Metastatic disease adrenal

Lymphatic metastases in HCC are not common. They are seen in no more than 10-15% even in autopsy cases, especially in the hepatic hilar lymph nodes (Bartolozzi and Lencioni 1999). Extrahepatic hematogenous metastases are usually associated with advanced-stage tumors. The lung is the most common site of metastases, followed by the bone and the adrenal gland. CT is valuable for the diagnosis of adenopathies and distant metastatic disease, except for bone metastases. Assessment of tumor spread in selected patients (i.e. candidates for liver transplantation, inclusion in therapeutic trials) may therefore require thin section spiral CT of the chest and bone scintigraphy. 

The combination of RA plus IFN plus subcutaneous interleukin-2 plus 5-fluorouracil was given to 44 patients with progressive metastatic RCC and resulted in a major response rate of 44%, including six complete responses. Responding cancers included lung, liver and adrenal cancers. Responses were durable in 19 of the 20 responding cases and prolonged stabilization of disease occurred in 21 patients (47%). Another study of RA plus IFN in 19 patients with metastatic disease that was refractory to IFN, interleukin-2 and chemotherapy achieved a major response rate of 21% (4/19) [27]. 

If endogenous Cushing s syndrome, determine if patient is an appropriate candidate for surgical resection of the tumor. Does the patient have any conditions that contraindicate surgical resection, such as advanced disease (metastatic adrenal carcinoma) ... 

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