Gastric Cancer with Radiographically Occult Metastatic Disease: Biology, Challenges, and Diagnostic Approaches

Gastric adenocarcinoma is an aggressive cancer that demonstrates heterogeneous biology depending on patient ethnicity, tumor location, tumor type, and genetic profile. It remains the third leading cause of cancer deaths worldwide and was estimated to result in 782,000 deaths in 2018. Challenges exist in accurately assessing the disease burden, as available radiological staging often underestimates metastatic disease. This diagnostic handicap, along with the poor understanding of the heterogeneous biology of gastric cancer, has hindered the development of effective therapeutic solutions and thus halted improvement in patient outcomes over the last few decades. The management of occult peritoneal disease is complicated, as most patients are understaged by standard imaging studies and therefore thought to have local diseases. In this article, we systematically review recent literature on the limitations that are associated with standard radiographic staging, discuss recent molecular biology advances to better identify and diagnose occult peritoneal disease, and propose possible management strategies to approach this complicated clinical problem.

Changes of Serum CEA Level after Resection of Colorectal Carcinoma

Introduction :Carcinoembryonic antigen is the most commonly used tumour associatedantigen in the management of patients with colorectal carcinoma. The test appearsuseful to determine prognosis and to monitor patients with colorectal carcinoma for earlyrecurrence, persistent elevation of CEA for a month after operation suggests thepresence of occult metastatic disease. Objective: The study was done to compare pre and postoperative CEA level in colorectalcarcinoma patient and to analyze the relationship of CEA and different Dukes stage inpre operative period of colorectal carcinoma patients. Methods: This cross-sectional and cohort study was performed to look at the change inCEA level among 97 colorectal carcinoma patients in pre and post operative state in thedepartment of surgical oncology, NICRH from January 2010 to June 2012. Results :Statistically significant changes was found in pre and postoperative CEA levelin colorectal carcinoma patient (p <.001). Preoperative CEA level was raised in Dukes8(40%) and Dukes C(54%). Conclusion :Postoperative CEA level was significantly reduced after resection of colorectalcarcinoma and neck neoplasm. Journal of Surgical Sciences (2016) Vol. 20 (1) : 3-6

Sex- and Site-Related Significance in Cutaneous Head and Neck Melanoma

Cutaneous head and neck melanoma is a separate subgroup of cutaneous melanoma that has a worse prognosis than other primary sites. The aim of this article is to examine the significance of sex and site of primary lesion as additional risk factors. Primary localization distribution and metastatic disease in the neck in a retrospective cohort of 159 patients with cutaneous head and neck malignant melanoma were analyzed. Men develop primary melanoma more frequently than women in the left peripheral head and neck regions ( P = .0364), as well as clinically visible and occult metastatic disease in the left side of the neck ( P = .0138). Patients with clinically occult regional metastatic disease showed a significantly poorer survival rate than the rest of the group that underwent elective neck dissections ( P = .0270). Left-sided disease in male patients may be an additional risk factor in cutaneous head and neck melanoma. Performing elective neck dissections in high-risk patients might identify patients with occult metastatic disease and worse prognosis but does not offer any significant therapeutic benefit.