Metastatic obstruction

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Transient increase in bone pain transient increase in tumour mass, resulting in ureteral obstruction and/or spinal cord compression in patients with metastatic prostate cancer hot flashes... 

Jeffers (T2) did electrophoretic studies on serum alkaline phosphatase in hepatobiliary and skeletal disease (Fig. 1). They found eight separate zones of alkaline phosphatase activity arranged in three distinct patterns, and suggested the use of the starch-gel zymogram in the differentiation between obstructive, metastatic, or infiltrative hepatobiliary disease, parenchymal hepatic disease, and osteoblastic disorders. 

Metastatic breast carcinoma is the most likely diagnosis in this case. The liver function tests indicate that there is little hepatocellular damage present and that bilirubin excretion is normal. These findings, however, do not exclude the possibility of hepatic metastasis, giving rise to localized areas of intrahepatic obstruction. 

Serum bile salt concentrations or concentration ratios are of no value in distinguishing between intrahepatic and extrahepatic bile duct obstruction or cholestasis. Patients with metastatic or primary hepatic tumors may have values identical to those with cancer or stone occluding the common bile duct. Drug-induced cholestasis or the cholestatic phase of viral hepatitis may give identical results. 

Small bowel tumor, either primary or metastatic, can be identified as a cause of bowel obstruction (Ko et al. 1993a). At the end of dilated small bowel or between the dilated bowel loops, a tumor can be identified when the tumor is fairly large (Fig. 4.1). 

The most common cause of colonic obstruction is carcinoma, either primary or metastatic, whereas the most common cause of small bowel obstruction is adhesions therefore, it is necessary to differentiate colonic obstruction from small bowel obstruction. Radiographs of the abdomen may be useful for the diagnosis of colonic obstruction in 60-70% of cases (Gore and Eisenberg 1994). Once colonic obstruction is suspected, contrast enema, is indicated to confirm the obstruction and to determine its level, severity, and cause (Amberg 1994). In the CT era, multidetector row CT examination is the best method for the evaluation of patients with acute abdomen including colon obstruction (Sinha and Verma 2005b Patak et al. 2005). 

Acute obstruction of the colon and rectum is caused by a number of benign and malignant diseases but by far the most frequent aetiology is colorectal carcinoma (Parker et al. 1997 Deans et al. 1994). Other maUg-nant causes include infiltration from adjacent mahg-nant tumour and metastatic involvement. Benign conditions such as diverticuhtis or other inflammatory bowel diseases (Crohn s disease, tuberculosis) and anastomotic or post-irradiation strictures are less frequent (Cascales-Sanchez et al. 1997 Rodier et al. 1987 De Lange and Shaffer 1991). 

Patients with unresectable primary tumours or recurrent or metastatic infiltration causing obstruction present a particular dilemma because of their limited life expectancy and would clearly benefit from a minimally invasive, low-risk alternative to relieve the obstructive symptoms. Recent preliminary reports on the application of expandable metal stents as a minimally invasive approach to relieve acute colonic distension (Dohmoto 1991 Keen and Orsay 1992 Spinelli et al. 1992 Itabashi et al. 1993 Tejero et al. 1994) have stimulated significant interest. 

The commonest malignant cause of mid-ureteric obstruction is extrinsic compression by metastatic lymphadenopathy retroperitoneal tumors are less common and are listed in Table 7.1. 

Sinusoidal obstruction syndrome (veno-occlusive disease) has been reported in a patient receiving bevacizumab for metastatic colorectal cancer [195" ]. Venous thromboembolism in general has been reported to occur with a higher incidence during bevacizumab treatment [196 ]. 

In contrast to HCC, increased bilirubin levels in metastatic liver disease arise more from biliary obstruction in infiltrative and end-stage disease than from chemotherapy toxicity (Coin et al. 2005). 

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