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We report two observations of malignant gastric and pancreatic tumors with choroid metastasis. Clinical course was rapidly and spontaneously unfavorable.
Cytokeratins are epithelial markers whose expression is not lost during malignant transformation. The level of soluble cytokeratin fragment 19 was measured with an enzyme immunoassay method developed by Boehringer Mannheim (Enzymum-test CYFRA 21-1) in the serum of 200 male and 50 female patients with NSCLC (Non Small Cell Lung Cancer) lung cancer (120 planocellulare and 80 adenocarcinoma in males; 22 planocellulare and 28 adenocarcinoma in females). The comparative group comprised 50 young healthy males and 50 females without any clinical proof for malignancy or any other lung disease. The aim of this investigation was to find out if any possible statistical difference exists in the serum level of CYFRA 21-1 between patients with lung cancer and healthy controls, and also between different types of lung cancers. The mean value of serum CYFRA 21-1 in NSCLC (6.25 ng/ml) was significantly higher than in healthy controls (1.26 ng/ml) (p < 0.001). Sensitivity for CYFRA 21-1 (using 3.3 ng/ml, a cut-off value corresponding to a 98% specificity for healthy controls) in NSCLC was 60.5%. Positive CYFRA 21-1 levels were significantly higher in patient with carcinoma planocellulare (66.2%) than in adenocarcinoma (52.1%). CYFRA 21-1 levels were significantly different between squamous cell carcinoma (6.52 ng/ml) and adenocarcinoma (5.86 ng/ml) (p < 0.05). Our results indicate that CYFRA 21-1 may be a useful tumor marker in NSCLC, especially in carcinoma planocellulare. CYFRA 21-1 may also be useful in identification of the preoperative stages of diseases and the postoperative monitoring of NSCLC.
Advances in diagnostic methods and treatment modalities for lung cancer in the recent years were reviewed. Computed tomograph and other lung imaging devices facilitated early detection of small nodule, or diagnosis of extension of cancer. In addition to bronchofiberscopy, fluorescence endoscopy, tracheo-bronchial stenting, or photodynamic therapy brought marked advances in diagnosis as well as treatment of lung cancer at hilar and peripheral regions. Most of the comparative study to evaluate postoperative adjuvant therapy showed negative results. However, it is expected that induction therapy will improve surgical result of advanced lung cancer. Surgery for lung cancer showed great improvements in terms of operative mortality, operative methods (bronchoplastic surgery, combined resection of adjacent organ invasion, extensive lymph node dissection, or limited lung resection) and surgical outcome.
Following initial diagnostic work-up and histological confirmation of a metastatic lesion, an extensive search may fail to locate a primary cancer site. Two case reports are presented. A retrospective analysis was done of 255 patients with metastases of unknown origin; 231 patients (over 90%) have since died. Of 34 patients with autopsy information, no primary lesion was found in 20. In the remaining 14 cases, prior knowledge of the primary site would not have influenced either therapy or proganosis. A plea is made for judicious restraint in the use of diagnostic imaging procedures to search exhaustively for a primary cancer site.
In developing diagnostic reagents for the radioimaging of prostatic cancer, methods were optimized for the purification of two mouse IgG1 monoclonal antibodies raised against prostate-specific acid phosphatase and produced in cell culture. Two different two-step methods were selected. One method consisted of two successive ion exchange chromatographic steps on Mono S and Mono Q; in the other method, Mono S chromatography was followed by hydrophobic interaction (Alkyl Superose) chromatography. In both cases, fast protein liquid chromatography (FPLC) instrumentation was used. The antibodies were purified from cell culture media containing fetal calf serum (1-5%). Highly pure (greater than 95%) IgG1 antibodies, free of contaminating serum-derived proteins or column materials, were obtained in good yield (greater than 90% recovery). The purified antibodies completely retained their immunological reactivity towards prostate-specific acid phosphatase and were sterile and pyrogen-free. Since the monoclonal antibodies produced were intended for applications in vivo, an essential feature of the methods selected was the availability of in situ cleaning procedures for sterilization of the gel materials and for the inactivation of viruses and pyrogens in the gels. The methods developed could be readily scaled up for preparative purposes.
Most frequently the diagnostic of gastric cancer is established in advanced stages. Practically, was noticed that local evolution advances the appearance of metastases. The authors are presenting 159 cases of locally advanced gastric cancer (LAGC) out of 211 gastric cancers submitted to surgery between 1984-1995. The surgical possibilities in such situation specifically adapted to each case, are discussed. The operation has an important role in appreciating local and regional extension, solving complications and even performing radical resections.
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Circulating autoantibodies are useful diagnostic markers of cancers and autoimmune diseases. Research over the past decade has resulted in some reports on the presence of autoantibodies against disease-related proteins such as annexin-I & II, recoverin and protein gene product 9.5 in the sera of patients with lung cancer, and also against calreticulin and alpha-enolase in autoimmune diseases. In this study, we first identified the a-enolase autoantibody in the sera of patients with lung adenocarcinoma by proteomics-based analysis. The comparison of two-dimensional polyacrylamide gel electrophoresis (2D-PAGE)/western blot (WB)/ECL detection revealed distinct distributions of antibodies in the sera of lung adenocarcinoma, tuberculosis and healthy subjects which reacted with soluble proteins derived from the adenocarcinoma A549 cell line. We found 16 spots in patients with adenocarcinoma by 2D-PAGE/WB/ECL detection and identified alpha-enolase, chaperonin, and other autoantibodies in the adenocarcinoma patients' sera. The specificities of an antibody against alpha-enolase was preliminarily observed in sera from 3 of 5 patients with adenocarcinoma, 0 of 10 patients with tuberculosis and 0 of 10 healthy subjects. In conclusion, we first identified alpha-enolase autoantibody in sera of lung adenocarcinoma and the autoantibody was seemed to be a specific marker of the lung adenocarcinoma. In addition, we also identified various autoantibodies in esophageal cancer, hepatocellular carcinoma, and non-Hodgkin's lymphoma. Moreover, we tried to identify the corresponding antigen of an unknown anti-cytoplasmic autoantibody, and an anti-red blood cell antibody by proteomics-based analysis. These antibodies might become new diagnosis markers.
Seventeen general practitioners (GPs) were evaluated to assess their ability to recognize malignant, borderline and benign skin lesions before and after a novel, cheap and quick skin cancer educational programme. They were tested without prior warning on two occasions using two sets of 30 clinical slides. Between each test the GPs were given a lecture based on an illustrated booklet of similar lesions. The results showed an improvement in the GPs' diagnostic skills (P < 0.05), but nevertheless a wide variation in diagnostic ability between GPs remained. Our study highlights a simple, effective and inexpensive method for teaching GPs the diagnostic clinical features of skin cancer. Further work is needed to improve their diagnostic accuracy in the long term.
In an era of fiscal restraint, it is important to evaluate the resources required to diagnose and treat serious illnesses. As breast cancer is the major malignancy affecting Canadian women, Statistics Canada has analysed the resources required to manage this disease in Canada, and the associated costs. Here we report the cost of initial diagnosis and treatment of nonmetastatic breast cancer, including adjuvant therapies. Treatment algorithms for Stages I, II, and III of the disease were derived by age group (< 50 or > or = 50 years old), principally from Canadian cancer registry data, supplemented, where necessary, by the results of surveys of Canadian oncologists. Data were obtained on breast cancer incidence by age, diagnostic work-up, stage at diagnosis, initial treatment, follow-up practice, duration of hospitalization and direct care costs. The direct health care costs associated with 'standard' diagnostic and therapeutic approaches were calculated for a cohort of 17,700 Canadian women diagnosed in 1995. Early stage (Stages I and II) breast cancer represented 87% of all incident cases, with 77% of cases occurring in women > or = 50 years. Variations were noted in the rate of partial vs total mastectomy, according to stage and age group. Direct costs for diagnosis and initial treatment ranged from $8014 for Stage II women > or = 50 years old, to $10,897 for Stage III women < 50 years old. Except for Stage III women < 50 years old, the largest expenditure was for hospitalization for surgery, followed by radiotherapy costs. Chemotherapy was the largest cost component for Stage III women < 50 years old. This report describes the cost of diagnosis and initial treatment of nonmetastatic breast cancer in Canada, assuming current practice patterns. A second report will describe the lifetime costs of treating all stages of breast cancer. These data will then be incorporated into Statistics Canada's Population Health Model (POHEM) to perform cost-effectiveness studies of new therapeutic interventions for breast cancer, such as the cost-effectiveness of day surgery, or of radiotherapy to all breast cancer patients undergoing breast surgery.
PURPOSE: To examine the cost and efficacy of diagnostic work-up in patients with invasive cervical cancer. MATERIALS AND METHODS: In 246 patients with invasive cervical cancer, all diagnostic tests performed before treatment were recorded. Patients were divided into two groups: those who underwent magnetic resonance (MR) imaging as the initial study (n = 105) and those who did not (n = 141). A list of 1995 Medicare global payments was used to measure cost. Bayesian analysis (likelihood ratios derived from a literature search) was performed for bladder, rectal, parameterial, and nodal involvement in stage Ib disease. RESULTS: Significantly fewer procedures and fewer invasive studies were performed in the MR imaging group. Net cost savings for the MR imaging group was $401 for all patients and $449 for patients with stage Ib disease. For stage Ib disease, the 0% pretest probability of bladder or rectal invasion does not justify the routine use of barium enema examination, cystoscopy, or proctoscopy. The increase in predictive values for parameterial and nodal disease was highest for MR imaging when tumor size was at least 2 cm. CONCLUSION: Guidelines for the pretreatment work-up of clinical stage Ib cervical cancer need revision. MR imaging should be used as an adjunct to clinical evaluation.
Sixteen histologically documented testicular cancer specimens obtained at diagnostic procedures following induction chemotherapy with cis-platinum containing regimens were cloned in soft agar. Seven (44%) of the specimens cultured formed colonies with a mean cloning efficiency of .021%. Colony formation was observed with all the common histologic subtypes of testicular cancer (seminoma, embryonal carcinoma, choriocarcinoma and mixed tumors). In vitro drug sensitivity tests were performed using cis-platinum, vinblastine and VP-16. Three of four specimens demonstrated a decrease in colony formation to less than 50% of controls after a 1 h exposure to VP-16 at 300 micrograms/ml. Two of these patients had a response to treatment with a VP-16 based salvage regimen. Immunoperoxidase staining of the colonies for alpha feto protein and human chorionic gonadotropin were correlated with the serum levels of these tumor markers determined at the time the specimen was obtained. In three instances the same markers were elevated in the serum as detected within cells which formed the colonies; however, in two other cases the marker(s) that was elevated in the serum was not expressed in the colonies. In one case a biopsy of a residual retroperitoneal mass following chemotherapy histologically was a teratoma, but it formed colonies in the assay which stained positive for alpha feto protein. This patient subsequently developed an elevated serum alpha feto protein. These studies have demonstrated that (a) testicular cancer can be cloned directly in soft agar; (b) a heterogeneous tumor cell population exists in metastatic testicular cancer specimens; and (c) a dose response exists for VP-16 in relapsed testicular cancer which suggests that increasing the dose of VP-16 may be clinically beneficial.
Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.
Transrectal ultrasound guided needle biopsies of the prostate are routinely performed to diagnose and stage prostate cancer. This diagnostic technique is a safe method to diagnose prostate cancer with few major complications but frequent minor complications.
PURPOSE: The purpose of this study was to characterize the diagnostic performance of a regimen of CT screening for lung cancer. METHODS: Using a common protocol/regimen of screening, 2968 asymptomatic persons at high risk for lung cancer were enrolled in two studies [Early Lung Cancer Action Projects (ELCAP) I and II] for baseline and annual repeat screening. A total of 4538 annual repeat screenings were performed. The regimen's diagnostic performance was characterized in terms of frequency of positive result of the initial CT as well as of screen-diagnosis and Stage I screen-diagnosis among all diagnoses (interim-diagnoses included), all separately for baseline and annual repeat screenings. RESULTS: The proportions with positive result of the initial CT were 12% and 6% in the baseline and repeat screenings, respectively. The proportions of screen-diagnoses among all diagnoses (interim-diagnoses included) were 97% and 99% in the baseline and repeat cycles, respectively. The corresponding proportions of pre-surgical Stage I screen-diagnoses were 95% and 93%. CONCLUSION: The performance of the ELCAP regimen is quite satisfactory in avoiding over many positive results of the initial CT, and it produces highly promising diagnostic results as for the attainment of cure by early intervention.
A new diagnostic blood test for cancer, the Structuredness of Cytoplasmic Matrix (SCM) test, has been widely claimed to distinguish between normal healthy controls and patients with malignant disease. It has also been claimed that the test distinguishes between patients with nonmalignant conditions and patients with cancer. Furthermore, it has been stated that the test makes it possible to identify the specific type of tumor in each case. In view of the importance of these claims, the study was repeated under identical laboratory conditions. Six hundred and twenty-one blood samples from controls and various groups of patients were processed in an exhaustive investigation. Four objectives were set: (1) to apply the test to a group of normal healthy individuals; (2) to apply the test to a group of patients with nonmalignant disease; (3) to apply the test to a group of cancer patients; and (4) to attempt to relate the degree of positivity of the test, if any, to the extent or stage of the tumor. Using the results described, confirmation of any of the above claims was not achieved. From this study, it is concluded that the test is of no clinical value.
To evaluate the importance of trace amounts of elements in thyroid cancer etiology and diagnostics, instrumental neutron activation analysis has been used to estimate Ag, Co, Cr, Fe, Hg, I,Rb, Sb, Sc, Se, and Zn concentrations in malignant and benign thyroid nodules as well as in apparently intact paranodular thyroid tissue. Resected material from 135 patients was obtained from operations. Forty-five cancer cases were diagnosed and the rest were of benign nodules. The thyroid glands of 65 people, 53 male and 12 female, who died and unexpected death or committed suicide, were used as a control group. Trace element contents of the International Atomic Energy Agency reference material H-4 (animal muscle) were analysed simultaneously with the thyroid tissue in order to evaluate the accuracy of the obtained data. No dependence of trace element contents on sex and age (14-80 years) was found for normal thyroids. In paranodular tissue, the Ag, Co, Hg, I and Rb contents were much higher for malignant and benign nodules than they were for the standard. There was also a slight deficiency of Se in the nodules compared with the standard. This result supports the hypothesis that the direct toxic heavy metal influence on thyrocytes plays a major role in thyroid cancer etiology, provided that an adequate level of the defence mechanisms is absent. Iodine concentrations are 15 times lower, on average, in malignant compared with benign nodules. It is also shown that the radio between the iodine concentration in nodular and paranodular tissue can be used for in vivo thyroid cancer diagnostics.
The role of diagnostic laparoscopy in patients with periampullary and pancreatic malignancies is controversial. A retrospective review was performed including all patients (n = 188) with a periampullary or pancreatic malignancy who underwent both CT and laparotomy at our institution between January 1997 and December 1999. The overall resectability rate for all periampullary cancers was 67.3% (115 of 171 patients). This compared favorably with the resectability rate for cancers of the pancreatic body and tail (3 of 17 patients, 17.6%; P < 0.01 vs. periampullary cancers). Fifty percent of patients with periampullary cancers were unresectable because of metastatic disease, whereas metastatic disease precluded resection in 64.3% of patients with cancers of the pancreatic body and tail. After patients undergoing operative palliation were eliminated, a nontherapeutic laparotomy would have been precluded by the use of diagnostic laparoscopy in only 2.3% of patients with periampullary cancers (4 of 171 patients). In contrast, 6 (35.3%) of 17 patients with cancers of the pancreatic body and tail underwent a nontherapeutic laparotomy (P < 0.01 vs. periampullary cancers). One hundred fifty-eight (84%) of the 188 CT reports reviewed could be definitively categorized as either "likely to be resectable" or "likely to be unresectable." The remaining 16% were equivocal. Of the 107 patients categorized as likely to be resectable, 89 were actually resected (83.2%). In contrast, only 10 of the 51 patients categorized as likely to be unresectable could be resected (19.6%).