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PubMed1997

Normalization of the tumor marker CA-125 after oophorectomy in a patient with paraneoplastic cerebellar degeneration without detectable cancer.

A 61-year-old woman developed severe subacute cerebellar degeneration in association with a neuronal antinuclear autoantibody. Neurologic investigations were remarkable only for mild CSF leukocytosis. Despite no radiographic evidence of cancer, a salpingo-oophorectomy was performed on the basis of an increased gynecologic cancer marker (CA-125) and the neurologic symptoms that were strongly suggestive of paraneoplastic cerebellar degeneration. Although no tumor was detected in the surgical specimen, CA-125 levels normalized after surgery. The patient remains stable 12 months after surgery with a severe cerebellar syndrome, no evidence of cancer, and persistent circulating antineuronal autoantibodies. An elevated tumor marker in a patient with a presumed paraneoplastic neurologic disorder should suffice as evidence of an occult neoplasm, and guide definitive treatment.

Autoantibodies↗
PubMed2006

High incidence of prostate cancer detected by saturation biopsy after previous negative biopsy series.

OBJECTIVES: We explored the yield of saturation biopsy and developed a nomogram predicting the probability of prostate cancer (PCa) on the basis of saturation biopsy. MATERIALS AND METHODS: Between 2001 and 2004, saturation biopsies (average of 24 cores) were performed in 161 men with persistently elevated prostate specific antigen (PSA) level (median, 9 ng/ml). All had at least two previously negative, eight-core biopsy sessions. PCa predictors on saturation biopsy were integrated within multivariate nomograms. RESULTS: PCa detection was 41% (n=66 of 161). PSA density and transition zone volume were the most significant predictors of PCa on saturation biopsy. The accuracy of the nomogram with the best performance characteristics was 72%. CONCLUSIONS: Saturation biopsy may be indicated in men with a persistent suspicion of PCa. High-risk individuals can be identified accurately with our nomogram.

Adult↗
PubMed1994

Survival of men with clinically localized prostate cancer detected in the eighth decade of life.

We reviewed our experience with the management of men 70 to 79 years old with clinically localized prostate cancer to determine whether surgical candidates were likely to die of intercurrent disease soon after the disease was diagnosed. Of 101 men in the eighth decade of life who were surgical candidates by all criteria other than patient age 44 underwent radical prostatectomy, whereas 57 were managed by medical therapy including observation, radiation therapy and/or androgen deprivation. Five patients died in the surgical group at a median followup of 59 months, only 1 of whom died of intercurrent disease. Among 15 deaths in the medical group metastatic prostate cancer was the most common cause and all deaths from prostate cancer occurred more than 3 years after diagnosis. Survival for the surgical group was significantly better than that for the medical group during followup (p < 0.01 log-rank test). We conclude that men at our institution who underwent radical prostatectomy in the eighth decade of life did not frequently die of intercurrent disease, and experienced acceptable morbidity and mortality rates. We believe that men with localized prostate cancer should not be denied a radical operation based on age alone.

Age Factors↗
PubMed2000

Paranasopharyngeal space involvement in nasopharyngeal cancer: detection by CT and MRI.

Paranasopharyngeal tumour extension (PTE) from nasopharyngeal carcinoma (NPC) is staged in its own subgroup in the American Joint Committee on Cancer classification. Most large clinical trials use computed tomography (CT) to stage PTE, but diagnosis relies on indirect signs of tumour invasion such as asymmetry of the parapharyngeal fat. Magnetic resonance imaging (MRI) has the advantage of directly revealing PTE because of its ability to depict the complex anatomical structures that form the boundary of the nasopharynx. The aim of this study was to compare CT and MRI in the identification of PTE and to determine whether the imaging modality used influenced staging of the disease. The MRI and CT scans of 78 patients (156 parapharyngeal regions) with NPC were assessed for PTE. On MRI, PTE was considered to be positive when there was tumour invasion through the complex anatomical structures of the nasopharyngeal wall. When using CT, it was considered positive when there was: (1) distortion of the parapharyngeal fat plane; or (2) extension beyond a line drawn from the medial pterygoid plate to the lateral aspect of the carotid artery. CT scanning and MRI were compared. PTE was judged to be present in 28 of 78 (36%) patients by MRI and in 41 of 78 (53%) scanning by CT when using criterion 1 or 2. An analysis of the discordant findings revealed that MRI was positive in three sides of the nasopharynx in early tumour extension through the pharyngobasilar fascia but not identified with CT by using criterion 1 or 2. MRI was negative in 20 and 21 sides of the nasopharynx that were judged to be positive on CT by using criterion 1 and 2 respectively. In these patients MRI revealed that the positive CT scan was caused by a large tumour compressing but not invading the parapharyngeal fat space, a metastatic lateral retropharyngeal node, or a combination of the two. The imaging modality used for staging NPC has an impact on the staging of PTE. CT scanning suggested the presence of PTE more frequently than MRI because of its inability to distinguish the primary tumour from lateral retropharyngeal nodes, and direct tumour invasion of the parapharyngeal region from tumour compression. The imaging modality and criteria used for staging PTE should be taken into consideration when assessing the results of clinical studies.

Adult↗
PubMed2004

Development of a rare cell fractionation device: application for cancer detection.

Isolating rare cells from biological fluids including whole blood or bone marrow is an interesting biological problem. Characterization of a few metastatic cells from cancer patients for further study is desirable for prognosis/diagnosis. Traditional methods have not proven adequate, due to the compositional complexity of blood, with its large numbers of cell types. To separate individual cells based on their mechanical characteristics, we have developed a series of massively parallel microfabricated sieving device. These devices were constructed with four successively narrower regions of channels numbering approximately 1800 per region. As cells traversed the device, they encountered each region and stopped at a gap width that prohibited passage due to their size. Cultured neuroblastoma cells, when mixed with whole blood and applied to the device, were retained in the 10-microm-wide by 20-microm-deep channels. All other cells migrated to the output. A derivative of the same device was utilized to characterize migration of whole blood. Adult white blood cells were retained at the 2.5-microm-wide by 5-microm-deep channels, while red blood cells passed through these channels. Devices designed to capture rare cells in peripheral circulation for downstream analysis will provide an important tool for diagnosis and treatment.

Cell Separation↗
PubMed2002

Recurrent laryngeal nerve palsy in patients with lung cancer: detection with PET-CT image fusion -- report of six cases.

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) was performed for preoperative staging of lung cancer. In six of 184 patients, there was an intense FDG accumulation in the lower anterior neck. Fusion of PET and computed tomographic images revealed that the focal FDG uptake was localized in the internal laryngeal muscles. This finding was a result of compensatory laryngeal muscle activation caused by contralateral recurrent laryngeal nerve palsy due to direct nerve invasion by lung cancer of the left mediastinum or lung apices. The knowledge of this pitfall is important to avoid false-positive PET results.

Adult↗
PubMed1987

[Basic principles of a breast cancer detection program].

The results of different programmes for screening carried out at present in foreign countries give sufficient proof of the value of screening for cancer of the breast in asymptomatic women of over 50 years of age. There is a significant reduction in mortality between 30 and 70%, according to different studies. Women who were screened had their cancers diagnosed at an earlier stage of the illness than those who were not screened whatever the ages of the women were. These results give a basis for planning screening in France. However, controlled pilot studies should still be carried out to widen screening in a country. These studies should in particular look at technical methods, evaluate the quality of the information that is obtained and the acceptability by women, as well as the training of radiologists and the qualities of the methods used. Finally, each programme should be controlled by the Public Authorities who will be paying for it.

Adult↗
PubMed1997

[The use of high resolution MR imaging for pre-treatment evaluation of breast cancer: detection of intraductal spread].

Thirty-two patients were examined in order to evaluate the role of high-resolution MRI in the treatment planning of breast cancer. A 1.5T Signa imager (GE Medical Systems) was used with dedicated receive-only breast coil. The pulse sequence based on RARE was used with the fat-suppression technique. After examining both breasts with larger FOV (30 cm), the affected breast alone was examined with smaller FOV (18 cm) and larger matrix (512 x 384) with Gd enhancement. Breast cancer showed more prominent and earlier enhancement compared with normal breast tissue. Linear or spotty continuous enhancement from the main tumor was considered to be suggestive of intraductal spread. Of 32 patients, 20 showed linear or spotty enhancement around the main tumor on MRI, and 15 of these 20 had intraductal spread. On the other hand, 12 out of 32 patients were considered to have little intraductal spread on MRI, and these findings corresponded to the pathological findings. Sensitivity, specificity and accuracy of detecting intraductal spread were 88%, 75% and 78%, respectively. In order to evaluate the extent of intraductal spread, further study using more precise correlation with pathology is necessary. High-resolution MRI was also considered to be useful for evaluating the presence of multifocal or multicentric focies or muscle invasion.

Adenocarcinoma↗
PubMed2002

Mismatch repair genes and microsatellite instability as molecular markers for gynecological cancer detection.

Due to major developments in genetics over the past decade, molecular biology tests are serving promising tools in early diagnosis and follow-up of cancer patients. Recent epidemiological studies revealed that the risk for each individual to develop cancer is closely linked to his/her own genetic potentialities. Some populations that are defective in DNA repair processes, for example in Xeroderma pigmentosum or in the Lynch syndrome, are particularly prone to cancer due to the accumulation of mutations within the genome. Such populations would benefit from the development of tests aimed at identifying people who are particularly at risk. Here, we review some data suggesting that the inactivation of mismatch repair is often found in endometrial cancer and we discuss molecular-based strategies that would help to identify the affected individuals in families with cases of glandular malignancies.

Aneuploidy↗
PubMedDate not supplied

Distribution of large-bowel cancers detected by occult blood test in asymptomatic patients.

A randomized, controlled study on occult blood in stool was conducted in 48,000 asymptomatic participants, ages 50 to 80 years. Those with positive hemoccult test results underwent a complete colonic workup including colonoscopy and, in some cases, an air-contrast barium-enema examination when total colonoscopy could not be accomplished. From April 1976 to December 1980, 113 patients (62 men and 51 women), with an average age of 66 years, were found to have invasive carcinomas of the large bowel: right colon--25 per cent, transverse colon (included both flexures)--9 per cent, descending colon--10 percent, sigmoid and rectosigmoid--42 per cent, rectum--12 per cent, anal canal--2 per cent. The stages of the cancers were: Dukes' A--57 per cent, Dukes' B--21 per cent, Dukes' C--19 per cent, Dukes' D--3 per cent. The findings suggest that a complete colonic workup is required for the detection and diagnosis of large-bowel cancers in asymptomatic patients.

Aged↗
PubMed2004

Clinical and pathologic features of prostate cancer detected after repeat false-negative biopsy in a screening population.

BACKGROUND: The present study was designed to investigate whether the clinical or pathologic features of prostate cancer (PCa) are related to the number of repeat biopsies required to establish the diagnosis of PCa. METHODS: Between February 1993 and August 2000, 653 patients were evaluated in this retrospective study. All patients underwent transrectal ultrasound-guided biopsy of the prostate prior to radical retropubic prostatectomy. The pathologic findings of specimens obtained at radical prostatectomy and pelvic lymph node dissection as well as PSA levels, findings on DRE, prostate volumes, transition zone volumes, and age were analyzed separately for all PCa patients diagnosed at the first set of biopsies (group A) and compared with the data of those diagnosed at the 2nd-5th set of biopsies (group B). In a second step, we compared the results obtained from patients diagnosed at the 2nd set of biopsies (group B1) with those of patients diagnosed at the 3rd to 5th set of biopsies (group B2). RESULTS: Gleason scores, pathologic tumor stages, and tumor volumes in group B were found to be significantly decreased compared to group A. But from the 2nd to 5th serial biopsy no further decrease in pathologic stage, Gleason score, or tumor volume was observed. On the contrary, there was a tendency towards higher tumor stages and Gleason scores. Of the tumors detected after the second false-negative set of biopsies almost 70% were lesions with Gleason scores of 6 or higher. CONCLUSIONS: False-negative results at the first needle biopsy are predictive of a lower pathologic stage and grade as well as smaller tumor volumes of PCa diagnosed at repeat sets of biopsies. False-negative results on repeat biopsy, however, have no prognostic significance for the tumor stage of PCas detected at subsequent sets of biopsies.

Aged↗
PubMed1998

Cervical lymph node involvement in head and neck cancer detectable as expression of a spliced transcript of type II keratin K5.

Metastatic spread to cervical lymph nodes is a major determinant of outcome in head and neck cancer. One hundred and ninety-six lymph nodes dissected from fresh surgical specimens from 24 patients with primary head and neck squamous cell carcinoma (SCC) were bisected. Messenger RNA (mRNA) extracted from one half and from a segment of the primary tumour was amplified by reverse transcriptase (RT)-polymerase chain reaction (PCR) with primers flanking the fifth intron of human type II keratin K5. DNA bands resolved by agarose gel electrophoresis were confirmed as specific transcripts by sequencing. The other half of each node was fixed in formalin for histology and, in selected nodes, for immunohistology for cytokeratins. Of 153 nodes suitable for analysis, 14 nodes contained metastatic tumour detected by light microscopy and also tested positive for K5 mRNA by RT-PCR. Fifty-six nodes were histologically negative for tumour but positive for K5 mRNA, and 83 nodes were negative for both histology and K5 mRNA. Extracts of the primary tumour always reacted positively for K5 by RT-PCR, whereas lymph nodes from patients without malignancies, and blood lymphocytes from a healthy volunteer reacted negatively. RT-PCR designed to detect the presence of processed transcripts of type II keratin K5 in stratified squamous epithelial cells may be a sensitive technique to detect the presence of viable and potentially metastatic carcinoma cells in lymph nodes draining head and neck SCC.

Biomarkers, Tumor↗
PubMed1993

An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density.

Prostate-specific antigen (PSA) is the most accurate serum marker for cancer of the prostate (CaP). However, its sensitivity and specificity are suboptimal, especially at values ranging between 4.1 and 10.0 ng/ml (monoclonal), because benign prostatic hypertrophy and hyperplasia (BPH) and CaP frequently coexist in this range. This study was undertaken to determine the value of incorporating prostate volume measurements with serum PSA levels in a quotient (PSA/volume) entitled PSA density (PSAD). A total of 3140 patients were analyzed and stratified by serum PSA, digital rectal examination (DRE), transrectal prostate ultrasound (TRUS), TRUS volume determination and PSAD. All patients were referred for evaluation and therefore do not represent a screened population. Patients underwent prostate biopsies when abnormalities in TRUS or DRE were detected. Although both PSA and PSAD have statistical significance when the serum PSA value is < or = 4.0 ng/ml, neither has clinical significance in differentiating BPH from CaP. At serum levels ranging between 4.1 and 10.0 ng/ml, PSA has no ability to differentiate BPH from CaP, whereas PSAD does so with statistical and clinical significance. When the PSA value is between 10.1 and 20.0 ng/ml, only PSAD is statistically significant. When PSA exceeds 20 ng/ml, PSAD is redundant. We conclude that all patients with an abnormality on DRE or TRUS should undergo prostate biopsy. If the PSA value is < or = 4.0 ng/ml, TRUS and PSAD are not warranted and routine biopsy is not recommended. For intermediate PSA levels, 4.1-10.0 ng/ml, TRUS, TRUS prostate volume, and PSAD are important.2_

Aged↗
PubMed2002

Impact of screening on breast cancer detection. Retrospective comparative study of two periods ten years apart.

OBJECTIVE: The aim of this study was to evaluate changes in the mode of discovery of breast cancer in the last 15 years. We compared two periods separated by a 10-year interval, during which a mass mammographic screening programme was established in our department. MATERIALS AND METHOD: We made a retrospective comparison of the records of female patients with breast cancer diagnosed in our hospital over the period 1986-1989 (first period) and 1997-1999 (second period). The mass screening programme for breast cancer began in 1995. RESULTS: We collected 372 patients in the first period and 341 in the second. We found a significant change in the mode of the discovery of breast cancer between the two periods: 80.2% versus 51.9%, respectively, of the cases of breast cancer were discovered by breast self-examination, 10.2% versus 13.7% were discovered by a physician, and 4.8% versus 29.1% were discovered by routine mammography as part of an individual or mass screening programme. The mean size of the tumours decreased significantly (2.6 cm versus 2.3 cm: p = 0.019), and the number of tumours with initial metastases or lymph node involvement decreased, almost attaining the level of significance (p = 0.06). It is difficult to compare the survival and disease-free survival curves because of the short follow-up in the second period (median follow-up = 10 months). However, a marked difference appears to be developing (p < 0.0001): patients diagnosed by mammography are showing better survival and disease-free survival compared with the others. DISCUSSION: We observed that more widespread use of mammography screening for breast cancer led to smaller tumours being discovered during the second period, with less lymph node involvement and less initial metastasis. Breast cancer screening is one of the most intensively evaluated health care practices with eight completed randomized trials yet its net benefit has remained controversial. It has been shown that, at least for patients aged 50 to 70, properly organized mass screening for breast cancer led to a reduction in mortality rate. However, individual breast self-exam, physician and mammographic screening can interfere with assessment of mass screening programmes in terms of individual benefit. In addition, introducing a mass screening programme may induce opportunistic screening in non-invited age groups and influence health behaviour in the target and non target populations. A retrospective study was performed to evaluate the mode of discovery, the diagnostic presentation, and prognostic factors in breast cancer in a French department before and after initiation of a mass-screening programme (MSP).

Adult↗
PubMedDate not supplied

Recruitment of underserved women for breast cancer detection programs.

PURPOSE: The purpose of this correlational, nonexperimental study was to survey a sample of uninsured/underinsured women entering a no-cost, state-funded breast cancer screening program to identify factors that might enhance existing recruitment strategies and adherence to breast cancer screening. OVERVIEW: Inadequate access to breast cancer screening contributes to the high morbidity and mortality that have been documented in low-income American women with breast cancer. Two hundred and four participants in a no-cost cancer screening program at the Johns Hopkins Oncology Center's East Baltimore Community Health Program in Maryland were surveyed by telephone to identify methods to enhance recruitment strategies. The survey solicited information in areas such as demographics, healthcare practices, and recruitment sources. Knowledge about breast cancer and its treatment, perceived control over health matters, and the practice of preventive measures were low in this group. Based on the data obtained, recruitment strategies better tailored to this population were developed and implemented. CLINICAL IMPLICATIONS: Recruiters and clinicians must understand that for impoverished women, day-to-day survival takes precedence over most other issues. The possibility of a condition that may cause illness or death 10 to 20 years from now is of less importance than obtaining food, clothing, and shelter today. This program demonstrates that services such as transportation and child care are important elements of care for this population. Culturally sensitive recruitment strategies, personalized care, and vigilant follow-up are important requisites to breast cancer screening programs. A multidisciplinary team effort is critical in bringing together the elements required for a successful screening program.

Adult↗
PubMed1989

[A case report of renal cancer detected unexpectedly by X-ray CT during observations in the clinical course of cervical carcinoma].

The case is a 55-year old woman whose mother died of gastric cancer. In 1984 she underwent radiotherapy for cervical squamous cell carcinoma stage IIIb and had since been under the periodical observations. In 1987 she happened to undergo abdominal X-ray CT scans, and with an image of tumor mass revealed in the right kidney, she was admitted to our hospital. A clinical diagnosis of the right renal cancer was made, and radical nephrectomy was performed. Histological diagnosis was renal cell cancer pT2N0M0. This is the 7th reported case among the cases of double cancer of the cervix and the kidney in Japan. Multiple primary malignancies consist of these two cancers, and the renal carcinoma as an incidental finding with image procedure were discussed.

Carcinoma, Renal Cell↗
PubMed2003

[Gene expression of MMP1 and TIMP1 in lung cancer detected with a cDNA microarray technique].

OBJECTIVE: To investigate the gene expression of matrix metalloproteinases 1 (MMP1) and tissue inhibitors of matrix metalloprotainases 1(TIMP1) in squmas cell lung cancer and adenocarcinoma. METHODS: Gene expression profile cDNA microarray egntaining 4,096 genes was used to identify differentially expressed genes in squmas cell lung cancer and adenocarcinoma, and to analyze the gene expression of MMP1 and TIMP1. RESULTS: Gene MMP1 and TIMP1 were differentially expressed in both squmas cell lung cancer and adenocarcinoma, and both of them were up-regulated. CONCLUSION: MMP1 and TIMP1 may be important molecular markers of squmas cell lung cancer and adenocarcinoma.

Adenocarcinoma↗