Metastases adrenal

Nofetumomab is a mouse monoclonal antibody coupled to 99mTc that is used for diagnostic purposes to determine extent of disease and to stage patients with small cell lung cancer. It binds a 40-kD antigen found on many tumor cell types, but also on some normal cells. It is an accurate indicator of extent of disease in biopsy-confirmed small cell lung cancer except in those patients with brain or adrenal metastases. 

About 15% of patients with recurrent cervical cancer develop adrenal metastases [98]. Vary rare are splenic, pancreatic, gastrointestinal, and renal metastases. 

The phase I experience with SCH66336 involved 20 patients using a twice a day schedule over 7 days every 21 days. A recommended phase II dose of 350 mg was determined, with DLT consisting of severe fatigue. Eight patients had stable disease, and treatment for up to 10 cycles was possible in a few patients. Antitumor activity was reported in one patient with advanced NSCLC who had a greater than 50% reduction in an adrenal metastasis and received treatment for 14 months (174). 

Similarly, Fidler (F3) found that B16-F1 and F10 melanoma cells produced metastasis exclusively in the lungs. This occurred even though the cells were injected intracardially and thus had to pass through capillary beds of other tissues before reaching the lungs. Other B16 melanoma sublines have been isolated that selectively metastasize to brain, adrenals, and ovaries [reviewed in Nicolson (N3)]. 

Because of early dissemination, staging of patients with small-cell lung cancer is more extensive than for patients with NSCLC. It is important to rule out distant metastasis because it will change the role of thoracic radiation in the treatment of these patients. Staging should include a complete history and physical examination, CAT scans of chest and upper abdomen to include the liver and adrenal glands, brain MRI scan, bone scan, complete blood count, and a possible bone marrow aspiration and biopsy. 

Adrenal cortical carcinomas are rare, highly malignant tumors which account for only 0.2% of deaths due to cancer in the United States. Their incidence has been estimated a two per milhon per year. About half of these tumors produce hormonal and metabolic syndromes that lead to their discovery. The other half are silent and are defined with the appearance of metastasis or when the primary tumor becomes large enough to produce abdominal symptoms. While adrenal cancer can occur at any age, most cases are discovered between the ages of 30-50 years (Brennan 1987 Schteingart 2000). 

Hematogenous metastasis to the adrenal glands is common, exceeded in frequency only by metastasis to the lung, liver, and bone. Autopsies have documented... 

Recurrent anastomotic ulcers when they occur are usually found on the jejunal side of the anastomosis (Fig. 5.8a). In patients who present with persistent or complex duodenal or anastomotic ulcer, especially if associated with diarrhoea, weight loss, and liver metastasis, Zollinger-Ellison syndrome should be suspected. The syndrome consists of recurrent intractable peptic ulcers caused by hypergastrinae-mia produced by gastrin-secreting tumours of the pancreas (75%) or duodenum (15%) (Hirschowitz 1997). Tumour localisation is critical to aid in the identification of patients with potentially respectable disease (Berg and Wolfe 1991). Twenty percent of patients have multiple endocrine neoplasia type I which includes parathyroid, pituitary, and adrenal tumours. 

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