Introduction Patients with Stage IV cancer and bowel obstruction (BO) present a complicated management problem. We sought to determine if specific parameters could predict outcome after surgery. Methods Records of patients with Stage IV cancer and BO treated from 1991–2008 were reviewed. For surgical patients, 30-day morbidity and 90-day mortality were assessed using exact multivariable Logistic regression methods. Results Of 198 patients, 132 (66.7%) underwent surgery, 66 medical treatment alone, and demographics were similar. 41 (20.7%) patients were diagnosed with Stage IV cancer and BO synchronously, all treated surgically; the remaining presented metachronously. Medically managed patients were more likely to have received chemotherapy in the 30 days prior to BO [45/66 (68.2%) vs 40/132 (30.3%), p <0.01]. In the surgical group, 30-day morbidity was 35.6%, while 90-day mortality was 42.3%. Median overall survival for synchronous patients was 14.1 months (95 % CI 7.6, 23.2), and 3.7 months (95 % CI 2.5, 5.2) and 3.6 months (95 % CI 1.5, 5.2) for metachronous patients treated surgically and medically, respectively. A multivariate model for 90-day surgical mortality identified low serum albumin, metachronous presentation, and ECOG > 1 as predictors of death (p<0.05). A model for 30-day surgical morbidity yielded low hematocrit as a predictive factor (p<0.05). Conclusions This cohort identifies characteristics indicative of morbidity and mortality in Stage IV cancer and BO. Low serum albumin, ECOG > 1, and metachronous presentation predicted for 90-day surgical mortality. These data suggest factors that can be used to frame treatment discussion plans with patients.

This presumptive study concerns the value of lumpectomy as a curative procedure for minimal breast carcinoma, defined as an operable cancer no larger than 2 cm in diameter, with no palpable axillary lymph nodes, and, in peripherally located lesions, no Paget's disease. From 199 surgically treated mammary cancer patients, 40 cases met the minimal criteria. Thirty‐eight of the minimal breast carcinoma patients had a radical mastectomy and two had a supraradical procedure. The pathology findings and survival data were analyzed in these minimal carcinoma cases, and it was calculated that lumpectomy alone would have left cancer cells in 48% of the patients because of regional lymph node involvement by cancer, extension of cells from a peripheral cancer to the nipple ducts, or presence of a second carcinoma in the breast. However, the estimated 30‐year cure rate in these radical surgically treated patients was 86%.

Malignant histiocytosis (MH) is a rapidly fatal systemic disease for which there is no adequate therapy. A case of MH with involvement of both eyes resulting in bilateral blindness is presented. Infiltration with malignant cells was seen in the ciliary bodies at autopsy. Attempts at treatment for this complication are discussed.

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.