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PubMed2003

[Molecular diagnostics of prostate cancer].

Although a number of studies have identified molecular markers for prostate cancer, their clinical utility remains mainly unclear. Markers, which allow improved determination of the biological aggressiveness of individual prostate cancers, may help to optimize therapeutic management of this heterogeneous tumor type. Here, a subset of molecular markers, which are intensively discussed in the literature or which are supposed to gain clinical utility in the future, are described in more detail. For a better survey, the markers are divided into (a) susceptibility markers, (b) malignancy markers, and (c) aggressiveness markers. The number of markers described as well as the inconsistency across studies in assessing their clinical utility reflect the heterogeneity of prostate cancer also on a genetic level so that it is unlikely that a single marker will gain clinical relevance. Future research must include systematic analysis of the clinical utility of not only single markers but rather of marker profiles in appropriate studies.

Genetic Markers↗
PubMed1990

Topographic classification, clinical characteristics, and diagnostic delay of cancer of the larynx/hypopharynx in Torino, Italy.

The case series of a population-based case-control study of laryngeal and hypopharyngeal cancers in Torino, Italy, included 281 men with clinical and anamnestic data. Two hundred fifteen, 28, and 38 cancers originated from the endolarynx, epilarynx, and hypopharynx, respectively. Regions invaded by the tumor were divided into 26 subsites. A classification based on the number of invaded subsites was proposed, which agreed well with the T classification of the TNM system. Cancers originating from the hypopharynx invaded more subsites than cancers from the endolarynx, and among the latter, supraglottic were more invasive than glottic lesions. The number of invaded subsites was strongly associated with nodal involvement. Among symptoms at onset of disease and at diagnosis, patients with endolaryngeal lesions reported dysphonia and dyspnea more frequently, and patients with lesions from other regions had a higher prevalence of dysphagia, odynophagia, otalgia, and adenopathia. Clinical and epidemiologic results of this study suggest considering the endolarynx, epilarynx, and hypopharynx as separate anatomic entities. Diagnostic delay was not associated with tumor size and showed a negative trend with involvement of cervical lymph nodes, suggesting that stage at diagnosis is due to intrinsic differences in tumor aggressiveness.

Carcinoma, Squamous Cell↗
PubMed2004

[Risk of radiation-related cancer following exposure to diagnostic radiation].

The paper on the risk of radiation-related cancer following exposure to diagnostic X-ray, appeared in the issue of Jan 31, 2004 of the Lancet, and described an attributable risk estimate of 3.2% from the current medical exposure among the cancer incidences in Japan. While the fact that Japan is known as a country with the highest level of medical exposure, the quantification of radiation-related cancer risk have made quite an impact on medical society. The risk estimate based on the linear-non-threshold (LNT) dose response that remains unresolved scientifically need further research, but the radiation risk has been a useful tool not only for decision-making by risk-benefit analysis such as justification of medical use of radiation, but also for comparison with other risks. Recent radiation biology suggests that a bystander effect and adaptive response might modify the estimated cancer risk based on the LNT model at low doses. The risk from most diagnostic X-rays may be so small that excess cancer due to radiation can not be statistically detected. However, a diagnosis giving a relatively higher dose such as computer tomography in children should be carefully justified using a risk estimate. Raising awareness of low-dose cancer risk should involve not only understanding the process of risk estimation including data and assumption but also understanding there is indirect evidence for risk of lower level radiation exposure in medical procedures.

Adult↗
PubMed2006

Genomic platforms for cancer research: potential diagnostic and prognostic applications in clinical oncology.

The completion of the Human Genome Project and the achievement of similar goals in other organisms have generated a huge amount of free available information with high potential in biomedical sciences. However, the identification of the DNA sequence was only a starting point for genomic research. This research has been facilitated by the development of new powerful genomic tools that allow the use of the wide amount of genomic information generated to address new biological and biomedical questions. One of these widely accepted and accessible technologies is DNA microarrays. Although the most popular use of DNA microarrays is gene expression profiling, due to the continuous advances in microarray technologies, scientists have also successfully used them for multiple applications, including genotyping, re-sequencing, DNA copy number analysis and DNA methylation. In short, DNA microarrays are changing the way cancer research scientists are addressing different biological questions and will allow the translation of genome research to clinical practice.

Biomedical Research↗
PubMed1992

Diagnostic imaging in cancer.

Screening chest radiographs do not reduce mortality from lung cancer. Should an incidental noncalcified pulmonary parenchymal nodule be discovered, chest CT will demonstrate one third of such patients to, in fact, have the multiple nodules of metastatic disease. CT is very helpful to guide fine needle aspiration biopsy of lung lesions and to assist in evaluation for resectability. MR can be helpful in special circumstances, including the definition of the extent of paravertebral, superior sulcus, and diaphragmatic lesions. Endorectal ultrasound is not sensitive enough to function as a screening tool for prostate cancer but is used routinely to guide biopsies. CT and MR are rarely helpful in staging this disease. Given the highly characteristic trait of bone metastasis in prostate cancer, a bone scan is mandatory in all patients. Double contrast barium enema can be used as an adjunct or alternative to sigmoidoscopy for colorectal cancer screening, in the preoperative evaluation of patients, and in postoperative surveillance. CT and MR can detect macroscopic adenopathy and liver metastases; CT is generally the preferred study. Screening mammography can have a major impact in reducing breast cancer mortality. It is recommended that a baseline study be obtained at age 35. Annual or biannual examinations should commence at age 40. Any palpable lesion, whether or not it is demonstrated mammographically, must be subjected to biopsy. Ultrasound is the most useful initial imaging study for evaluating pelvic masses. MR will, on occasion, identify the origin of a mass not determinable from ultrasound scan. MR is particularly valuable to identify parametrial spread (inoperability) of cervical cancer, and has been underused for this purpose. Surgery remains the mainstay for the staging of ovarian and endometrial cancer, although CT can be helpful to identify macroscopic relapse, ascites, or liver metastases. Bone scan and liver CT remain the standard procedures for detecting metastases in these respective organ systems. MR can be invaluable in the imaging of epidural metastasis and spinal cord compression in patients with vertebral metastatic disease. Contrast-enhanced MR is more sensitive than contrast-enhanced CT for detecting brain metastases, but the latter remains a useful tool. Chest CT can improve the detection of pulmonary metastases when this is of crucial importance.

Biopsy, Needle↗
PubMed1981

Diagnostic errors in cancers of the nasal cavity and paranasal sinuses. The essential role of surgery.

Two hundred eighty-two cases of 624 cases of carcinoma of the nasal cavity and paranasal sinuses were studied. All had a clinical evaluation of the extent of carcinoma, followed by surgical procedures. By a process of defining 13 possible compartments or extensions and enumerating them before and after surgery, it was possible to show that approximately one third of the cases had errors in preoperative assessment. Underestimates preponderated. It is suggested that diagnosis is one important role of surgery, in addition to the directly therapeutic effect of excision. Surgery is also essential as a guide to further excision and to the accurate application of radiotherapy treatment fields.

Diagnostic Errors↗
PubMed1987

Evaluation of carbohydrate antigens 19-9 and 12-5 in patients with pancreatic cancer.

The diagnostic value of the tumor-associated antigens Ca 19-9 and Ca 12-5 was tested in 130 subjects (38 healthy controls, 37 carcinomas of the pancreas, 23 chronic pancreatitis, 23 extrapancreatic gastrointestinal cancers, 9 endocrine pancreatic tumors). Ca 19-9 levels above 37 U/ml were obtained in 67.6% and Ca 12-5 levels above 39 U/ml in 45.9% of carcinomas of the pancreas, 4.3 and 8.7%, respectively, of chronic pancreatis, 21.7 and 17.4% of extrapancreatic gastrointestinal tumors, and 0 and 11.1% of endocrine pancreatic tumors and in none of the healthy controls. Results of preoperative determination of Ca 19-9 and Ca 12-5 gave a sensitivity of 67.6 and 45.9%, a specificity of 91.8 and 90.9%, a predictive value of a positive test of 80.6 and 70.8%. When elevation of both antigens was required, sensitivity decreased to 32.4% but specificity rose to 97.3%. All but one of the pancreatic cancer patients were at stage 3 and 4. The only patient with pancreatic cancer in stage 1 had normal levels of both markers. Ca 19-9 and Ca 12-5, whether alone or associated, represent a good diagnostic test for differentiating pancreatic cancer from chronic pancreatitis. Due to the low sensitivity of both markers, the tests are of limited value when any other diagnostic evidence of pancreatic cancer is absent.

Antigens, Neoplasm↗
PubMed2006

Prostate-specific antigen 'velocity' as a diagnostic test for prostate cancer.

BACKGROUND: Prostate-specific antigen "velocity" (slope) is promoted as a diagnostic test for prostate cancer, but its clinical usefulness is uncertain. Accordingly, we evaluated the sensitivity of prostate-specific antigen (PSA) velocity among men who are diagnosed subsequently with prostate cancer. METHODS: Among 64,545 men receiving primary care at any of nine Veterans Affairs Medical Centers during 1989-1990, 1,313 men at least 50 years old had an incident diagnosis of prostate cancer during 1991-1995. PSA velocity values obtained prior to diagnosis ("test") were compared with results from prostate biopsies ("truth"). RESULTS: Among men (n = 493) with at least two tests before diagnosis, the sensitivity of PSA velocity > or = 0.75 ng/mL/yr was 75.5% (95% confidence interval [CI] 71.7-79.3) overall and 48.1% (95% CI 34.8-61.5) among men with normal values of PSA (< 4.0 ng/mL). Based on published data for specificity and prevalence, the estimated positive predictive value of PSA velocity > or = 0.75 ng/mL/yr is as low as 5%. CONCLUSION: PSA velocity may have limited usefulness as a diagnostic test for prostate cancer.

Aged↗
PubMed1994

The pathological features and prognosis of prostate cancer detectable with current diagnostic tests.

The discrepancy between the high prevalence of prostate cancer found at autopsy and the low incidence of clinical cancer prompted a study to determine whether the new diagnostic tests, that is ultrasonography and serum prostatic specific antigen (PSA) levels, detect prostate cancer at an earlier stage than the traditional test, digital rectal examination, without detecting a larger proportion of clinically unimportant cancer. Clinically detected cancer treated by radical prostatectomy (306 cases) and incidental cancer found in cystoprostatectomy specimens (90) were categorized into 3 groups by the volume, grade, extent of the cancer and outcome of treatment: clinically unimportant tumor (0.5 cm.3 or less, Gleason grades 1 to 3 and confined to the prostate), clinically important curable cancer (more than 0.5 cm.3 or grade 4 or 5 and confined, or with microscopic extracapsular extension) or advanced disease (extensive extracapsular extension, seminal vesicle invasion or lymph node metastases). Of 306 clinically detected tumors 9% were unimportant and 29% were advanced. In contrast, incidental cystoprostatectomy disease was either unimportant (78%) or curable (22%) and no tumor was advanced (p < 0.0005). Cancer detectable by digital rectal examination, ultrasonography or PSA was distributed similarly among the 3 groups. Impalpable cancer detected by PSA was less likely to be advanced (11%) than cancer detected by digital rectal examination (34%, p = 0.01) but no more likely to be unimportant (13% versus 8%). Of 29 tumors detected only by systematic biopsies because of an elevated PSA level only 4% were advanced, while 17% were unimportant. Cancer detectable with each of the available diagnostic tests was similar and differed distinctly from that found incidentally in cystoprostatectomy specimens. The detection of impalpable cancer by PSA or ultrasound decreased the proportion of advanced tumor detected without increasing significantly the detection of unimportant disease.

Adult↗
PubMed1995

Attitudes of European urologists to early prostatic carcinoma. I. Diagnostic work-up on suspected prostatic cancer cases.

The diagnostic work-ups of 656 European urologists on theoretical cases of suspected early prostatic carcinoma were surveyed. The diagnostic work-ups varied considerably among the urologists. There was strong agreement that digital rectal examination (DRE) and prostate-specific antigen (PSA) should be used routinely in these cases, but there was a lack of agreement concerning the use of transrectal ultrasound examination (TRUS), prostate biopsies and bone scan. However, the use of TRUS, bone scan and biopsies was correlated positively to the PSA level and negatively to age (p < 0.0001), but was not correlated to whether the patient was asymptomatic or suffered from prostatism. Ninety-two percent of the urologists would perform biopsies if a palpable lesion were present. If the PSA was elevated, 22% would use biopsies if it was 7 ng/l, 62% if it was 15 ng/l and 83% if it was 35 ng/l. These results indicate that a majority of European urologists would attempt to diagnose prostatic cancer with biopsies only when results of DRE and PSA predict a high risk that the cancer is no longer organ-confined.

Adult↗
PubMedDate not supplied

Evaluation of the barium-enema examination and colonoscopy in diagnosis of colonic cancer.

The diagnostic value of colonoscopy was investigated in 123 patients with certain or questionable cancer of the colon as demonstrated by an ordinary barium-enema examination. The diagnosis was revised by laparotomy or clinical follow-up studies in cases of patients having no operation. The following conclusions were deduced: 1) The number of unnecessary laparotomies may be reduced by doing colonoscopy in patients with certain or questionable cancer of the colon as demonstrated by ordinary barium-enema studies. 2) The gain in diagnostic value of adding a colonoscopy to a barium-enema examination is more pronounced in patients with questionable than in those with certain cancer as visualized by the barium-enema studies. 3) The risk of missing a cancer of the colon during colonoscopy is very small if an experienced examiner looking for cancer performs the colonoscopy. 4) Colonoscopy is of little diagnostic value in cases of patients who have radiologic evidence of stenosis of the sigmoid colon. 5) The number of patients selected for colonoscopy on the basis of radiologic evidence suggesting cancer probably can be reduced by refinement of the barium-enema examination.

Adult↗
PubMed2003

Diagnostic delay and prognosis in invasive bladder cancer.

OBJECTIVES: To study diagnostic delay in invasive bladder cancer in a population-based material with long-term follow-up, and to evaluate whether delay in diagnosis affects the risk of bladder cancer death. MATERIAL AND METHODS: In a previous study, 177 patients with invasive bladder cancer (T1-T4) diagnosed in 1988 were investigated with regard to diagnostic delay. A review of all available clinical records was performed. In the present study, causes of death for these patients were registered over a 12-year follow-up period, and the impact of diagnostic delay on bladder cancer death was studied by means of survival analysis. RESULTS: The median diagnostic delay in the material was 144 days. When the patients were stratified into groups with diagnostic delays of 0-3, 3-6, 6-12 and >12 months, those with T1 tumours in the two groups with a diagnostic delay of <6 months showed a trend towards a decreased risk of bladder cancer death. In contrast, in patients with muscle-invasive disease, a significantly increased risk of bladder cancer death was noted for those with a diagnostic delay of <6 months. CONCLUSION: A trend towards better prognosis was found for patients with T1 tumours with a shorter diagnostic delay. The poor prognosis of patients with muscle-invasive disease and a short diagnostic delay suggests aggressive behaviour of the tumour and may explain the worse prognosis in these patients.

Age Distribution↗
PubMed2001

Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors.

PURPOSE: To evaluate the proposed cancer-related fatigue (CRF) diagnostic criteria in a sample of cancer survivors. More accurate prevalence estimates of CRF may result in improved diagnosis and management of one of the most common symptoms associated with cancer and its treatment. METHODS: Three hundred seventy-nine individuals who had been treated with chemotherapy, either alone or in combination with radiation therapy, were surveyed. Patients were asked background questions about their current condition, their medical history, and the frequency of fatigue during their chemotherapy. Additionally, patients who reported experiencing fatigue at least a few days each month during treatment were asked a series of questions about the impact of fatigue on their daily functioning. RESULTS: One hundred forty-one (37%) individuals reported at least 2 weeks of fatigue in the previous month. Of the respondents who had received their last treatment more than 5 years ago, 33% still reported at least a 2-week period of fatigue in the month before the interview. Evaluation of the proposed criteria revealed that 17% of respondents met at least two criteria for CRF. CONCLUSION: The prevalence of diagnosable CRF in the individuals in this sample, most of whom had completed treatment more than 1 year ago, was 17%-lower than expected based on previous reports that have used less-strict criteria. In a sizable number of people, CRF persists well beyond active treatment and should be a focus of intervention. Although they will require replication in other samples and clinical validation, these formal diagnostic criteria can be a step toward common language and a better understanding of the severity range and persistence of CRF.

Data Collection↗
PubMed2005

Diagnostics of rectal cancer: endorectal ultrasound.

In rectal cancer, accurate preoperative staging is essential to adequately select patients for different therapeutic regimes. Endosonography has been proven to be an accurate staging modality in multiple prospective studies. A recent large retrospective study, however, has cast doubt on the actual accuracy of endorectal ultrasound for staging rectal cancer in everyday clinical routines. The results of endosonographic staging of rectal tumours over a period of 10 years at the Department of Surgery of the University of Heidelberg are presented. In a first time period, 424 patients with rectal cancer were staged by endosonography and the data recorded prospectively. The examinations were exclusively done by four surgeons with high experience and scientific interest in endosonography. The second time period comprises 332 patients with rectal tumours (including adenomas) having undergone endosonography by six different examiners after introduction of this staging method into the clinical routine. The data here were analysed retrospectively. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated for the T and N classifications for both series. In the second series, eight factors which have been postulated to influence staging accuracy in the literature were included in a regression analysis in order to identify relevant factors for staging inaccuracies. Accuracy for staging of the T classification was 81% in the first series versus 71.7% in the second series. In the regression analysis of the second series, status post-chemoradiation proved to be the most significant factor for staging inaccuracy (p < 0.0002). When excluding all patients having undergone chemoradiation, the accuracy for staging of the T classification rose to 76%. A major problem of endosonography in this second series was overstaging; the T category was overestimated in 76 cases (22.9% of patients). The main error here was overstaging of adenomas as cancerous lesions (45.5% of all adenomas) and T2-cancers as more advanced cancers (42.2% of all T2-cancers). When excluding the adenomas from this analysis, the accuracy increased to 73.5%. Accuracy for staging of the N classification was 76% in the first series versus 71% in the second series. Status post-chemoradiation again was a relevant factor (p < 0.0003); when excluding these patients the accuracy increased to 73%. The accuracy of endosonography for rectal tumours decreases after introduction of the method into the everyday clinical routine. Nonetheless, apart from magnetic resonance imaging with an endorectal coil, rectal endosonography is still the most accurate staging modality for rectal tumours and allows adequate selection of patients for different therapeutic regimes. As the major problem of rectal endosonography is overstaging, more patients are likely to undergo overtreatment rather than undertreatment. Endosonography is inaccurate in staging patients having undergone chemoradiation.

Endosonography↗
PubMed1976

Utilization of diagnostic techniques for cancer of the breast - early diagnosis.

Early diagnosis of breast cancer is the only method with proven potential for lowering the death rate from the disease. Early diagnosis means, in a practical way, detection of preclinical cancer - finding the cancer before it would ordinarily be detected in the normal course of events. This involves mass screening of apparently well women.

Adult↗