Palliative Percutaneous Jejunal Stent for Patients with Short Bowel Syndrome

Gastrointestinal obstruction is a common preterminal event in patients with gastric and pancreatic cancer who often undergo palliative bypass surgery. Although endoscopic palliation with self-expandable metallic stents has emerged as a safe and effective alternative to surgery, experience with this technique remains limited. In particular, a proximal jejunal obstruction requires more technical expertise than a duodenal obstruction. Palliative treatment modalities include both surgical and nonsurgical approaches. In this report, we describe the successful placement of self-expandable metallic stents at the proximal jejunum using a combination of percutaneous endoscopic, intraoperative, and transstomal stenting. Usually endoscopy is not indicated in cases of proximal jejunal obstruction, but some cases may require palliative endoscopy instead of bypass operation

Successful paclitaxel-based chemotherapy for an alpha-fetoprotein-producing gastric cancer patient with multiple liver metastases

<p>Abstract</p> <p>Background</p> <p>Alpha-fetoprotein (AFP)-producing gastric cancer is known to frequently cause multiple liver metastases and to have an extremely poor prognosis.</p> <p>Case presentation</p> <p>A 64-year-old Japanese man admitted to our hospital was diagnosed with gastric cancer with liver metastases. He underwent a total gastrectomy with splenectomy, and pathological stage IV disease according to the classification proposed by the Japanese Gastric Cancer Association was assigned. The histological diagnosis was poorly differentiated adenocarcinoma, and tumor production of AFP was confirmed by immunohistochemical staining. Following surgery, the patient received combination chemotherapy consisting of TS-1 and paclitaxel. Initially, AFP levels decreased dramatically and computed tomography (CT) revealed regression of liver metastases. However, multiple new liver metastases appeared and serum AFP levels increased after 5 months. A regimen of 5-FU plus paclitaxel followed by paclitaxel monotherapy was used next. Serum AFP levels once again decreased and CT showed regression or disappearance of liver metastases. The patient currently has a very good quality of life, and is receiving weekly paclitaxel monotherapy as an outpatient. No progression of liver metastases has been observed to date.</p> <p>Conclusion</p> <p>We consider this rare case to have significant value with respect to treatment of AFP-producing gastric cancer with multiple liver metastases, and propose that combining surgery with chemotherapeutic agents such as paclitaxel may lead to a better prognosis in such cases.</p

Granulocyte-colony stimulating factor producing rectal cancer

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TGF-β regulates invasive behavior of human pancreatic cancer cells by controlling Smad expression

Introduction: To investigate the role of Smads in tumor cell activation, we examined changes in Smad expression as well as changes in proliferative and invasive behaviors in transforming growth factor-β (TGF-β) – stimulated pancreatic cancer cells. Material and methods: Expression of TGF-β receptor type I (TβR-I) and type II (TβR-II) was determined using RT-PCR and Western blot analysis in the human pancreatic cancer cell lines BxPC-3, Capan-2, and PANC-1. TGF-β-mediated changes in Smad mRNA expression were examined using quantitative real-time RT-PCR. Proliferation of pancreatic cancer cells was monitored using an MTT assay and cell counting. Invasive behavior was examined using a Matrigel double-chamber assay. Results: TβR-I and TβR-II were expressed in all three cell lines studied here at the mRNA and protein level. Smad2/3 mRNA expression was decreased after TGF-β stimulation in all three cell lines, while Smad4 mRNA expression remained unchanged. Smad6/7 mRNA expression was also attenuated in all three cell lines. TGF-β enhanced the invasive capacity of all three cell lines, but had no effect on the proliferative behavior. Anti-TβR-II antibody inhibited this TGF-β-enhanced invasive potential in pancreatic cancer cells. Conclusions: The Smad pathway, particularly down-regulation of Smad2/3 and Smad6/7, may be responsible for TGF-β-induced invasion of human pancreatic cancer cells