Pain of terminal cancer patients.

The belief that cancer inevitably leads to a painful death is widespread. This may contribute to society's "cancerophobia" with subsequent frequent delays in seeking medical attention for suspected malignant neoplasms. We evaluated the degree of pain experienced by dying patients, with and without cancer, at a large medical center. Patterns of analgesic administration and physician and nurse progress notes demonstrated that patients dying with cancer had significantly higher preterminal daily pain ratings and significantly fewer pain-free days than patients dying without cancer (P less than .01). Nevertheless, approximately one quarter of cancer patients died without any pain or analgesic administration. A painful death from cancer is thus not inevitable.

Kaposi's sarcoma following chemotherapy for testicular cancer in a homosexual man: demonstration of cytomegalovirus RNA in sarcoma cells.

A 35-year-old white Jewish homosexual man who had undergone surgery and chemotherapy for an embryonal carcinoma of the testis subsequently developed Kaposi's sarcoma. The neoplasm involved the skin as well as visceral tissues. Tissue derived from a biopsy specimen of one of the skin lesions was used in the in situ hybridization technique for the detection of genetic material. Cytomegalovirus messenger RNA was identified in the neoplastic Kaposi cells in the skin. The significance of this finding is discussed.

Thrombophlebitis and cancer. A review.

Thrombophlebitis has been associated with virtually all cancers, especially gastrointestinal, urogenital, and lung neoplasms. Although occurring infrequently in cancer patients, thrombophlebitis may appear before the cancer has become symptomatic and may lead to an earlier diagnosis of cancer. The phlebitic syndrome associated with cancer, although not unique, is distinctive. It is often recurrent and migratory, often involves unusual locations, and is often resistant to anticoagulation therapy. Pulmonary emboli are frequent complications. The pathogenesis of phlebitis in cancer patients is not well understood. Evidence suggests that many cancer patients are hypercoagulable, with abnormalities in platelets, coagulation factors, and the fibrinolytic system. These changes may results from the elaboration of thromboplastin-like substances from the cancer tissue.

Invasive squamous cell carcinoma with sporotrichoid metastasis in a patient with cutaneous T cell lymphoma treated with chronic extracorporeal photopheresis.

An 83-year-old Caucasian man with cutaneous T-cell lymphoma developed an aggressive squamous cell carcinoma of the left forearm, which recurred and metastasized after Mohs micrographic surgery and systemic chemotherapy with cis-platin and 5-fluorouracil. He was treated with extracorporeal photopheresis, radiation therapy, PUVA photochemotherapy, and interferon therapy for cutaneous T-cell lymphoma. Aggressive squamous cell carcinoma can occur in the setting of extracorporeal photopheresis.

Combination chemotherapy for extracranial metastases of a primary malignant cerebral neoplasm.

A patient with a mixed malignant glioma metastatic to the bones and lungs failed to respond to two different broad-spectrum combination chemotherapy regimens which included Adriamycin, methotrexate, cyclophosphamide, CCNU and cis-dichlorodiammineplatinum(II).

Chemotherapy before radiotherapy and/or surgery for locally advanced squamous cell carcinomas of the head and neck.

Locally advanced (stage III and IV) squamous cell carcinomas of the head and neck are not well controlled with surgery and/or radiotherapy. Trials of chemotherapy before therapy is given for local disease are currently being conducted in an attempt to improve survival and cure rates. Initial studies are preliminary but suggest (1) possible benefit and (2) no excessive toxic effects after surgery and/or radiotherapy. Head and neck surgeons should be aware of the status of these studies.

Medical oncology in journals of internal medicine.

The coverage of medical oncology in internal medicine journals was evaluated by reviewing the contents of the 1974 and 1975 issues of three leading American internal medicine journals. The percentage of articles relevant to medical oncology compared favorably with figures for the other subspecialties of internal medicine. The subject matter of the medical oncology articles in the three journals was found to be complementary to the content spectrum of the subspecialty journal, Cancer. This distribution may be useful to the medical oncologist but may present a skewed view of recent developments in medical oncology to the nononcologist internist who relies largely on internal medicine journals for information regarding new trends in medical oncology. The implications of these findings are discussed, particularly with regard to the possibility that a similar situation exists for the other subspecialties of internal medicine.

Myocardial injury immediately following adriamycin administration.

A patient is described who developed chest pain during adriamycin administration given for the first time for small cell carcinoma of the lung. This was associated with the acute onset of atrial fibrillation with a rapid ventricular response. Although no electrocardiographic changes of myocardial ischemia developed, serum isoenzyme studies suggested that myocardial injury had occurred. The patient recovered but died suddenly three weeks later. Physicians should be aware of possible life-threatening arrhythmias developing during or shortly after adriamycin administration.

Combination chemotherapy for advanced squamous cell carcinoma of the head and neck.

Fifteen patients with advanced squamous cell carcinoma of the head and neck were treated with the six-drug Price-Hill regimen (vincristine, bleomycin, methotrexate, hydrocortisone, 5-fluorouracil, and leucovorin). Only two partial remissions were obtained, and the regimen produced moderate toxicity. Our results are not as favorable as those of Price and Hill.

Vincristine, adriamycin, and mitomycin (VAM) therapy for previously treated breast cancer. A preliminary report.

Fifteen patients with metastatic breast cancer previously treated with chemotherapy were treated with a regimen consisting of vincristine, Adriamycin, and mitomycin. Eleven patients (73%) responded with three complete and eight partial responses. The median duration of response was eight months. While all four nonresponders died within five months, the median duration of survival of responders was 18 months. Toxicity was significant but tolerable. Thus, this preliminary report suggests that this regimen is active in advanced previously treated breast cancer, providing meaningful remissions with acceptable toxicity.

Meningeal carcinomatosis in small cell carcinoma of the lung.

Small cell carcinoma of the lung is extremely sensitive to chemotherapy and radiation therapy. We describe the case of a patient who had a complete response to such treatment but relapsed with meningeal carcinomatosis. We propose that prophylactic therapy to the spinal cord as well as the brain should be considered in the treatment of patients with small cell carcinoma of the lung.

Ocular side effects of cancer chemotherapy.

The ocular side effects of cancer chemotherapeutic drugs are relatively uncommon. Patients with cancer may develop ocular problems due to metastases to the eye or central nervous system, side effects and radiotherapy or chemotherapy, or totally independent eye disorders. We present a review of the reported ocular toxicities of chemotherapeutic agents to assist the oncologist caring for such patients.

Metastatic Ewing sarcoma to the heart simulating adriamycin cardiotoxicity.

A 20-year-old man with metastatic Ewing Sarcoma developed severe congestive heart failure. Because he had been treated with a large amount of Adriamycin, the diagnosis was initially thought to be Adriamycin cardiotoxicity. However, ante- and post-mortem studies revealed the presence of massive cardiac metastases. At post-mortem, there was no evidence of Adriamycin cardiotoxicity. This case emphasizes that cardiac metastases must be considered in the differential diagnosis of heart failure in patients treated with Adriamycin.

Prostate cancer mimicking malignant lymphoma.

We report three patients evaluated on a medical service for lymphoma-like signs and symptoms. Although none had prostate or bone symptomatology, all three were found to have metastatic prostate cancer. These cases emphasize the propensity of prostate cancer to metastasize to lymph nodes as well as bones. Diagnostic and therapeutic implications are discussed.

Spontaneous regression of a pulmonary metastasis after nephrectomy for renal cell carcinoma.

Regressions of metastases following nephrectomy for renal cell carcinoma are rare. Most reported cases have involved pulmonary metastases. Hormonal and immunological mechanisms have been postulated. A case is described of a pulmonary metastasis which regressed after nephrectomy and which failed to recur despite the later appearance of new sites of pulmonary metastases. The literature is reviewed.

Prostatic cancer with an unusual presentation: polymyositis and mediastinal adenopathy.

A 67-year-old man with prostate cancer presented with acute polymyositis and vocal cord paralysis as a result of mediastinal lymphadenopathy. His clinical course was unusual, with the development of a malignant pleural effusion, supraclavicular adenopathy, and osteolytic bone lesions. Urologic symptoms developed only pre-terminally, and osteoblastic bone metastases were not documented. This case suggests that prostate cancer need not have a simple natural history.

Diagnosis of primary breast carcinoma through immunohistochemical detection of antigen related to mouse mammary tumor virus in metastatic lesions: a report of two cases.

Recent investigations have established that approximately half of human breast carcinomas contain an immunohistochemically detectable antigen which is cross-reactive with the 52000-dalton major glycoprotein (gp52) of the mouse mammary tumor virus (MMTV). This antigen can be localized in paraffin-embedded sections of routinely fixed tissues using heterologous antibodies to gp52 or MMTV. This report describes two patients with metastatic carcinoma in axillary lymph nodes without any clinical evidence of a primary lesion in the breast or elsewhere. The localization of the gp52-related antigen in paraffin-embedded sections of both metastatic lesions suggested the presence of primary mammary carcinoma. In both instances, this suggestion was ultimately confirmed by the finding of primary lesions in which the gp52-related antigen was also found.

Combination chemotherapy for advanced cutaneous T-cell lymphomas.

Seven patients with advanced cutaneous T-cell lymphomas were treated with a combination chemotherapy regimen of vincristine, doxorubicin (Adriamycin), bleomycin, methotrexate, leucovorin factor, 5-FU, and hydrocortisone. All patients had an objective response but only one had a complete clinical remission. Our results are compared to other regimens reported in the literature.

Colorectal carcinoma 15 years after the diagnosis of perianal Paget disease.

We report a patient with perianal Paget disease who developed a colorectal carcinoma fifteen years later, complicated by pseudomyxoma peritoneal. While perianal Paget disease is often associated with underlying carcinomas noted at the time of the diagnosis, we suggest that perianal Paget disease may also predispose to the future development of colorectal cancer.