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At least 631 records · Page 35Linked to original sources
PubMed1984

[Diagnostic importance of the tumor marker CA 19-9 in pancreatic cancer].

The diagnostic value of the tumour-associated antigen CA 19-9 was tested in 309 patients, 156 with malignancies (39 carcinoma of the pancreas, 117 extrapancreatic malignant tumour) and 153 patients with non-malignant disease (54 chronic pancreatitis, 25 acute pancreatitis, 74 general surgical disease). Levels above the normal range of 6-37 U/ml were obtained in 95% of patients with carcinoma of the pancreas (mean value 528 U/ml), in 31% of patients with gastric carcinoma and 16% with colorectal carcinoma (mean 8 U/ml). Results of the pre-operative determination of CA 19-9 indicated for carcinoma of the pancreas a sensitivity of 95%, a specificity of 87% and an overall accuracy of 88%. Pre-operatively elevated CA 19-9 concentrations in patients with carcinoma of the pancreas fell to normal after curative resection of the neoplasm. After palliative operation or in inoperable carcinoma CA 19-9 serum concentrations were never less than 37 U/ml.

Acute Disease↗
PubMed1989

Diagnostic value of mucin-like carcinoma-associated antigen (MCA) in breast cancer.

The diagnostic value of mucin-like carcinoma-associated antigen (MCA) was compared to that of carcinoembryonic antigen (CEA) and/or CA 15.3 in patients with breast cancer. A total of 368 patients with breast cancer were studied, of whom 253 were free of metastases, whereas 94 had either skeletal or visceral metastases or diffuse metastatic disease. The diagnostic sensitivity of MCA proved to be comparable to that of CA 15.3 and superior to that of CEA in patients with metastatic breast cancer. In contrast, the specificity of MCA was superior to that of CA 15.3. Finally, the diagnostic sensitivity of each of the tested tumour markers, i.e. MCA, CEA and CA 15.3, could be improved by their combined use. We conclude that MCA, either alone or in combination with CA 15.3 and CEA, can improve the monitoring of disease progression in patients with metastatic breast cancer.

Antigens, Neoplasm↗
PubMed2004

Molecular diagnostics: a new frontier in cancer prevention.

The promise of molecular diagnostics for cancer prevention in terms of early detection rests on two premises: assays can be developed to measure proteins, DNA, RNA or metabolites that accurately and reproducibly detect incipient neoplasias; and that this early detection will eventually result in a decrease in morbidity and mortality and therefore benefit patients. Novel molecular technologies, including laser capture microdissection, time-of-flight mass spectrometry, DNA microarrays, tissue arrays, protein microarrays and antibody microarrays, are being developed to investigate the molecular differences between disease and normal cells and detect cancer-specific alterations in proteins, DNA and RNA in body fluids. Although literally hundreds of articles are published each year describing alterations in genes or proteins that are associated with cancer, very few result in useful molecular diagnostics for early cancer detection. Thus, there remains a critical need for new biomarkers for use in early detection and for assay methods that allow the translation of these biomarkers from the laboratory to the clinic.

Biomarkers, Tumor↗
PubMed2000

Diagnostic investigations in cancer pain.

Defining the specific cause of pain in patients with cancer often has substantial therapeutic and prognostic implications. This process often requires the use of specific diagnostic investigations. Here we critically review the diagnostic investigations used in the evaluation of common pain problems in patients with cancer. Familiarity with this information facilitates the development of efficient and rational diagnostic strategies.

Back Pain↗
PubMed2002

Inhibins/activins as diagnostic markers for ovarian cancer.

It is widely recognised that the early detection and subsequent assessment of recurrence of ovarian cancers are key steps for successful treatment. Available serum markers (e.g. CA125) are sensitive for some epithelial carcinomas (e.g. serous, endometrioid, clear cell), however, these markers are less sensitive for granulosa cell tumours and mucinous carcinomas. Serum inhibin is an ovarian product which decreases to non detectable levels after menopause, however, certain ovarian cancers (mucinous carcinomas and sex cord stromal tumours such as granulosa cell tumours) continue to produce inhibin which provides a basis for a serum diagnostic test. Studies from this and other laboratories have investigated the suitability of inhibin as a diagnostic marker by identifying which inhibin (inhibin A (alphabetaA), inhibin B (alphabetaB), free alpha subunit) or activin (betaAbetaA) form is associated with these cancers. Available data show that inhibin assays which detect all inhibin forms, i.e. assays which detect the alpha subunit both as the free form and as an alphabeta subunit dimer provide the highest sensitivity/specificity characteristics as an ovarian cancer diagnostic test. This review will discuss the data supporting these observations and show recent studies in which a new alpha subunit monoclonal antibody-based ELISA is used as a potential diagnostic test. Furthermore, based on the high sensitivity/specificity characteristics of the respective assays for the various types of ovarian cancer, the combination of the inhibin assay with CA125 detects the majority of all ovarian cancers.

Activins↗
PubMed2006

Systematic reviews of diagnostic tests in cancer: review of methods and reporting.

OBJECTIVES: To assess the methods and reporting of systematic reviews of diagnostic tests. DATA SOURCES: Systematic searches of Medline, Embase, and five other databases identified reviews of tests used in patients with cancer. Of these, 89 satisfied our inclusion criteria of reporting accuracy of the test compared with a reference test, including an electronic search, and published since 1990. REVIEW METHODS: All reviews were assessed for methods and reporting of objectives, search strategy, participants, clinical setting, index and reference tests, study design, study results, graphs, meta-analysis, quality, bias, and procedures in the review. We assessed 25 randomly selected reviews in more detail. RESULTS: 75% (67) of the reviews stated inclusion criteria, 49% (44) tabulated characteristics of included studies, 40% (36) reported details of study design, 17% (15) reported on the clinical setting, 17% (15) reported on the severity of disease in participants, and 49% (44) reported on whether the tumours were primary, metastatic, or recurrent. Of the 25 reviews assessed in detail, 68% (17) stated the reference standard used in the review, 36% (9) reported the definition of a positive result for the index test, and 56% (14) reported sensitivity, specificity, and sample sizes for individual studies. Of the 89 reviews, 61% (54) attempted to formally synthesise results of the studies and 32% (29) reported formal assessments of study quality. CONCLUSIONS: Reliability and relevance of current systematic reviews of diagnostic tests is compromised by poor reporting and review methods.

Bias↗
PubMed2006

Oral cancer: experiences and diagnostic abilities elicited by dentists in North-western Spain.

BACKGROUND: Opinions, knowledge, behaviours and attitudes of general dental practitioners on oral cancer prevention and detection have been reported from many countries. However, experiences and skills of oral cancer detection have not been evaluated systematically. OBJECTIVE: To obtain information on behaviours of screening and ability to correctly detect oral cancer and precancer among general dentists (GDP) in North-western Spain. SUBJECTS AND METHODS: Thirty-two randomly selected GDPs completed questionnaires and then classified 50 projected images of clinical lesions, into cancer, precancer or benign lesions. RESULTS: 87.5% reported conducting routine oral examinations, 84.4% provided routine advice to their subjects for risk modifications and 84.4% claimed to biopsy a suspected oral mucosal lesion that they detected in practice. In a quasi research setting using clinical slides, the sensitivity of visual diagnosis of a cancerous lesion was 61.4% and precancer 59.5%. The diagnostic accuracy reported here is lower than what is already reported by evaluation of published screening programmes by dentists. CONCLUSIONS: Our data from Spain suggest a need for improving the diagnostic ability of GDPs in the visual detection of oral cancer/precancer by strengthening continuing professional education.

Clinical Competence↗
PubMed2006

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge.

OBJECTIVES: To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer. MATERIALS AND METHODS: We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented. RESULTS: There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months. CONCLUSION: EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.

Adolescent↗
PubMed1993

Rashes in immunocompromised cancer patients. The diagnostic yield of skin biopsy and its effects on therapy.

BACKGROUND AND DESIGN: Rashes in immunocompromised cancer patients can be important, and skin biopsies are often recommended for their evaluation. The objectives of this study were to determine how often skin biopsy in these patients is performed and how often it alters diagnosis and therapy. Records of all immunocompromised adults with cancer and acute rash seen by dermatology consultants on a hematology-oncology ward of a university hospital for 39 months were reviewed to determine patients' course and outcome (190 episodes of rash in 123 patients). RESULTS: Skin biopsies were performed on 108 rashes (57%); 82 rashes (43%) were evaluated without biopsy. Among the 108 patients who underwent a biopsy of their rashes, the biopsy findings supported the prebiopsy diagnosis in 51% (95% confidence interval [CI], 42% to 60%), altered it in 44% (95% CI, 35% to 53%), and did not contribute to the final diagnosis in 6% (95% CI, 2% to 12%). Fifteen of 108 biopsies (14%) (95% CI, 7% to 21%) changed systemic therapy. Most treatment changes were for cutaneous reactions to drugs; biopsy never resulted in the diagnosis of untreated systemic infection. Biopsy findings that altered diagnoses were not more likely to change therapy. Among the 82 rashes in which biopsies were not performed, review of the chart revealed no adverse sequelae (0%) (95% CI, 0% to 5%), which would have made a biopsy advisable. CONCLUSIONS: Skin biopsy findings often changed dermatologic diagnoses in immunocompromised cancer patients, but treatment changes based on biopsy results were much less common, and altered diagnoses in patients who underwent biopsy often did not change therapy. Untreated systemic infection was never diagnosed by means of a skin biopsy. Skin biopsies of these rashes may not be mandatory for either diagnostic or therapeutic reasons.

Adolescent↗
PubMed2006

[General practitioners' attitudes towards the diagnosis of lung cancer and the diagnostic organisation].

INTRODUCTION: The aim of this study was to determine whether there is a nihilistic attitude towards diagnosing lung cancer among Danish general practitioners (GPs) and to obtain the GPs' evaluation of the present approach to lung cancer diagnosis. MATERIALS AND METHODS: A questionnaire was sent to 1,186 randomly selected GPs. Most of the questions addressed the possibilities of improving primary prevention, GPs' attitudes towards diagnosing lung cancer, their opinions about waiting times and their clinical practice. RESULTS: A total of 848 (71%) completed the questionnaire. Only 12% agreed with the statement that the prognosis for lung cancer is so unfavourable that there is no hurry to diagnose the disease, while 22% agreed to the statement that diagnostic delay rarely means anything for the prognosis. About half of the GPs found the diagnostic period too long. There were, however, wide variations among the different counties in Denmark. The majority of GPs followed the recommendations of the Danish Lung Cancer Group for diagnosing lung cancer, especially the elderly GPs, who were also more inclined to make follow-up appointments after lung infections. More than one in every four practitioners was reluctant to use the word "cancer" in referrals to hospitals or for investigation. CONCLUSION: The study showed that Danish GPs do not have a nihilistic attitude towards diagnosing lung cancer and that elderly practitioners are more careful about diagnosing lung cancer. GPs' satisfaction with waiting times varies widely among the different counties in Denmark. Many practitioners were reluctant to use the word "cancer" in referrals.

Adult↗
PubMed2000

Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II.

Sensitive parameters of inflammation are rare in neutropenic cancer patients. In this study, procalcitonin (PCT), C-reactive protein (CRP), interleukin 6 (IL-6), IL-8, the soluble IL-2 receptor (sIL-2R) and the soluble tumour necrosis factor receptor II (sTNFRII) were evaluated for their diagnostic relevance in febrile episodes of cancer patients. Plasma or serum levels of these parameters were determined in neutropenic children with febrile episodes (n = 122) classified according to both the kind of infection [60 cases of fever of unknown origin (FUO), 28 cases of localized infection, 13 cases of pneumonia, 20 cases of bacteraemia, one case of fungaemia] and the World Health Organization (WHO) score of chemotherapy-induced mucositis. At baseline and during the febrile episodes, the highest levels of all parameters were observed in cases of gram-negative bacteraemia. However, in FUO and localized infections, low or only slightly elevated median levels of all parameters were documented. The degree of chemotherapy-induced mucositis did not influence the value of any parameter. In comparison with the other inflammatory parameters, PCT (optimum cut-off level 0.5 microg/l) was a more sensitive and more specific parameter in the diagnosis of high-risk (gram-negative bacteraemia) and low-risk (FUO) episodes, as well as in the sequential assessment of all febrile neutropenic episodes.

Adolescent↗
PubMed1992

Unilateral facial pain as the first symptom of lung cancer: are there diagnostic clues?

We describe three patients with unilateral facial pain due to non-metastatic lung cancer and review 11 published cases. Pain, most frequently located on the right side and around the ear, as well as digital clubbing can be clues to an early diagnosis. Compression of the vagus nerve by the tumour or by mediastinal adenopathy is most likely responsible for the facial pain and could play a role in pulmonary osteoarthropathy.

Adult↗
PubMed2000

Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer?

A diagnostic iodine-131 (131I) total body scan (TBS) is usually recommended 6 to 12 months after thyroid ablation for differentiated thyroid carcinoma. Its usefulness was evaluated in 256 consecutive patients treated and followed up at the Institut Gustave Roussy for papillary (n = 200), well differentiated (n = 27), or poorly differentiated (n = 29) follicular thyroid carcinomas. All patients underwent a near-total or total thyroidectomy and 131I ablation with 3.7 GBq (100 mCi). No TBS was performed before 131I ablation. The TBS performed after the administration of 131I to destroy the thyroid remnants showed uptake (<2%) limited to the thyroid bed. A diagnostic 131I-TBS was obtained after withdrawal of T4 treatment, with either 74 MBq (2 mCi; n = 82) or 185 MBq (5 mCi; n = 174), 6 to 12 months after initial treatment, with serum thyroglobulin (Tg) determination. No interference in the Tg assay was found in these 256 patients. Uptake in the thyroid bed was not detected (total ablation) in 236 patients, was visible but too low to be measured in 19 patients, and attained 1% in only 1 patient. No uptake was found outside the thyroid bed. The serum Tg level, once thyroid hormone treatment had been withdrawn, was below 1 ng/mL in 210 patients, ranged from 1-10 ng/mL in 31 patients, and was above 10 ng/mL in 15 patients. A 131I-TBS performed with 3.7 GBq in nine patients with a Tg level above 10 ng/mL, showed foci of uptake outside the thyroid bed in three patients; lung metastases were demonstrated by a CT scan in another patient, and palpable lymph node metastases were found in one patient. In conclusion, a diagnostic 131I-TBS with 74-185 MBq performed 1 yr after thyroid ablation demonstrated no abnormal uptake; it did not correlate with results of Tg determination and only confirmed the completeness of thyroid ablation. The serum Tg level obtained after withdrawal of T4 treatment permits the selection of patients with a Tg level exceeding 10 ng/mL, for scanning with 3.7 GBq (100 mCi).

Adolescent↗
PubMed2004

CD40 expression in prostate cancer: a potential diagnostic and therapeutic molecule.

CD40, a member of the TNF receptor superfamily, is widely expressed on human immune cells. It is also frequently expressed on epithelial malignancies, suggesting that CD40 may contribute to the pathogenesis of some cancers. Activation of CD40 in cancer cells induces growth inhibition and sensitization to apoptotic stimuli. This study investigates CD40 expression in archival tissue from patients with prostate cancer. In all cases, normal prostatic acini expressed CD40, however, in 56 of 57 cases of prostate cancer no CD40 expression was detected. In the one other case, patchy CD40 expression was associated with prostatic in situ neoplasia. In conclusion, invasive prostate cancer is a CD40-negative tumour. These data may be relevant as a diagnostic tool; in providing insight into progression of cancer from normal epithelium; and in identifying novel therapeutic strategies for prostate cancer.

Aged↗
PubMed2006

Use of guideline recommended follow-up care in cancer survivors: routine or diagnostic indications?

BACKGROUND: After potentially curative cancer treatment, patients may receive procedures for routine monitoring for recurrence or for evaluation of symptoms or signs. OBJECTIVE: We sought to characterize surveillance care guideline-recommended and other procedures performed in cancer survivors according to routine versus diagnostic indications. METHODS: This was a retrospective cohort study of paper and electronic medical records between 1990 and 2000 from a large midwestern U.S. integrated health care delivery system of 500 patients who received curative treatment of breast, colorectal, endometrial, lung, or prostate cancer. Our measures were the indications for potential surveillance procedures as recommended by clinical practice guidelines or otherwise. RESULTS: Among 14,670 procedures of interest received, 82.0% were performed for routine surveillance, whereas 10.6% were performed for diagnostic indications and 7.3% had indeterminate indications. Office visits most were often delivered for routine indications (91.6%), followed by guideline recommended tests for local recurrence (range 74.1-98.4%, depending on the specific test and cancer). In general, tests that were not recommended in established guidelines were for the purposes of detection of metastatic recurrence and were less often delivered for routine indications (overall frequency 59.2%, P<0.0001 compared with recommended testing). CONCLUSION: Office visits and testing for local recurrence of cancer generally are performed for routine surveillance, regardless of recommendation by practice guidelines. Because procedures not recommended by practice guidelines were more often for diagnostic purposes, classification of patients as undergoing intensive surveillance may be misleading and may require record review to confirm.

Cohort Studies↗
PubMed1990

The diagnostic validity of the serum tumor marker phosphohexose isomerase (PHI) in patients with gastrointestinal, kidney, and breast cancer.

The diagnostic validity of the glycolytic enzyme phosphohexose isomerase (PHI) as a serum tumor marker was evaluated. For this purpose the sensitivity of PHI was determined in 435 patients with histopathologically defined, malignant gastrointestinal, kidney, and mammary tumors prior to primary treatment. To assess the specificity, PHI serum activities were measured in 181 patients with benign diseases and disorders from an internal practice. In gastrointestinal and kidney cancer, PHI reached an overall diagnostic sensitivity of about 70%, and a specificity of 92% was obtained. Even in early stages without metastasis, elevated PHI serum levels were found in about 60% of the patients. In mammary cancer, however, a sensitivity of only 40% was observed. PHI activity can be measured without the need for highly technical skills and equipment, in a short time and at low cost. These data suggest that serum PHI can be a useful indicator in the preventive checkup of gastrointestinal and renal cancer in medical practice.

Biomarkers, Tumor↗