Facts about Ovarian Metastastis From the Colon

According to the Mayo Clinic, "Symptoms of ovarian cancer are nonspecific and mimic those of many other more common conditions, including digestive and bladder disorders." Colon cancer may also spread to the lymph nodes, bones, lungs and liver. There are particular signs and symptoms that the cancer has spread to the ovaries.

Abdominal Discomfort

• Patients with colon cancer that has spread to the ovaries may have already been experiencing pain, fullness or bloating in the abdomen from the colon cancer and may not realize the cancer has spread. Patients may also experience persistent indigestion, gas or nausea as well as changes in bowel habits, such as constipation. One may lose their appetite or quickly feel full after a meal.

Pelvic Discomfort

• Women may experience pain during intercourse, lower back pain and general pelvic discomfort. According to the Mayo Clinic, patients may also experience changes in bladder habits, including a frequent need to urinate as well as changes in menstruation (more bleeding, much less bleeding or erratic bleeding).

The following is an abstract from a Colorectal Medical Journal

Abstract

Objective  To improve management of ovarian metastasis through assessment of clinicopathological features and treatment outcomes associated with ovarian metastasis from colorectal cancer.

Method  We recruited 103 subjects who were diagnosed with ovarian metastasis and subjected to surgery between June 1989 and December 2005. Clinical and pathological variables were evaluated. Survival and its associated factors were analysed with a median follow-up of 31 months after ovarian surgery (range 1–129 months).

Results  The mean age at diagnosis was 46 years (range 14–72 years), synchronous ovarian metastasis occurred in 74 patients and metachronous in 29 patients. The primary tumour was more commonly associated with the colon rather than the rectum (84/1608, 5.2%vs 19/1534, 1.2%, P < 0.001). Combined metastases occurred in 69 patients (67%). Complete resection was achieved in 34 (33%) patients without other metastases. The estimated 5-year disease free survival and overall survival rate were 40.1% and 26.6%, respectively. From univariate analysis, lymphovascular invasion (35.6%vs 12.8%, P = 0.034), combined metastasis (50.9%vs 15.6%, P = 0.0035) and bilaterale ovarian metastasis (36.4%vs 10.6%, P = 0.015) were identified as significant poor prognosis factors, and from multivariate analysis combined metastasis and bilaterale ovarian metastasis were significant (P = 0.034 and P = 0.015, respectively).

Conclusion  This study suggests a role for regular follow-up computed tomography scans within 6 months postoperatively and tumour marker assays for the early detection of ovarian metastasis in premenopausal women after primary surgery, especially in colonic patients with poor prognostic factors.

Diagnosis

A pelvic examination and imaging including CT scan^[39] and trans-vaginal ultrasound are essential. Physical examination may reveal increased abdominal girth and/or ascites (fluid within the abdominal cavity). Pelvic examination may reveal an ovarian or abdominal mass. The pelvic examination can include a Rectovaginal component for better palpation of the ovaries. For very young patients, magnetic resonance imaging may be preferred to rectal and vaginal examination.
To definitively diagnose ovarian cancer, a surgical procedure to take a look into the abdomen is required. This can be an open procedure (laparotomy, incision through the abdominal wall) or keyhole surgery (laparoscopy). During this procedure, suspicious areas will be removed and sent for microscopic analysis. Fluid from the abdominal cavity can also be analysed for cancerous cells. If there is cancer, this procedure can also determine its spread (which is a form of tumor staging).

Staging

Ovarian cancer staging is by the FIGO staging system and uses information obtained after surgery, which can include a total abdominal hysterectomy, removal of (usually) both ovaries and fallopian tubes, (usually) the omentum, and pelvic (peritoneal) washings for cytopathology. The AJCC stage is the same as the FIGO stage. The AJCC staging system describes the extent of the primary Tumor (T), the absence or presence of metastasis to nearby lymph Nodes (N), and the absence or presence of distant Metastasis (M).^[43]

• Stage I — limited to one or both ovaries
  • IA — involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
  • IB — involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
  • IC — tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
• Stage II — pelvic extension or implants
  • IIA — extension or implants onto uterus or fallopian tube; negative washings
  • IIB — extension or implants onto other pelvic structures; negative washings
  • IIC — pelvic extension or implants with positive peritoneal washings

 Advanced Ovarian Cancer

Ovarian adenocarcinoma deposit in the mesentry of the small bowel

• Stage III — peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum
  • IIIA — microscopic peritoneal metastases beyond pelvis
  • IIIB — macroscopic peritoneal metastases beyond pelvis less than 2 cm in size
  • IIIC — peritoneal metastases beyond pelvis > 2 cm or lymph node metastases
• Stage IV — distant metastases to the liver or outside the peritoneal cavity

                                   Testimonial of Patient with Colon Cancer that Metastasized to Ovary

http://ovariancancer.jhmi.edu/prognosis.cfm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650975/
 

Learn About Thymoma and Thymic Cancer

The thymus is a specialized organ of the immune system which is also the lymph system.  It is a small organ that lies under the breast bone. The thymus produces white cells which fight off infections in our body.

The thymus is composed of two identical lobes and is located anatomically in the anterior superior mediastinum, in front of the heart and behind the sternum.
Histologically, the thymus can be divided into a central medulla and a peripheral cortex which is surrounded by an outer capsule.  The cortex and medulla play different roles in the development of T-cells.  Cells in the thymus can be divided into thymic stromal cells and cells of hematopoietic origin (derived from bone marrow resident hematopoietic stem cells).  Developing T-cells are referred to as thymocytes and are of hematopoietic origin.  Stromal cells include thymic cortical epithelial cells, thymic medullary epithelial cells, and dendritic cells.
The thymus provides an inductive environment for development of T-lymphocytes from hematopoietic progenitor cells.  In addition, thymic stromal cells allow for the selection of a functional and self-tolerant T-cell repertoire.  Therefore, one of the most important roles of the thymus is the induction of central tolerance.
The thymus is largest and most active during the neonatal and pre-adolescent periods.  By the early teens, the thymus begins to atrophy and thymic stroma is replaced by adipose (fat) tissue.  Nevertheless, residual T lymphopoiesis continues throughout adult life.

There are different types of tumors of the thymus. Thymoma and thymic carcinoma are tumors that affect the surface thymus. Thymoma tumors look almost like the normal tissue and does not spread beyond the thymus. The thymic tumor cells are very different from the thymus tissue and spread rapidly through the body.

                                                         Encapsulated Thymoma

  

                      
                              Tumor cells in lymphoepithelioma-like thymic carcinoma have large, round, vesicular nuclei with prominent nucleoli. The tumor cells are positive for keratin and many cases contain EBV genome 


Tumor cells in lymphoepithelioma-like thymic carcinoma have large, round, vesicular nuclei with prominent nucleoli. The tumor cells are positive for keratin and many cases contain EBV genome.  

Possible signs of thymoma and thymic carcinoma include a cough and chest pain.

Sometimes thymoma and thymic carcinoma do not cause symptoms. The cancer may be found during a routine chest x-ray. The following symptoms may be caused by thymoma, thymic carcinoma, or other conditions. A doctor should be consulted if any of the following problems occur:

• A cough that doesn't go away.
• Chest pain.
• Trouble breathing
•  

 The diagnosis is determined through chest x-rays, MRI scans and CT scans

Stages of Thymoma and Thymic Carcinoma

Tests done to detect thymoma or thymic carcinoma are also used to stage the disease.
Staging is the process used to find out if cancer has spread from the thymus to other parts of the body. The findings made during surgery and the results of tests and procedures are used to determine the stage of the disease. It is important to know the stage in order to plan treatment.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body. 

                                        Professor Michael Bakker Discusses Thyoma

For more info:

http://my.clevelandclinic.org/disorders/thymoma/hic_thymoma_and_thymic_carcinoma.aspx

http://www.cancer.gov/cancertopics/types/thymoma

Melanoma Of The Eye

When melanoma is discussed we immediately think of cancer of the skin , but it also can be present in our eyes. This type of cancer is called Intraocular Melanoma.

                                                               Melanoma in the iris of the eye.

                                                            Melanoma in the retina of the eye


Intraocular melanoma begins in the middle of 3 layers of the wall of the eye. The outer layer includes the white sclera (the "white of the eye") and the clear cornea at the front of the eye. The inner layer has a lining of nerve tissue, called the retina, which senses light and sends images along the optic nerve to the brain.

This type of cancer most often occurs in people who are middle aged. In most cases of intraocular melanoma, doctors detect the cancer during a routine eye examination. The chance of recovery (prognosis) will depend on factors such as the size and cell type of the cancer. This type of melanoma is rare.

Most people with intraocular melanoma experience no symptoms of the cancer in its early stages. Melanoma that starts in the iris may appear as a dark spot on the iris. Intraocular melanoma that is in the ciliary body or choroid may cause blurry vision.

Age and sun exposure may increase the risk of developing intraocular melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for intraocular melanoma include the following:

• Older age
• Being white
• Having a fair complexion (light skin) or green or blue eyes.
• Being able to tan

Possible signs of intraocular melanoma include a dark spot on the iris or blurred vision.
Intraocular melanoma may not cause any early symptoms. It is sometimes found during a routine eye exam when the doctor dilates the pupil and looks into the eye. The following symptoms may be caused by intraocular melanoma or by other conditions. A doctor should be consulted if any of these problems occur:

• A dark spot on the iris
• Blurred vision
• A change in the shape of the pupil
• A change in vision

Glaucoma may develop if the tumor causes the retina to separate from the eye. If this happens, there may be no symptoms, or symptoms may include the following:

• Eye pain
• Blurred vision
• Eye redness
• Nausea

 

Doctors stage intraocular melanoma based on the area of the eye where the tumor is found and the size of the tumor. The stages of intraocular melanoma include:

 

• Iris melanoma
• Ciliary body melanoma
• Small choroidal melanoma
• Medium and large choroidal melanoma
• Extraocular extension and metastatic intraocular melanoma
• Recurrent intraocular melanoma. 
•  

Iris Melanoma

Intraocular melanoma of the iris occurs in the front colored part of the eye. Iris melanomas usually grow slowly and do not spread to other parts of the body.

 

Ciliary Body Melanoma

Intraocular melanoma of the ciliary body occurs in the back part of the eye.

 

Small Choroidal Melanoma

Intraocular melanoma of the choroid occurs in the back part of the eye. This type of tumor is classified by the size of the tumor. A small choroidal melanoma is 3 millimeters or less in thickness.

 

Medium and Large Choroidal Melanoma

Intraocular melanomas of the choroid occur in the back part of the eye. This type of tumor is classified by the size of the tumor. Medium and large choroidal melanomas are more than 3 millimeters in thickness.

 

Extraocular Extension and Metastatic Intraocular Melanoma

In extraocular extension and metastatic intraocular melanoma, the melanoma has spread outside the eye, to the nerve behind the eye (the optic nerve), to the eye socket, or to other parts of the body.

 

Recurrent

Recurrent intraocular melanoma refers to cases of the cancer that have come back (recurred) after they were treated.

 

Treatment for Intraocular Melanoma

Treatment options for intraocular melanoma may include:

 

• Surgery (taking out the cancer)
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• Laser therapy (using an intensely powerful beam of light to destroy the tumor or blood vessels that feed the tumor).

 

In some cases (such as when the cancer is small and causing no symptoms), the treatment plan may involve monitoring the patient's cancer carefully and waiting to treat it until it changes or causes symptoms. This is sometimes known as watchful waiting.  

                                           Video of a cancerous tumor of eye surgically removed.

http://my.clevelandclinic.org/disorders/intraocular_melanoma/hic_intraocular_melanoma.aspx

http://skin-cancer.emedtv.com/intraocular-melanoma/intraocular-melanoma-p3.html

Chordoma Tumor Found In Children And Young Teens

Chorodoma tumors can affect any age but in children and adolescents tumors behave very aggressively and have high levels of mitotic activity, hypercellularity, and pleomorphism;13 some authors have suggested that the prognosis for patients younger than 40 years of age is significantly better than that for the older population  survival rates for the younger is 10 years.
Chordomas in children and adolescents comprise <5% of all chordomas and most frequently develop in the base of the skull or at end of the spine (in the sacrum or the coccyx [the tail bone]) with about equal frequency. The cells that give rise to chordoma come from the notochord. The notochord is an important structure in the early embryo that disappears before birth. However, even after birth, some cells from the notochord remain in bones at the base of the skull, in vertebrae, and in the tail bone. Rarely, one of these cells, which are called notochord remnants, undergoes changes that give rise to a chordoma.

                                          

In the United States, there are around 300 new cases of chordoma diagnosed each year. Based on this statistic, the annual incidence of chordoma is approximately one new case per million people per year. The incidence in Europe appears to be similar, but is unknown in other continents. Chordomas account for about 3% of all bone tumors and about 20% of primary spinal tumors. Chordomas are the most common tumor of the sacrum and cervical spine.

What are the signs and Symptoms?

The most common signs of chordoma are pain and neurological changes. Skull base chordomas most often cause headache, neck pain, diplopia (double vision), or facial nerve palsy (paralysis of facial muscles). Chordomas of the spine and sacrum can cause changes in bowel and/or bladder function, pain, aching, tingling, numbness, or weakness of the arms and legs. Often sacral chordomas do not cause symptoms until the tumor is quite large and sometimes a lump is the first sign of a sacral chordoma.

What is the treatment for Chordomas?

Surgery
Currently, surgery is the first-line treatment for chordomas. Complete resection (removing the entire tumor) during the first surgery provides the best chances for local control and long-term survival.To achieve a complete resection, aggressive surgery is often required and can lead to significant complications or side-effects.
The goal of surgery should be to remove as much of the tumor as possible without causing unacceptable harm. Because outcome and prognosis are largely dependent on the success of the initial surgery, before having any operation it is very important to get multiple opinions from surgical teams who have experience treating chordomas on a regular basis. Some medical centers have multidisciplinary teams of experts who review cases and can help create a coordinated treatment plan for patients with chordomas.
Treatment of patients with chordoma of the skull base is a challenge for neurosurgeons. Because of the origin of the tumor from the bone at the base of the skull, exceptionally complete resection can be achieved. Microscopic total removal of chordoma frequently is followed by the finding of residual tumor in the postoperative computerized tomography and MR images. The recurrence rate, even after radical resection, remains high. The deep localization of chordomas at the middle of the skull base makes surgical access to these tumors difficult; nevertheless, many approaches lead to the clival from the superior, anterior or lateral view. The patterns of spread of the skull base chordoma preclude the use of a single surgical approach. Approaches to chordomas of the skull base should be based on the characteristics of growth in each case, and sometimes two or more skull base procedures may be necessary to achieve a radical removal. Extensive excision has an important role in the treatment of skull base chordoma; however, sometimes unacceptable procedure-related morbidity may occur. Currently, many authors consider that most cases of chordoma should be treated with resection. The average survival for patients with untreated chordoma is estimated to be 28 months after the onset of symptoms.32 Survival after surgery or radiation therapy, or both, ranges from 3.6 to 6.6 years, and all tumors are seen to recur with time.^[ On average, recurrence is observed from 2 to 3 years after primary treatment, but sometimes the tumor recurs more than 10 years after initial treatment.


Radiotherapy
In many cases, radiation therapy following surgery is recommended and can improve chances of local control and survival. Because chordomas do not grow rapidly, high doses of radiation are required to kill the tumor cells. Chordomas that are close to critical structures (arteries, brain, brainstem, cranial nerves, dura, spinal nerves), often limit the dose of radiation that can be safely delivered to the tumor. In most cases, proton beam radiation can maximize the dose of radiation to the tumor, while sparing adjacent critical structures. Intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (CyberKnife® or Gamma Knife®) and carbon-ion radiotherapy are also sometimes used to treat chordoma.

You may be wondering about chemotherapy to kill the tumor cells,but it has been found that this treatment has not been very effective in most patients with chordoma tumors.  There is hope because clinical trials are going on to find a successful chemotherapy drug.

                                        Dr. Chandranath Sen lecturing about Sugical treatment of 
                                              Chordoma tumors
 
For more information : /www.chordomafoundation.org/chordoma/