Philip Rubin

Cancer of the Gastrointestinal Tract: D. Gastric Cancer: Treatment Principles

ABSTRACT DESPITE the gains in therapeutic techniques, there has been no major improvement in the long-term survival of patients with stomach cancer. The detection of gastric cancer through clinical and roentgenographic findings pronounces a death sentence on the patient; merely the overt recognition of this cancer is a sign of advancement. Most clinical reports read the same1,2: for every 100 patients, 60 to 80 undergo exploratory surgery; resections are performed in 30 to 40, and 5% to 15% survive, depending on the number of patients in whom disease is limited to the stomach. Marshall3 has shown that the five-year survival decreases from 34.8% to 7.2% when lymph nodal invasion occurs. This is the most critical factor in determining prognosis; lymph node invasion is present in two thirds of patients who undergo resection.3There is little correlation between the aggressiveness of surgical resection and the ultimate outcome for the patient. The

Cancer of the Urogenital Tract: Bladder Cancer: Group 3, Stage D, Grades III and IV: Metastatic Carcinomas

Palliation in advanced cancer (Introductory Figure) is mainly relief from distressing symptoms. Subjective improvement by any modality is not considered effective unless it is accompanied by some objective regression of the tumor. Treatment for stage D bladder cancer can give the patient benefit without always directly attacking the cancer. Major complaints are related to obstruction, infection, and hemorrhage, and each can be relieved by different maneuvers requiring either surgical treatment or radiotherapy. Diversion of the urinary stream is an important contribution to caring for this stage of bladder cancer; numerous means of accomplishing this task are available. The morbidity and mortality must be considered and depend upon the medical problems of the host. Often, diversion may be sufficient to provide symptomatic relief, but hemorrhage and infection may not be controlled without vigorous treatment. Jacobs presents his views on this topic. Irradiation for advanced cancer with intent to palliate may require