Anaemia in cancer: pathophysiology and treatment.

Anaemia in cancer patients is multifactorial and may occur as a either a direct effect of the cancer, as a result of the cancer treatment itself, or due to chemical factors produced by the cancer. The clinical symptoms of anaemia vary according to the individual's capacity to respond to blood loss or reduced red cell production. The haematological features in anaemic patients depend on the different types of malignant disease. Clinical and laboratory evaluation, and examination of the bone marrow can provide important diagnostic clues in many cases. Decisions are commonly made based on subjective consideration rather than on objective data. Blood transfusion involves many hazards, some of which may be reduced or avoided. Erythropoietin (EPO) treatment has been found to be effective in preventing anaemia and in reducing the need for blood transfusions, although it would be useful to identify high-risk patient subgroups who would benefit most from this expensive treatment. In advanced cancer patients the use of blood transfusion should be evaluated on an individual basis, according to the presence of distressing symptoms and life expectancy. These measures are unlikely to have an effect in irreversible and progressive bleeding states.

Immunocytochemical determination of estrogen and progesterone receptors on 219 fine-needle aspirates of breast cancer. A prospective study.

Fine needle aspirates from breast carcinomas of 219 patients were examined cytologically and for the determination of estrogen receptors (ER) and, in 145 of these cases, of progesterone receptors (PR), with the immunocytochemical technique. The traditional biochemical method was also followed for the post-surgical examination of the excised tumour for the determination of the ER and PR contents. In 149 of the 219 cases involving the determination of the ER, and in 112 of those where the PR was determined, the results were compared with those obtained using the biochemical method. Assuming the biochemical technique to be reliable, we obtained the following results with the immunocytochemical method for the ER: 84 true positives, 54 true negatives, 6 false negatives, 5 false positives, 93.3% sensitivity, 91.5% specificity, 94.3% positive predictive value, 90% negative predictive value, 92.6% accuracy, coefficient of correlation 0.83, p = 0.000006. For the PR, we obtained: 42 true positives, 60 true negatives, 6 false positives, 4 false negatives, 91.3% sensitivity, 90.9% specificity, 87.5% positive predictive value, 93.7% negative predictive value, 91.07% accuracy, coefficient of correlation of 0.83, p = 0.000001. Excluding those patients who underwent neoadjuvant treatment, the ER showed 94.3% sensitivity, 98.1% specificity, 98.8% positive predictive value, 91.5% negative predictive value and 95.8% accuracy, and the PR gave 93.3% sensitivity, 93.7% specificity, 91.3% positive predictive value, 95.2 negative predictive value and 93.7% accuracy.