Treatment of primary squamous cell carcinoma of the upper urinary tract

Article Abstract:

As urine is formed in the kidney, it flows into the renal pelvis, and from there flows through the ureter to the urinary bladder. Cancers of the upper part of the urinary tract, the renal pelvis and ureter, are less common than cancers of the bladder and lower portion of the urinary tract. Primary cancer of the upper urinary tract accounts for four or five percent of urinary tract cancers. Of these, the type called transitional cell carcinoma is most common, accounting for 85 to 95 percent of upper urinary tract cancers. Squamous cell carcinoma of the upper urinary tract is less common, and accounts for, at most, 15 percent of such cancers. The relative rarity of squamous cell carcinoma of the upper urinary tract generally prevents any single hospital or medical institution from gaining much experience with this form of cancer. The authors report their experience with 46 patients with squamous cell carcinoma of the upper urinary tract; these patients were treated over a 44-year period. An important feature of this cancer is the lack of any particular symptom suggesting its presence. Kidney stones may be precipitated by this cancer, but were present in only 5 of the 46 cases. As a result of the absence of characteristic symptoms, this cancer was generally diagnosed after significant delay. In 84 percent of the cases, the cancers were already in an advanced stage at the time of diagnosis. Only 22 percent of the patients survived for 2 years after the diagnosis of squamous cell carcinoma of the upper urinary tract. Most patients died within one year. Curiously, males outnumbered females in the study group by over four to one. Comparison of these patients with published reports of transitional cell carcinoma reveal that the transitional cell carcinomas are more likely to be diagnosed at an early stage, and patients with transitional cell carcinoma have a much greater chance of survival. In published reports, about 80 percent of patients with transitional cell carcinoma are alive at one year, in contrast with 28 percent of the patients in the current study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prognosis, Urinary tract cancer, Urologic cancer

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The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity

Article Abstract:

Traditionally, surgery for squamous cell carcinoma of the oral cavity, a type of mouth cancer, involved the removal of virtually all the lymph nodes of the neck. This procedure may remove some of the opportunities for the cancer cells to spread, but it also decreases the general health of the patient, and results in a poorer appearance. If practical, it would be advantageous to limit dissection of the lymph nodes of the neck to a minimum, consistent with the protection of the patient. A review of 501 patients who underwent 516 radical neck dissections is presented. The results demonstrate that metastatic spread of mouth cancer to the neck lymph nodes was very likely, and that 90 percent of the patients who were thought to have no lymph node spread had to return to surgery for lymph node removal. However, the metastatic spread was not equally distributed between all the lymph nodes of the neck. The authors diagram five levels of lymph nodes in the neck, and demonstrate that only the first three levels are likely to develop cancer involvement. The data support the current notion that it may be possible to provide adequate care while limiting lymph node dissection. However, this data was obtained from patients who had radical neck dissection. It remains to be determined if a group of patients treated with a more conservative surgical protocol will achieve comparable rates of survival; the authors plan such a prospective study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Statistics, Mouth cancer, Lymphatic metastasis

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