Malignant tumors of the small intestine: a review of 144 cases.

Cancer of the small intestine represents less than two per cent of all the malignant tumors of the gastrointestinal tract. Because they are infrequent tumors, a review of a tumor registry was performed to analyze response to treatment of the disease and prognostic factors. A retrospective review of patients with primary cancer of the small intestine was performed using the Department of Defense Tumor Registry. The registry was accessed to determine stage, types of cancer, intervention, and patient outcomes. TNM staging and follow-up were available on 144 patients from 1970 to 1996. Median follow-up was 38.9 months. There were 92 (64%) males and 52 (38%) females. The median age was 55.7 years. The types of small intestinal cancer included 68 patients (47%) with adenocarcinoma, 41 patients (28%) with carcinoid, 18 patients (13%) with leiomyosarcoma, and 17 patients (12%) with lymphoma. The overall 5-year survival was 57 per cent and the median survival was 52 months. Survival of patients with adenocarcinoma was not dependent on location within the small bowel. Survival was best for early-stage tumors and when lesions could be completely resected.

Prognostic factors for adenocarcinoma of the gallbladder: an analysis of 162 cases.

Carcinoma of the gallbladder is a rare neoplasm and is associated with a dismal prognosis. To analyze the natural history of this disease and prognostic factors, a large tumor registry database was accessed. During the period 1972 to 1995, 214 patients were entered. Adequate follow-up was available on 162 patients, and this group forms the basis of this review. There were 54 males and 108 females with a median age of 62 years. Median follow-up was 7 months. Right upper quadrant abdominal pain was the most frequent presenting symptom. Fifteen patients had an incidental finding of carcinoma after cholecystectomy. Overall, 5-year survival was 25 per cent, with a median survival time of 9.7 months. Survival was improved for patients with local disease compared with those with regional or metastatic disease. One hundred nine patients underwent surgical therapy. Complete resection was possible in 36 patients, whereas 44 patients had residual disease. Median survival time for patients with no residual disease was 67.2 months, whereas those for patients with microscopic residual tumor and gross residual tumor were 8.9 and 3.8 months, respectively (P < 0.000001). Gallbladder cancer is often diagnosed at an advanced stage and is associated with a poor prognosis. In patients with localized disease, surgical treatment provides the opportunity for long-term survival only when a complete resection can be performed. Prognosis for patients with microscopic residual and gross residual disease is similar.

Axillary lymph node dissection: does it have a role in primary breast cancer?

The role of elective lymph node dissection has been increasingly questioned for the treatment of primary breast cancer. In an attempt to evaluate whether or not axillary lymph node dissection is of value in early breast cancer, a retrospective review of all breast cancers treated at Eisenhower Army Medical Center was conducted. During that time, 434 patients with breast cancer were treated. Eighty-six of those patients had lesions that were 2.0 cm or smaller. Eighty-one patients underwent axillary lymph node dissection. Twenty-four patients were found to have positive axillary nodes (28%). If the patients were further divided into those with lesions 1.0 centimeters or less versus 1.1-2.0 cm, the incidence of node positivity was 19 per cent and 35 per cent, respectively. Of the patients who underwent axillary lymph node dissection, 60 per cent of those whose lymph nodes were negative received no further treatment, whereas those whose lymph nodes were positive received additional therapy 92 per cent of the time. An additional 8 per cent of the node-negative patients received radiation therapy as the only added therapy after segmental mastectomy with axillary lymph node dissection. Our study demonstrates, or at least suggests, that node positivity did influence subsequent therapy. In addition, the relatively high incidence of positive axillary nodes (28%) in these early breast cancers supports the potential therapeutic benefit of axillary node dissection.