Melanoma metastatic to stomach, small bowel, or colon

Article Abstract:

Melanoma is a tumor, usually involving the skin, which contains melanocytes (cells that produce melanin, the black or brown pigment that occurs naturally in the skin, hair, and iris of the eye). Metastasis (cancer spread) to the stomach, bowel, or colon is not often diagnosed in melanoma patients (less than 5 percent), but approximately 60 percent of patients who die from melanoma have evidence of metastasis to the gastrointestinal tract at autopsy. Patients who develop distant cancer spread from a primary melanoma have a poor prognosis and usually do not undergo surgery. However, some studies have reported reduction of symptoms following surgery. A review was undertaken of 32 patients who underwent surgery for melanoma with metastasis to the stomach or intestines to determine the amount of symptomatic relief that was provided and to identify factors that might influence prognosis. Usually the operations were emergencies, performed for mainly for bleeding (38 percent), obstruction (31 percent), and abdominal pain (25 percent). The average patient age was 45, and 26 patients had more than one site of metastasis. The time from diagnosis to first systemic spread ranged from three months to almost five years, with an average of 26 months. At surgery, 26 patients had multiple sites of metastasis; only four patients were able to have all the metastasis removed. Survival after surgery ranged from 1 to 42 months, with an average of 6.2 months. Estimated survival at three years was 18 percent. Two years after surgery, five patients were still alive, and only one was disease-free at 39 months after surgery. The death rate from surgery was 3 percent. Because of the low surgical death rate, it is recommended that palliative surgery (surgery for relief of symptoms only) be considered when needed to improve quality of life, even though long-term survival is unlikely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Metastasis, Cancer metastasis, Melanoma

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Radical surgery for gastric cancer: A review of the Japanese experience

Article Abstract:

The cure rate for gastric cancer (cancer of the stomach) in the United States is 15 percent, with a maximum survival rate of 5 years. However in Japan, the 5-year survival rate is greater than 60 percent. In an effort to explain this difference, the occurrence and subsequent treatment of gastric cancer in Japan was reviewed. With improved diagnostic techniques such as the fiberoptic gastrointestinal endoscope, more early stage cancers can be detected. In Japan, people who are at high risk are routinely screened for gastric cancer. The number of people diagnosed with early gastric cancer has increased from 2 percent in 1950 to over 30 percent in 1980. When gastric cancer is diagnosed at an early stage, it is more easily cured. Since Japan has more cases of early cancer, this, in part, accounts for the survival rate differences between the two countries. Surgical samples are more thoroughly evaluated in Japan and the staging of the cancer, which includes ascertainment of lymph node involvement, is more accurate than in the United States. A greater number of lymph nodes, including small nodes, are examined and surgically removed in patients in Japan compared with patients in the United States. The practice of removing distal lymph nodes should be reexamined by researchers in the United States to improve survival rates. However, more accurate staging in Japan may account for the differences in survival rates which occur at the various stages. It is suggested that a national trial in the United States be conducted to see if radical lymph node resection would make a difference in survival rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Radical surgery for gastric cancer: a review of the Japanese experience

Article Abstract:

The cure rate for gastric cancer (cancer of the stomach) in the United States is 15 percent, with a maximum survival rate of 5 years. However in Japan, the 5-year survival rate is approximately 50 percent. In an effort to explain this difference, the occurrence and subsequent treatment of gastric cancer in Japan was reviewed. It appears that the improved survival rate is due to a number of factors. There is a greater occurrence of early stage disease in Japan. Improved diagnostic techniques such as use of the fiberoptic gastrointestinal endoscope, make early stage cancers more detectable. Fiberoptic gastrointestinal endoscope enables visualization of internal organs by using a long flexible instrument which is inserted through a body cavity. When gastric cancer is diagnosed at an early stage, it is more easily cured. Surgical samples are thoroughly evaluated and the staging of the cancer is more accurate in Japan. A greater number of lymph nodes, including small nodes, are examined and surgically removed more frequently in patients treated in Japan compared with patients in the United States. The practice of removing distal lymph nodes should be reexamined by researchers in the United States to improve survival rates. Removal of organs that contain metastases improve survival rates. However, radical surgery which includes the removal of adjacent organs that do not contain cancer, such as the pancreas and spleen does not improve survival rates for gastric cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

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