do Tratamento , Triazóis/uso terapêuticoRESUMO
A 69-year-old man complained of abdominal pain and appetite loss. Advanced gastric cancer with bilateral adrenal metastases( stage â £)was revealed via an examination. XP(cisplatin and capecitabine)chemotherapy was administered. As a result, the tumor was reduced prominently, and his symptoms disappeared 3 months later. However, the cancer recurred 7 months later. Because of the tumor growth, the stent was detained for a passage obstacle by local increase of the tumor 12 months later. The patient died 14 months later.
Assuntos
Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/secundário , Idoso , Capecitabina/administração & dosagem , Cisplatino/administração & dosagem , Evolução Fatal , Humanos , Masculino , Recidiva , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: The p53/MDM2/p14ARF pathway is one of the major signaling cascades involved in the regulation of apoptosis. Although many tumors have been reported to show disruption of the p53/MDM2/p14ARF pathway, few studies have examined p53, MDM2, and p14ARF simultaneously in colorectal carcinoma. The present study was undertaken to clarify whether correlations exist among MDM2, p53, and p14ARF in colorectal cancer. METHODS: We determined the presence of mutations in the p53 gene, MDM2 expression, and methylation status of the p14ARF in 97 primary colorectal carcinoma specimens. Associations with survival and clinicopathologic factors were investigated. RESULTS: At least one abnormality of these three molecules was found in 82 (84 percent) tumors. We observed a significant inverse association between MDM2 expression and tumor invasion (P = 0.01). Furthermore, the presence of liver metastasis was also significantly associated with low MDM2 expression (P = 0.02). CONCLUSIONS: The results suggest that disruption of the p53/MDM2/p14ARF pathway may frequently participate in colonic carcinogenesis and that MDM2 expression status may be a factor in the prediction of potential invasion and liver metastasis of colorectal carcinomas.