H. F. Given

An evaluation of preoperative CA 15-3 measurement in primary breast carcinoma.

In this study of 500 patients with breast carcinoma, we have prospectively assessed the role of preoperative CA 15-3 as a marker of disease burden over a 7 year period. CA 15-3 levels at presentation correlate with stage of disease, tumour size, lymph node status, the presence of metastases and lymphocyte infiltration into the tumour. CA 15-3 alone is not an independent prognostic indicator, although a serum level of > 40 U ml-1 has a positive predictive value of 83% for the presence of advanced disease. We recommend the routine use of this marker in the preoperative assessment of primary breast carcinoma.

The prognostic value of the tumor marker CA 15-3 at initial diagnosis of patients with breast cancer.

CA 15–3 has been most widely used as a serum tumor marker in follow-up and detection of breast cancer recurrence. In this study we have specifically focused upon the prognostic implications and utility of preoperative CA 15–3 levels. We have identified on our database 414 patients with breast cancer in whom serial levels of the serum tumor marker CA 15–3 had been determined at diagnosis and follow-up. We have analyzed the follow-up and clinical outcomes in these patients and from this data we have assessed the potential of CA 15–3 as a predictor of five-year overall and disease-free survival. Our results show that an initially elevated CA 15–3 level is associated with a very poor prognosis in both early and late stage disease. Elevated pre-biopsy CA 15–3 levels are associated with 14% five-year disease-free survival rates and 17% overall survival rates at five years. In contrast, normal CA 15–3 levels are associated with 47% five-year disease-free survival rates and 54% overall survival rates at five years (p<0.01). Comparison of five-year survival rates between patients with elevated and normal CA 15–3 levels in early breast cancer (stage I and II) also showed significant differences, with survival being 41% and 75%, respectively (p<0.01).

Are elevated levels of the tumour marker CA19-9 of any clinical significance?--an evaluation.

CA 19-9 is a tumour marker which has been used widely in patients with pancreatic adenocarcinoma. Elevated levels are associated with advanced disease at presentation and disease progression during follow-up. CA19-9 levels may also be elevated in a variety of other malignant and benign conditions. This study examined the significance and implications of elevated CA19-9 levels. An analysis of all CA19-9 measurements performed over a 4 yr period was undertaken and 204 patients with elevated CA19-9 levels were identified. One hundred and thirty patients (63.7 per cent) had malignant conditions and 74 (36.3 per cent) had benign conditions or no definite cause was found. There was a significant correlation between CA19-9 levels and CEA (r=0.3137; P<0.001) as well as alkaline phosphatase, ALT, AST, bilirubin, gamma glutamyl transpeptidase and lactate dehydrogenase. CA19-9 levels were significantly lower in patients with benign pathology than those with malignant pathology. Similar differences were observed for CEA. CA19-9 levels were in fact highest in patients with pancreatic carcinoma (P<0.05) while no significant differences were observed for CEA. In conclusion CA19-9 may be elevated in both benign as well as malignant conditions and interpretation of CA19-9 results must be made in light of the clinical condition of the patient.

Prognostic implications of p53 and bcl-2 expression in 108 women with stage two breast cancer.

BackgroundThe mortality and morbidity of patients with breast cancer can vary even between individuals with similar histological stage at diagnosis. Identification of those individuals with prognostically poorer tumours is an essential prerequisite in planning adjuvant therapies.Some prognostic indices of tumour size, grade, oestrogen receptor status and nodal status are well established.AimThe aim of this study was to examine the prognostic role of information relating to proto-oncogene and tumour suppressor gene expression.Methods108 women with stage II breast cancer were studied. Tumour expression of p53 and bcl-2 were scored and then correlated with recurrence and mortality.ResultsWe have shown that individuals poorly expressing bcl-2 in their tumours have a poorer disease-free and overall survival than those who express bcl-2. When p53 was strongly expressed, it was associated with poorer disease-free and overall survival.ConclusionThe profiling of individual tumour genetic expression of proto-oncogenes may allow for more specific identification of patients at higher risk’ of recurrence in breast cancer.

URINARY CYTOLOGY IN THE DETECTION OF BLADDER CARCINOMA

We have analysed the accuracy of cytological examination of voided urine in a population of 265 patients presenting with suspected bladder lesions.Bladder carcinoma was confirmed by tissue histopathology in 51 patients. Of these, 42 were identified correctly by urinary cytology examination. Overall 34 patients were labelled as frankly malignant on cytology, of whom 2 were negative on final histology. 13 patients had been designated as suspicious however with 3 benign on final histological diagnosis.These data give a sensitivity for diagnosis of bladder cancer by urinary cytology of 82%, a specificity of 97%, a positive predictive value of 94%, and a negative predictive value of 96%.

Mucin-like carcinoma associated antigen (MCA) at presentation with breast cancer

The usefulness of serum measurements of mucin-like carcinoma associated antigen (MCA) in 100 women at presentation with breast cancer was evaluated. Peripheral venous blood was drawn and MCA values determined by radioimmunoassay. Twenty women presenting with benign breast disease and 20 normal women served as controls.There was no difference in the MCA values between the benign breast disease group and the normal group: 4.1 ±0.9 units/ml versus 5.0 ±0.75 units/ml (mean ±sem). The following were the MCA values for patients by stage; stage 1: 11.2 ±1.02, stage 2: 11.0 ±1.29, stage 3: 20.2 ±6.7, stage 4: 31 ±5.0. Statistical analysis of stage versus controls showed significant elevations only in stage 3 and 4 disease (p<0.05). We conclude that MCA may be a useful serum tumour marker only in advanced breast cancer but is unreliable in detection of early breast cancer.

Synchronous metastatic breast cancer in a husband and wife

We present the first reported case of synchronous metastatic breast carcinoma in a husband and wife.

Anorectal functional deficit in the brown bowel syndrome

The Brown Bowel Syndrome is characterised by degeneration and pigmentation of large bowel mucosa. We present a report of this unusual syndrome in which, for the first time, a functional deficit, reflected in a reduced internal anal sphincter tone, is documented. This abnormality was reversed following sub-total colectomy and vitamin E therapy.

Correlation of Her-2/Neu detection and angiogenesis in breast cancer — Proposed role in micrometastatic progression

ConclusionOverexpression/amplificatio n of Her-2/Neu increases angiogenesis in breast cancer. Her-2/Neu amplification is seen in bone marrow micrometastatic cells and correlates with Her-2/Neu amplification in primary tumour. The proangiogenic effect of Her2/Neu may represent metastatic progression in bone marrow micrometastases and may therefore be a potential target for the treatment of micrometastatic disease.

Comparison of detection of micrometostases in rib marrow aspirates compared to iliac crest aspirates

ConclusionIliac crest marrow remains the standard sampling site for detection of bone marrow micrometastases in breast cancer patients.