Surgery for metastases to the brain

Article Abstract:

One of the primary reasons for the mortality associated with cancer is the potential for metastasis, the spread of cancer throughout the body. Secondary tumors, which have migrated from the original cancer, occasionally develop in the brain where surgery is difficult or impossible. The customary treatment for brain metastases is radiotherapy; chemotherapy is ineffective and surgery has been thought to be of little value. In the February 22, 1990 issue of The New England Journal of Medicine, Patchel et al. conclude that a full 25 percent of patients with metastases to the brain may be helped by surgery. Half of all brain metastases involve only a single tumor, and half of those are in locations which are amenable to surgery. Although virtually all patients with brain metastasis will die within two years regardless of treatment, surgery allows these patients to live out their remaining time with greater independence and improved quality of life. Perhaps another compelling reason for the consideration of surgery is the relatively high frequency (6 in 54 cases) of misdiagnosing a primary brain tumor as a metastasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Brain cancer, editorial

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Spinal cord compression from epidural metastases

Article Abstract:

Epidural spinal cord compression occurs in 5% of patients who die of cancer. It must be diagnosed early to preserve normal function. Half the metastases come from breast, lung or prostate cancer and usually occurs in the thoracic vertebrae. Most common initial symptoms are increasing axial, referred or nerve root pain which worsens with movement, straight leg raises, or neck movement. Weakness, incontinence, sensory loss or paralysis may follow. Bed rest worsens the pain, differing from usual back disease. Diagnosis from X-rays and bone scans can find metastases in 85% of adult patients. Magnetic resonance imaging (MRI) is recommended only if X-rays and neurological examinations are normal but the patient complains of pain. Corticosteroids improve function and alleviate pain for the short term but their long term benefit is unknown. Radiation therapy is another frequent treatment technique. Anterior decompression surgery is being used more as well.

Diagnosis, Spinal cord compression

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Extended lymph-node dissection for gastric cancer

Article Abstract:

Extended lymph-node removal does not appear to improve the prognosis of patients with stomach cancer. Japanese surgeons often perform extended lymph-node removal when treating stomach cancer, but this practice is not popular in America. Surgeons compared limited lymph-node removal with extended lymph-node removal in 996 patients with stomach cancer between 1989 and 1993. Five-year survival rates were similar in both groups but the patients who had extended lymph-node removal had more surgical complications, more deaths postoperatively, and spent a longer time in the hospital.

Stomach cancer, Lymph nodes, Lymph node excision

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