A missed breast cancer.

The purpose of this case report is to point out that it is possible to misdiagnose a breast cancer when the classical findings, the mammogram and cytology, are all negative.

Colorectal cancer: a large unselected Australian series.

An unselected prospective consecutive series of 575 patients with a single adenocarcinoma of the colon and of 331 patients with a single adenocarcinoma of the rectum registered between 1971 and 1984 at the Princess Alexandra Hospital is reported. The tumours were staged according to the Australian Clinicopathological Staging (ACPS) System. Approximately one-quarter of the patients were incurable when they presented. For curative operations for carcinoma of the colon, the operative mortality was 3%. For curative operations for carcinoma of the rectum, the operative mortality was 1% for abdominoperineal resection and 4.5% for anterior resection. The relative 5 year survival for all patients was 54.5%. The findings are compared with other large Australian series as well as with series from the United Kingdom and the United States.

Emergency right hemicolectomy in colon carcinoma: a prospective study.

The morbidity and mortality in right hemicolectomy for carcinoma of the colon is examined, with particular attention to the influence of emergency surgery and advanced disease. Of the 244 patients who had surgery, 57 required emergency surgery and 187 elective surgery. The overall mortality was 5.7% with no difference statistically between the elective and emergency groups. Anastomotic complications were significantly greater in the groups undergoing emergency resection and elective palliative surgery when compared with elective curative surgery. All patients with advanced disease had a higher morbidity and mortality, both in elective and emergency surgery. The factors most important in relation to mortality and morbidity were thus advanced disease, advanced age and cardiorespiratory complications. This being the case, it is felt that the present management of emergency right hemicolectomy with anastomosis should continue to be the treatment of choice for obstructing or perforated carcinomas of the right colon.

Melanoma: issues of importance to the clinician.

The prognosis of melanoma is no longer hopeless. It can be diagnosed at an early biological stage when simple surgical excision is curative. Public and professional education is necessary to achieve and maintain the successful management of this potentially dangerous tumour.

Staging of colorectal cancer. The Australian clinico-pathological staging (ACPS) system compared with Dukes' system.

A new system, the Australian Clinico-pathological Staging (ACPS) System, has recently been proposed for the recording and reporting of colorectal carcinoma. This system requires the accurate use of precise definitions, cooperation between surgeons and pathologist, and a complete pathology report. It utilizes all information available--clinical, radiologic, operative, pathologic--before a stage is allotted. This contrasts with Dukes' system, which is based solely on the pathologic examination of the resected carcinoma. It allows classifications of all cases of colorectal cancer seen, whether treated by resection, palliative surgery, local excision or not at all. The stage at presentation and the five-year survival of 490 patients with colorectal cancer are compared using the ACPS and Dukes' systems. Eighty-four cases were not classifiable under Dukes' system, and there was a significant difference in survival in one of the comparable groups of patients.

Terminology and classification of colorectal adenocarcinoma: the Australian clinico-pathological staging system.

A new system--the Australian Clinico-pathological Staging (ACPS) System--is proposed for the reporting of cases of colorectal adenocarcinoma. It utilizes all information available--clinical, operative and pathological--before a stage is allotted. This contrasts with Dukes' classification which is based solely on the pathological examination of the resected specimen. The ACPS has a special category 'D' for incurable cancer--those with a locally advanced irremovable tumour or with distant metastases. This method requires co-operation between clinician and pathologist and the use of precise terminology with strict adherence to definitions. The validity of the system is tested by analysing the survival pattern of 709 patients from Concord Hospital according to the ACPS and Dukes' system.

Colorectal cancer at the Princess Alexandra Hospital: a prospective study of 729 cases.

The results of treatment of 729 patients with cancer of the large bowel treated at the Princess Alexandra Hospital from January 1971 to December 1980 have been analysed. The majority (540 patients or 74.1%) presented with symptoms requiring investigation, and there was an incidence of acute obstruction of 17.6% (128 patients). In just over half the patients (55.3%) there was a significant delay in diagnosis. The operative mortality rate for curative resections for both rectal and colonic cancer was 2.7%. There was no mortality in 24 curative local resections for rectal cancer. The resection rate for the whole group was 87.4% and the age corrected 5-year survival rates were Dukes' A 99.1%; Dukes' B 78.3%; and Dukes' C 32.4%. These results are compared with those reported in a retrospective study from this Hospital in 1975 and with those from other Australian and overseas centres.

Pelvic recurrence after curative resection for carcinoma of the rectum.

Cases of carcinoma of the rectum have been prospectively studied from 1971-80. Two hundred and ten patients had curative resections and 25 of these developed clinical pelvic recurrence in the period of follow-up which ranges from one to eleven years. The rate of recurrence is found to be dependent on the level of the lesion and the degree of its local and lymphatic spread. Results from other papers are discussed. Measures to minimise local recurrence are discussed.

Leukocyte adherence inhibition: tumor specificity of cellular and serum-blocking reactions in human melanoma, breast cancer, and colorectal cancer.

Blood samples were obtained from hosptial patients suspected of having cancer (colorectal carcinoma, breast carcinoma, or melanoma) or from patients after surgical treatment for these cancers. Leukocytes were tested for reactivity with appropriate tumor extracts by leukocyte adherence inhibition (LAI), without knowledge of the diagnosis. Leukocytes from each patient were tested with the specific related extract corresponding to the suspected tumor type and with at least one unrelated extract. Each patient's serum was tested for its effect on the adherence of autologous leukocytes with specific tumor extract. Detailed leukocyte adherence data are presented for each of the 110 patients. Of the 75 patients eventually diagnosed as having cancer of one of the above types, 67 (89.3%) gave positive specific LAI reactions and only 5 (6.7%) reacted nonspecifically. Of the 35 patients with benign, unrelated, or unidentified disease, 10 (28.6%) gave positive reactions; most of these were patients with benign breast disease reacting with breast tumor extract. Leukocyte reactions with related extracts were almost always blocked by autologous serum (only two exceptions). When tested with allogeneic leukocytes reacting with their corresponding extracts, sera never blocked leukocytes of a different tumor type; in some cases they also failed to block leukocytes of the same tumor type although autologous leukocytes were blocked.

The significance of secretory IgA in middle ear fluid.

Studies of immunoglobulin levels in middle ear fluid in children with chronic otitis media show that MEF (middle ear fluid) IgA levels are proportionately higher than serum levels. Disproportionately elevated MEF IgA levels may be due to secretory IgA. Finding secretory IgA in MEF suggests the presence of a secretory epithelium and may define the etiology of chronic inflammation. Resolution of the secretory epithelium may be hastened with adequate ventilation of the middle ear space.

Mortality and complications of large-bowel resection for carcinoma.

The mortality and complications of large-bowel resection for carcinoma performed at the Princess Alexandra Hospital since the Colorectal Project commenced in 1971 are reviewed and compared with the results in other published series. There were 443 patients in this prospective study, and 375 underwent resection of their tumour. The overall operative mortality was 6.4% - for colonic lesions it was 8.0% and for rectal 3.4%. The mortality for elective curative resections was 2.6%, and for emergency resections it was 10.8%. The anastomotic leak rate was 6.8%, but was higher (16.6%) when the anastomosis was done at the time of emergency resection. No patient whose anastomosis leaked but who had had a previous defunctioning proximal colostomy died. There was a wound infection rate of 15.1%.

Carcinoma of the large bowel in patients aged 70 years and older.

In a prospective series of 443 cases of large-bowel cancer there were 192 cases occurring in patients aged 70 years and over. The resectability rate in this group was 84.9% and was almost identical with that of the whole series (84.6%). There was an overall operative mortality rate of 7.3% in the older age group, compared with 6.4% in the whole series. However, when octogenarians were considered, the resectability rate fell to 74.6% and the overall operative mortality rate increased to 19%. In the treatment of large-bowel cancer it would seem that special consideration should be given to octogenarians.