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A 52-year-old woman patient, who presented with lower abdominal pain, was suspected of having colonic intussusception. An enhanced CT examination indicated that the end of the small intestine or appendix tumor had invaginated into the transverse colon. The CT revealed no evidence of intestinal ischemia, the emergency operation was performed on the following day. After relieving a colonic intussusception, a mass of the appendix was found and we performed laparoscope-assisted ileocolic resection and D3 dissection because of a strong possibility of carcinoma. The patient was discharged 8 days after the surgery and showed no evidence of recurrence for 6 months after the surgery. In postoperative histopathological examination, appendix tumor was diagnosed as a low-grade appendiceal mucinous neoplasm(LAMN). Adult intussusception is a rare disease and most of the cases are caused by malignant lesions, and a treatment strategy for LAMN has not yet been established. We report this case , as there are very few reported cases of adult intussusception caused by LAMN, with a review of the relevant literature.

The effects of ondansetron hydrochloride (OND) were studied through 11 courses of chemotherapy, including 70 mg/m2 of cisplatin, in 9 patients with advanced esophageal cancer. During the observation period of 5 days, 4 mg of OND was given intravenously on the day of cisplatin infusion and orally for consecutive 4 days, and nausea was controlled by over 70%. Vomiting was controlled by over 80%. The inhibitory effect of OND on nausea and vomiting was found in 72.7% on the day of cisplatin injection and 88.9% overall. No other side effects of OND except slight increases in total bilirubin and LDH were found in any patient. These findings suggest that intravenous and oral administration of OND may inhibit chemotherapy-induced nausea and vomiting in patients with advanced esophageal cancer.

Examinations of peritoneal lavage smears (cy) in gastric cancer surgical stages III and IV are very important for determining the disease stage. We have been carrying out these examinations for 8 years. One hundred sixty patients with gastric cancer were examined. The incidence of cy positivity was higher in T4 than in T3, and higher in P1,2,3 than in P0. We performed intraperitoneal administration of CDDP in 10 patients with gastric cancer using a reservoir (Infuse-A-Port) implanted in the abdominal wall once a week. No difference in survival was observed between patients who received chemotherapy via i.p. and those who received it i.v.

Satisfactory therapeutic effects are rarely obtained with oral chemotherapy for gastric cancer. We have experienced successful treatment for synchronous hepatic metastasis of gastric cancer with 5'-DFUR and Lentinan. The patient was a 78-year-old female, diagnosed as having gastric cancer with multiple hepatic metastases, who underwent gastrectomy. Immunohistochemistry of the resected specimens with anti-thymidine phosphorylase (dThdPase) antibody yielded positive results for dThdPase in the primary tumor as well as the hepatic metastases. Two months after surgery, administration of 400 mg of 5'-DFUR per day and 2 mg i.v. of Lentinan every other week was started. Four months after discharge, carcinoembryonic antigen (CEA) in plasma showed an abrupt logarithmic decline. Furthermore, a 99% reduction in hepatic metastases was demonstrated by abdominal CT. At present, 22 months after surgery, the patient is managed on an outpatient basis with no complaints of any side effects. Immunochemotherapy using 5'-DFUR and Lentinan may be effective against gastric malignancies expressing dThdPase activity.

Examinations of peritoneal lavage smears (LC) and gastric wall brushing smear cytology (BC) appear to be important for determining accurately the stage of gastric cancer. We have been carrying out such examinations during gastric cancer surgery for 7 years. In the present study, we evaluated the results obtained from 287 patients with gastric cancer. Tumor invasion and peritoneal dissemination were correlated with a positive incidence of cancer cells in LC and/or BC. Gastric cancer showing serosal invasion was classified into positive for LC and/or BC and negative for LC and/or BC. Patients positive for LC and/or BC had a poorer prognosis. For future gastric cancer treatment, patients positive for peritoneal cytology are expected to be targeted for intensive treatment during or before surgery.

We investigated the correlation of intraoperative peritoneal lavage smear and gastric wall brushing smear cytology with macroscopic and histologic findings and prognosis, in 216 patients with gastric cancer. Some 196 of these patients underwent gastric resection and 20 did not. The incidence of positive cancer cells determined by these methods was significantly correlated with gastric resection, tumor invasion, and peritoneal dissemination. Among patients without macroscopic peritoneal dissemination, four were found to have positive peritoneal lavage smears or gastric wall brushing smears, respectively. The prognosis of these patients did not differ from that of patients with metastases to the adjacent peritoneum but not the distant peritoneum. These results suggest that peritoneal lavage smears and gastric wall brushing smears are useful for predicting the peritoneal cancer dissemination. Therefore we intend to target patients with no peritoneal metastases (Po) showing positive peritoneal cytology for intensive treatment.

This report describes the effect of intraperitoneal administration of CDDP for the treatment of peritoneal dissemination (P) in 20 patients with gastric cancer. Eight patients after palliative resection, 4 after non-resection and 8 with recurrent cancer were given 25 mg of CDDP through a reservoir (Infuse-A-Port) implanted in the abdominal wall once a week. Simultaneously, 400 mg/body/day of UFT and 2 mg/body/week of Lentinan were administered. Twelve of the patients died of disease at 6-19 months (median 7 months), but 8 have survived 3 to 15 months (median 6 months). Complete and partial responses were obtained in 7 of the 8 patients with recurrence (88%) for malignant ascites. No patient showed any toxicity from treatment. All patients receive the treatment in the outpatient clinic after discharge, and 17 patients have shown a long hospital-free survival.

We investigated the utility of intraoperative peritoneal lavage smears and gastric wall brushing smears for diagnosis of peritoneal dissemination and serosal involvement during gastric cancer surgery. One hundred fifty-three patients with gastric cancer were examined; 138 who underwent gastric resection and 15 who did not. The incidence of cancer cell positivity determined by these methods was 8.0% in resected cases, and 80.0% in unresected cases. According to macroscopic serosal invasion, the incidence of positive cytology was 0% for S0, 15.4% for S1, 13.0% for S2, and 38.7% for S3. According to microscopic wall invasion, the incidence of positivity was 0% for m and sm, 6.3% for mp, 0% for ss, and 22.2% for se and si. In terms of macroscopic peritoneal dissemination, the incidence of positivity was 2.6% for P0, 28.6% for P1, 42.9% for P2, and 90.0% for P3. These results suggest that peritoneal lavage smears and gastric wall brushing smears are useful for predicting the spread of peritoneal dissemination. Thus, further study of intraoperative fast-smear cytology seems warranted.

A phase I clinical study (a dose escalation test) of combined cisplatin (CDDP) + carboplatin (CBDCA) therapy was carried out in patients with primary or secondary lung cancer (PS 0-2) who had given prior informed consent to the study. The dose level of CDDP was set at 80 mg/m2, while five dose levels (200, 250, 300, 350, 400 mg/m2) of CBDCA were used. Three patients were allocated to each CBDCA dose group. Blood samples were taken immediately before and 0.5, 1, 2, 4, 6 and 24 hours after injection, and were examined for total Pt and free Pt level. The maximum tolerated dose (MTD) was CDDP 80 mg/m2 + CBDCA 400 mg/m2. Thrombocytopenia and leukopenia served as dose limiting factors (DLF). Total Pt and free Pt levels in blood after this combined therapy were higher than those after treatment with CDDP alone. The results from this study suggest that CDDP 80 mg/m2 + CBDCA 350 mg/m2 would be a suitable dose for phase II study of this combined chemotherapy. A multi-center pilot study based on these findings is now under way.

Carcinoembryonic antigen (CEA) in plasma is useful for the detection of recurrent colonic or gastric cancer and the monitoring of plasma in patients with recurrent cancer displaying therapeutic effect. We report a sharp decline of CEA in a patient with recurrent gastric cancer by 6 months oral administration of UFT. The patient was an 81-year-old male who had undergone gastrectomy for advanced gastric cancer. Eight months post-operatively, the plasma CEA began to rise logarithmically, and recurrent tumor in the remnant stomach and liver metastasis were detected by fibergastroscope (FGS) and abdominal CT. After administration of UFT at a dose of 300 mg per day, CEA abruptly declined logarithmically and normalized in 6 months. Presently marked reduction of recurrent foci and metastases were found by FGS and abdominal CT. Therefore sequential changes in plasma CEA in this patient can be considered to reflect the effect of therapy for recurrent gastric cancer by UFT.

Fourteen patients with advanced gastric cancer consisting of seven primary cases and seven recurrent cases were treated with the combination of etoposide, adriamycin and cisplatin (EAP). One of the primary cases (14%) and three of the recurrent cases (43%) responded to the therapy, but a high incidence of toxicities including leukopenia, thrombocytopenia, alopecia, nausea and vomiting was observed. It is concluded that EAP therapy can be useful in the treatment of advanced gastric cancer if countermeasures to the toxicities of these drugs are considered.