Identification of epidural neoplasm: radiography and bone scintigraphy in the symptomatic and asymptomatic spine

Article Abstract:

Cancer cells present in one part of the body can spread to the spinal cord and develop tumors which compress the spinal cord or nerve roots. These spinal metastases occur in five to 10 percent of the patients with metastatic cancer. A loss of body strength and control in the areas below the spinal tumor will develop if treatment is not effective. Treatment success depends on the severity of the deficit before treatment is instituted. However, only a small proportion of patients with signs and symptoms of spinal involvement, such as pain, will actually have a tumor. The advent of magnetic resonance imaging, the use of a magnetic field to visualize internal structures, is a noninvasive method for evaluating the spinal cord. It is difficult to justify using this and other expensive procedures, which expose patients to radioactive imaging materials, when only a few patients will benefit. In this study other methods of imaging bone tumors, bone scintigraphy and radiography (X-rays), were used to determine the risk for spinal disease. The records and imaging results of 43 patients were reviewed. Patients were either symptomatic (41 patients) or asymptomatic. In the symptomatic patient group, evidence of spinal disease was found in 86 percent of the patients with abnormal radiographs and eight percent with normal radiographs. Evidence of spinal disease was present in 69 percent of the patients with abnormal scintigrams and none with normal scintigrams. In the patients without symptoms, spinal disease was found in 43 percent of the patients with abnormal radiographs and three percent with the normal radiographs. Spinal disease was present in 14 percent of those with abnormal scintigrams and seven percent with normal scintigrams. Radiography was highly predictive of spinal disease and scintigraphy was less sensitive. Symptomatic patients with abnormal radiography results should have further evaluation with magnetic resonance imaging or computerized tomography. The management of asymptomatic patients with abnormal radiographs is less clear and requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Bones, Bone cancer, Radiography

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Treatment of squamous cell carcinoma of the anal canal

Article Abstract:

Squamous cell carcinoma of the anal canal accounts for only about 3 percent of all cancers of the gastrointestinal tract. The prognosis for cancer of the anal canal is better than that for some other gastrointestinal cancers. The authors have reviewed the cases of 42 patients treated for squamous cell carcinoma of the anal canal over an eight-year period. The patients were treated with multimodal therapy, which included chemotherapy, radiotherapy, and surgery. The chemotherapy consisted of mitomycin C and 5-fluorouracil, and the dose of radiotherapy was 3,000 cGy (a Gy, or Gary, is one Joule of energy absorbed per kilogram of tissue). Four to six weeks thereafter, the patients were evaluated and treated surgically depending on the apparent extent of cancer. Eighteen of the 42 patients were able to retain their continence. The five-year survival rate for these patients was 82 percent, and if only death from the cancer is considered, the survival rate was 87 percent. Some researchers have suggested that the most important prognostic indicator for patients with anal cancer is whether living cancer cells can still be observed in the anal tissues after therapy at the time of surgical resection. In the present study, 19 patients had no evidence of tumor in the surgical specimens. However, the majority (68 percent) of these patients achieved only a partial clinical response. Among the patients who achieved a complete clinical response to chemotherapy and radiotherapy, residual tumor was found in 44 percent. A comparison of the outcomes of these patients suggests that there is no significant difference between prognosis of those with evidence of tumor at the time of surgery and those without. Of the factors examined in the present study, only the physical size of the tumor proved to be a significant predictor of outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Colorectal cancer, Squamous cell carcinoma, Gastrointestinal diseases, Colorectal diseases, Intestinal diseases

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Efficacy of computed tomography of the thorax and upper abdomen and whole-body gallium scintigraphy for staging of lung cancer

Article Abstract:

The best way to determine the extent, or stage, of lung cancer is not agreed upon, particularly for detection of silent distant metastases (spread of cancer outside the original site). Gallium scintigraphy, an imaging technique that uses radioactivity, has been used, but this was controversial even before computed tomography (CT) was developed. The effectiveness in detection of metastases of lung cancer by CT of the chest and upper abdomen and gallium whole-body scans in 100 patients is reviewed. CT was significantly more accurate in 27 cases, while gallium scanning was much better in 9 patients, and the two techniques were equivalent in 39 other cases. Of the nine cases in which gallium was superior, metastases were suggested by results of clinical examination in four. In addition, minor additional information was provided by CT in 17 patients and by gallium scans in 8 cases. It is concluded that the two techniques are equivalent in ability to stage lung cancer, although additional metastases are occasionally identified by gallium scan. Gallium scans were found to be useful in distinguishing between lung cancer and inflammation-associated scarring, especially following surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, CT imaging, CAT scans, Isotopes, Lung cancer, Gallium

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