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Other Tumours of the Colon and Rectum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The primary peritoneal serous carcinoma is a very rare disease (217 cases reported worldwide between 1974 and 2006), involving mainly females aged between 33 and 70 years.39 The differential diagnosis with peritoneal carcinomatosis of ovarian origin and peritoneal mesothelioma is extremely difficult. The symptoms are that of classical peritoneal carcinomatosis with abdominal distension and non-specific abdominal pain. The diagnosis is a diagnosis of exclusion and requires histological typing-assisted immunohistochemical analysis (positivity for CEA, B72.3, BER-EP4, CD-15 and MI-LEU negativity for vimentin and calretinin) and biomolecular analysis (chromosome deletion, suppression 6q 23–24).48 Treatment is by the peritonectomy with systemic chemotherapy and/or intra-abdominal chemotherapy and hyperthermia (HIPEC). However, the prognosis is poor with a median overall survival of ten months.
The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In addition to relevant investigations to determine the underlying cause, e.g. liver function tests (LFTs), cardiac function, ultrasonography and/or CT scanning (Figure61.9) will determine much smaller quantities of ascites than possible clinically. These will often also diagnose aetiology, e.g. carcinomatosis or liver disease. Ascitic aspiration or tap (below) is now most commonly performed under imaging guidance to minimise the risk of visceral injury. After the bladder has been emptied, puncture of the peritoneum is carried out under local anaesthetic using a moderately sized trocar and cannula. Alternatively, a peritoneal drain may be inserted. In cases where the effusion is caused by cardiac failure, the fluid must be evacuated slowly. Fluid is sent for microscopy/ cytology, culture, including mycobacteria, and analysis of protein content and amylase. Unless other measures are taken the fluid soon reaccumulates, and repeated tappings remove valuable protein.
Ultrasound Assessment of Intra-Abdominal Spread of Ovarian Cancer
Published in Juan Luis Alcázar, Ultrasound Assessment in Gynecologic Oncology, 2018
Ultrasound has been traditionally considered as a poor technique for assessing tumor extension in ovarian cancer (23). However, in the mid-2000s, some studies reported that this technique could reliably evaluate the presence of omental involvement (24) as well as the presence of carcinomatosis (25).
The impact of preoperative MRI-based apparent diffusion coefficients on local recurrence and outcome in patients with cerebral metastases
Published in British Journal of Neurosurgery, 2023
Julia Steinmann, Marion Rapp, Hosai Sadat, Franziska Staub-Bartelt, Bernd Turowski, Hans-Jakob Steiger, Daniel Hänggi, Michael Sabel, Marcel A. Kamp
Despite complete resection in all 86 cases as assessed by an early MRI within 72h after surgery, 29 (33.7%) suffered from local recurrence with a mean local progression free survival of 5.8 ± 0.7 months. Mean overall survival of patients with local recurrence was 16.1 ± 3.5 months. 6 (20.6%) of the 29 patients with local recurrence additionally suffered from distant recurrence. 2 (6.9%) of the 29 patients had local recurrence, distant recurrence and leptomeningeal carcinomatosis. Also 2 (6.9%) patients had local recurrence and leptomeningeal carcinomatosis. 22 (25.6%) of all patients had distant recurrence only and 30 (34.9%) of all patients had no recurrence. Mean progression free survival of all patients was 9.7 ± 1.3 months and mean overall survival was 17.6 ± 2.2 months. Two sample t-test showed a significant difference (t = 3.1, p = 0.000) between progression free survival for patients with and without local recurrence, but there was no significant difference in overall survival for these patients.
Prolonged clinical response with regorafenib administered as second-line therapy in an elderly patient suffering from peritoneal carcinomatosis of colon cancer
Published in Journal of Chemotherapy, 2021
In July 2015, G.T., a woman born in 1934 and suffering from hypertension treated with nebivolol, after biopsy assessment of a neoformation detected by colonoscopy performed for rectal bleeding, underwent a sigmoid resection at the surgical department of our hospital. The histological examination found a moderately/poorly differentiated colon adenocarcinoma infiltrating and perforating the intestine without lymph node involvement. Radiological tests excluded the presence of metastases. Subsequently, the patient received 8 cycles of adjuvant chemotherapy with capecitabine until March 2016 without significant toxicities. After radiological reassessment, diffuse peritoneal carcinomatosis was documented. Once the KRAS mutation at codon 2 level was ascertained, the patient was treated with oxaliplatin and capecitabine excluding bevacizumab for the known hypertension. After 7 cycles of therapy, a positron emission tomography/computed tomography (PET-CT) diagnosed a radiological progression with the appearance of new carcinomatosis nodules (Figure 1A and B). The Peritoneal Cancer Index (PCI) score was low (< 10) and her performance status (PS) was optimal [Eastern Cooperative Oncology Group (ECOG)=0]. At this point, an irinotecan-based treatment was proposed, but the patient refused chemotherapy because of the anticipated alopecia that she would never have been able to accept.
Transimmunization restores immune surveillance and prevents recurrence in a syngeneic mouse model of ovarian cancer
Published in OncoImmunology, 2020
Ayesha B. Alvero, Douglas Hanlon, Mary Pitruzzello, Renata Filler, Eve Robinson, Olga Sobolev, Roslyn Tedja, Alessandra Ventura, Marcus Bosenberg, Patrick Han, Richard L. Edelson, Gil Mor
We hypothesized that because of the history of clinical success associated with ECP/TI and the increased knowledge of the underlying mechanism driving its anti-tumor effects, TI may provide an effective approach to modify the suppressive ovarian tumor microenvironment, stimulate potent anti-tumor T cell responses, and prevent ovarian cancer recurrence in our human-relevant model. Here we report significant vaccination effects of TI treatment in the prevention of ovarian cancer recurrence in a syngeneic, immunocompetent mouse model. We first describe the optimization of the orthotopic mouse model of high-grade serous ovarian cancer (HGSOC) in C57BL/6 J mice, which was developed with the goal of establishing a platform for the timely evaluation of novel therapeutic modalities including immunotherapies. Using this model, we demonstrate the efficacy of TI in delaying the progression of established tumors and, critically, in the prevention of recurrence and formation of carcinomatosis. TI inhibits the expansion of immune-suppressive TAMs and MDSC and restores immune surveillance in the tumor microenvironment and relevant lymphoid organs. Our data suggest that TI is able to prevent recurrence through a bi-directional/two-pronged enhancement of antigen-specific anti-tumor responses through DC, in combination with downregulation of tumor microenvironment-borne immunosuppression, evidence that TI can overcome barriers that had previously stifled existing immunotherapeutic strategies in ovarian cancer and possibly other solid tumors.