Edward F. Scanlon

The influence of surgical trauma on experimental metastasis

Influence of surgical trauma on experimental metastasis in healing wounds is investigated using a transplantable murine mammary carcinoma cell line, TA3Ha. Intravenous injection of 105, 106, and 2 × 106 TA3Ha cells into syngeneic Strain A mice led to liver or kidney tumor development in none of the 96, ten, and ten mice tested, respectively. In contrast, injection of 105 cells into mice immediately after hepatic wedge resection performed using milliwatt carbon dioxide laser and electrocautery resulted in tumor formation at the site of trauma in 21/37 (57%) and 25/52 (48%) mice, (P < 0.001) respectively. Similar results were obtained in mice subjected to partial nephrectomy using the laser (nine of 18) and electrocautery (eight of 13). These results clearly demonstrate that surgical trauma renders a nonprivileged organ susceptible to experimental metastasis formation, and that at least in this model both laser and electrocautery have similar effects. Tumor cell injection 1, 7, and 10 days posthepatic surgery resulted in 36%, 20%, and 0% tumor formation, respectively, indicating that the earlier events in wound healing support tumor implantation and/or growth better than those later on. Frequency of tumor formation at sites of trauma in the peritoneum induced by scalpel blade, laser, and electrocautery were 28%, 50% and 82%, respectively. Peritoneal tumors were seen in 33% of the nonsurgical mice. Skin incisions induced with the three above probes had little influence on experimental metastasis formation. Thus the influence of trauma on tumor formation is not uniform in every organ.

Symptomatology as an indicator of recurrent or metastatic breast cancer

Eight‐seven patients with recurrent breast cancer after mastectomy were analyzed for patterns of recurrence and methods of detection. After an average disease‐free interval of 30 months, 38% developed osseous metastases, 16% recurred locally, 10% had local plus systemic disease, 10% showed pulmonary metastases and the remainder were distributed among liver, brain, and remaining breast disease. In 79 patients recurrence was heralded by symptoms. Physical examination in five asymptomatic patients revealed local or supraclavicular recurrence. In only three asymptomatic patients was recurrence documented by “routine” chest x‐rays (in two), or liver enzymes/liver scan (in one). No asymptomatic disease was found by bone scan. It is concluded that periodic history, physical examination, and chest x‐rays are the most important components in the follow‐up of breast cancer patients. Radioisotope scans and other radiographs are valuable in confirming symptomatic disease and detecting additional disease, but cannot be recommended routinely in the asymptomatic patient because of low yield and cost. Cancer 43:956–960, 1979.

A mass screening program for colorectal cancer using chemical testing for occult blood in the stool

Following five promotional and educational programs on CBS‐TV news in Chicago, 54,101 Hemoccult® kits were requested by the public and distributed by seven cancer detection facilities. Only 14,074 individuals completed the test. Six hundred and seventeen or 4.38% were positive. Two hundred and fifteen test positive persons failed to respond to repeated notification. In 123 positives, diagnostic tests by the private physician were considered incomplete. In 33 positives, the private physician did no further testing at all. In 152 positives, no abnormality could be found, but work‐up was variable. One hundred and eighty‐seven had abnormalities other than cancer, including 40 with polyps. Twenty‐seven asymptomatic and two symptomatic cancers were found. Nearly two‐thirds had Dukes A or B lesions, while one‐third had Dukes C tumors.

Breast cancer patient's cell-mediated immune response to thomsen-friedenreich (T) antigen

Thomsen‐Friedenreich (T) antigenic specificity as determined with human serum anti‐T was found in reactive form in breast adenocarcinomata but not in healthy and generally not in benign breast tissues. T‐antigenic specificity was demonstrable in all metastatic breast carcinoma lesions. T specificity was also present in adeno‐ and squamous cell carcinomata from other organs; it was not found in the four melanomata, one glioblastoma, and seven benign non‐breast tumors. Breast carcinoma patients but not healthy people showed cellular immunity to T antigen in vivo and in vitro. Most striking was the delayed‐type cutaneous hypersensitivity reaction that was positive in over 85% of the ductal breast carcinoma patients tested, negative in over 94% benign breast disease patients, and in all presumably healthy individuals investigated. T antigen is readily available from healthy human red blood cells in uncontaminated form, and free of HL‐A and Australia antigens.

Preoperative and follow‐up procedures on patients with breast cancer

From July 1, 1975 to June 30, 1979, 194 patients were enrolled in a program under a contract from the NCI to study chemoimmunotherapy in patients with Stage II and Stage III breast cancer. Patients were treated in six‐week cycles for one year and were later followed at six month intervals. Pretreatment evaluation included complete blood count, SMA‐12, xerogram, chest x‐ray, and bone scan. The blood count and SMA‐12 were repeated every six weeks before each course of treatment, and all of the preoperative tests were repeated at the completion of one year of treatment. After the year of treatment, testing was variable depending upon the stage of the disease, the patients symptoms, and the individual preferences of the responsible physician. Up to the present time, there have been 38 recurrences in the 194 patients entered into this protocol. Twenty‐nine of the recurrences were symptomatic at the time of discovery, four were asymptomatic and detected on physical examination, and five asymptomatic recurrences were detected by routine testing. Review of 60 patients who developed recurrence during approximately the same interval but who were not on the protocol shows that 43 were symptomatic and 14 were discovered on routine physical examination; 3 patients were asymptomatic. During this time, five new breast cancers were discovered in patients included in this report. Three were discovered by xerogram and two by physical examination. Further studies need to be made to provide sound data for optimal follow‐up procedures on previously treated breast cancer patients. Careful history, physical examination, and evaluation of symptoms will identify most recurrences at a relatively early stage and extensive routine testing may not be worthwhile.

Tn, a carcinoma-associated antigen, reacts with anti-Tn of normal human sera

Tn antigen is the immediate precursor of the carcinoma (CA)‐associated T antigen; both are masked in non‐CA tissues. Tn antigen was detected by absorption of human anti‐Tn antibody in 46 of 50 primary breast CAs and in all 6 metastases originating from Tn‐positive primary CAs. Thirteen of 25 (52%) anaplastic CAs, but only 2 of 15 (13%) well differentiated CAs had more Tn than T; 1 anaplastic CA had neither antigen. Eighteen of 20 benign breast lesions had no Tn; the 2 positive lesions were premalignant. All 19 breast CAs, studied immunohistochemically, reacted strongly with human polyclonal anti‐Tn; benign or normal glandular tissues had minimal or no reactivity. Among live cancer cell lines, the most malignant sublines had more Tn than T on their cell surfaces. Preliminary studies with rodent monoclonal anti‐Tn and anti‐T antibodies gave immunohistochemical reactivity patterns similar to those of the polyclonal antibodies, but the former were less sensitive in absorption tests. Tn is a CA marker that promises to be useful in tumor detection.

Precursors of the blood group MN antigens as human carcinoma-associated antigens.

About 50 years ago, Hiibener, Thomsen and Friedenreich noted that in vitro bacterial infection of human blood may render erythrocytes panagglutinable by one’s own and all human sera, except those of infants, without visible change of the erythrocytes.2n.113 Later it was shown that red blood cells after exposure to influenza viruses became agglutinable.9 This acquired property has come to be known as the (Hubenerl-Thomsen-Friedenreich phenomenon and may cause errors in blood

Parathyroid adenomas following irradiation

Parathyroid adenomas have been demonstrated to occur following external head and neck irradiation. The median latency interval is 30 years. In a series of 74 consecutive patients with histologically diagnosed parathyroid adenomas, 25% gave a history of prior radiation exposure. When compared to a matched control incidence of 7.9%, statistical significance is reached at p < 0.01. Thyroid abnormalities were present in 68% of the irradiated patients, and 30% of these were malignant. Tumors of skin, breast, and parotid gland also occurred more frequently than expected. Forty‐seven percent of the irradiated group had malignant neoplasms within the radiation field. The histopathology of the radiation‐associated parathyroid adenomas is similar to that seen experimentally. Cancer 43:1078–1083, 1979.

Irradiation-induced polyglandular neoplasia of the head and neck

Eighteen patients are presented with twenty-one tumors of the head and neck, which include ten salivary gland tumors and eight parathyroid adenomas. Eight of the patients also had thyroid neoplasms. All patients had a history of prior irradiation to the head and neck. Seventy per cent of the salivary gland tumors and 37 per cent of the thyroid tumors were malignant. Recommendations are made for detection and treatment.

Small bowel perforation secondary to metastatic carcinoma of the lung.

This is a report of small bowel perforation secondary to a metastasis from a primary adenocarcinoma of lung in a 62‐year‐old woman five months after resection of the primary tumor. She had received radiation therapy and corticosteroids after surgery. Features of this and five previously reported cases are discussed. Modern therapy may alter the course of pulmonary cancer resulting in more frequent observation of this rare complication. Cancer 40:410–415, 1977.