BACKGROUND

Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis Yet it is poorly documented in the literature



METHODS

Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases A previously reported PC staging system was used to classify these 370 patients



RESULTS

Mean and median overall survival periods were 60 and 31 months, respectively Survival rates were mainly affected by the initial PC stage (98 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 37 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension) The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma Differentiation of the primary tumor did not influence the prognoses of patients with PC



CONCLUSIONS

A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies Cancer 2000;88:358–63 © 2000 American Cancer Society

Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study.

The role of albumin in critical illness

Publisher Summary This chapter summarizes the findings and hypotheses of cancer metastasis and elucidates the complex mechanisms involved in the pathogenesis of metastasis. The development of a metastasis is dependent on the interplay of host and tumor cell properties. The process is complex, highly selective, and represents the end stage of several destructive events from which few tumor cells survive. Malignant neoplasms may consist of a variety of subpopulations of cells with differing capabilities for invasion and metastasis. Only a few tumor cells within a primary neoplasm may actually invade blood vessels, and of those, even fewer survive in the circulation. The unique characteristics of tumor cells, including modifications in cell surface properties, adhesive capacities, cell motility, and enzyme secretion, are of paramount importance in determining the eventual outcome of the metastasis. Such acquired properties of malignant cells allow for interaction with host tissues and cells, which leads to tumor cell survival and growth. Three mechanisms are invoked to explain tumor cell invasion—(1) the rapid multiplication of malignant cells leading to growth and infiltration by mechanical pressure, (2) the destruction of host tissue by the products of the tumor cell, and (3) the lack of tumor cell adhesiveness accompanied by an increase in the cell motility.

The biology of cancer invasion and metastasis.

Low doses of laser were found to stimulate the regeneration not only of mechanically induced wounds but also of burns. The wound-healing stimulated by laser radiation involves an increased rate of epithelial growth, which may eventually be the starting point of neoplastic growth.

Effect of laser rays on wound healing

Intranasal trigeminal stimulation from odorous volatiles: Psychometric responses from anosmic and normal humans ☆

Thirty-five patients with decreased taste acuity (hypogeusia) and decreased olfactory acuity (hyposmia) with or without perverted taste (dysgeusia) and perverted smell (dysosmia) had elevated median detection and recognition thresholds for the taste of salt, sweet, sour, and bitter, and abnormal forced scaling of taste qualities. Electron micrographs of taste receptors showed pathological changes in the taste buds of these patients. No apparent cause could be found for this disturbing and unpleasant symptom complex. These abnormalities appear to comprise a new syndrome which we have termed idiopathic hypogeusia with dysgeusia, hyposmia, and dysosmia.

Idiopathic hypogeusia with dysgeusia, hyposmia, and dysosmia. A new syndrome.

A series of 84 patients with carcinoma of the larynx or hypopharynx was studied with regard to tumor host interaction. Prognostic evaluation of the “tumor” aspects of this interaction included preoperative staging (TNM), histologic grading of the primary tumor, and histologic examination for the presence of metastases confined to regional lymph nodes or extranodal spread. Morphological evidence of host resistance was judged by the presence and degree of lymphoid inflammatory infiltration around the primary tumor and factors suggestive of enhanced immune reactivity in lymph nodes, i.e., sinus histiocytosis, germinal center hyperplasia, plasmacytosis, and the presence of pyroninophilic blast cells. Of the factors evaluated, those which appeared to correlate best with 5-year survival were stage of disease, presence or absence of positive regional nodes, histologic grade of the primary tumor, lymphoid infiltration in the primary tumor, and extensive germinal center hyperpiasia in the regional nodes. The favorable prognosis attached to the presence of lymphoid infiltration or germinal center hyperpiasia, however, was not uniform for all patients. The presence of lymphoid infiltration was a favorable sign only in the group of patients with positive nodes or in those patients with well-differentiated (Grade I, II) tumors. The presence of extensive germinal center hyperpiasia was a favorable prognostic sign only in those patients with positive nodes or in those patients who had a poorly differentiated (Grade III, IV) tumor. None of the other morphological structures related to lymph node reactivity showed favorable prognostic significance. The relationship of morphology to host immune mechanisms was discussed.

Prognostic significance of histologic host response in cancer of the larynx or hypopharynx.

Summary The combined intracranial transfacial approach to the ethmoid, sphenoid, and frontal sinuses has been satisfactory in performing en bloc resection of cancer arising in or involving these anatomic areas. Fifty-four patients have been treated with this procedure, using the combined expertise of the neurosurgeon and the surgeon interested in the head and neck area. Two postoperative deaths have occurred, both attributed to meningitis. The long range postoperative morbidity is negligible, except as it relates to loss of the palate in all but eight patients and the orbital contents in thirty patients. The cumulative five year survival in this series of patients, forty-two of whom had failure of previous treatment, is 56 per cent. If the procedure is carried out with rigid attention to good surgical technic and the principles of en bloc tumor removal, this combined procedure has the following advantages: (1) allows accurate evaluation of the intracranial tumor extension, (2) protects the brain, (3) avoids cerebrospinal fistulization, (4) provides adequate hemostasis, (5) facilitates en bloc tumor resection, and (6) selectively conserves the orbital contents.

The ethmoid sinuses: a re-evaluation of surgical resection.

This review of the complications which developed in twenty-three of thirty-one patients who underwent a combined intracranial facial approach to the paranasal sinuses indicates that the cribriform plate and ethmoid sinuses can be safely resected. Two deaths (7 per cent) were associated with four instances of meningitis, the most severe of the complications encountered. Complications such as facial edema, cellulitis, wound and bone infection, cerebrospinal fluid leaks, diplopia, postoperative bleeding, and slough of graft were treated without subsequent disability. A greatly increased survival free of disease in this group of patients, 68 per cent of whom had not responded to treatment, indicates that the procedure should continue to be more frequently used to control paranasal sinus malignancy.

Complications of intracranial facial resection for tumors of the paranasal sinuses.

Through a planned program of anticipation and repeated orientation of all surgical personnel to the problems and procedures to be followed, seventeen of nineteen instances of massive spontaneous hemorrhage of the carotid artery have been successfully controlled. The restoration and stabilization of the patient's vital signs by point-pressure control of bleeding, maintenance of adequate ventilation, and rapid blood volume restoration, together with the emergency mobilization of hospital facilities, have allowed all but three of these patients to undergo successful ligation. No neurologic defects have resulted, and all have been restored to their prior “blowout” ambulatory status. Removal of a portion of the medial clavicle often facilitated ligation and wound closure. The common etiologic factor in this series of spontaneous hemorrhage of the carotid artery has been the combination of surgery for postirradiation recurrent cancer which was subsequently followed by wound breakdown secondary to tissue necrosis or fistula formation. In addition, tumor either grossly or microscopically has been present in at least seven instances. Three carotid artery hemorrhages in two patients occurred from infection alone after radical surgery. The incidence of spontaneous hemorrhage of the carotid artery has significantly decreased since, at the time of surgery, skin incisions overlying the carotid are avoided, all carotids are routinely covered with muscle flaps, and antibiotic prophylaxis is employed.

Robert C. Hoye

Papers

Idiopathic hypogeusia with dysgeusia, hyposmia, and dysosmia. A new syndrome.

Prognostic significance of histologic host response in cancer of the larynx or hypopharynx.

The ethmoid sinuses: a re-evaluation of surgical resection.

Complications of intracranial facial resection for tumors of the paranasal sinuses.

Spontaneous carotid artery hemorrhage after head and neck surgery.