Follow-up of patients with gastrointestinal cancer by tumor marker determination.

In addition to clinical examination and various diagnostic procedures, patients with gastrointestinal cancer (GIC) were also monitored by tumor marker (TM) determination. In total, 202 patients with GIC were postoperatively followed-up. According to in vivo diagnostic procedures, there were 133 (66%) patients without metastases, 63 (31%) patients with distant metastases, 48 (76%) of them with liver metastases, and six (3%) patients with local recurrences. During the 1990-1995 period, they were followed-up by serum TM concentration measurements on 1-8 occasions. At the time of initial diagnosis, TM were determined in a varying percent of the patients: CA 19-9 (100%), TPA (54%), CA 72-4 (49%), IAP (41%), CEA (41%) and AFP (25%). In the group of patients without metastases, the percentage of normal TM values ranged between 73%-100%, and TM sensitivity between 0%-86%. No ideal TM has as yet been discovered either for any malignant disease or for patients with GIC. Therefore, in the follow-up of patients with GIC we suggest the concentrations of at least two instead of only one TM (CA 19-9 and TPA or CEA) to be determined. It is also difficult to choose the best TM among numerous TM kits available on the market and to keep using it during a longitudinal follow-up study.

Natural killer cell activity, phagocytosis, and number of peripheral blood cells in breast cancer patients treated with tamoxifen.

The number of leukocytes, proportion and absolute number of granulocytes, lymphocytes, CD4+ cells, CD8+ cells, CD16+ cells, B-lymphocytes, monocytes, natural killer cell (NK) activity, and granulocyte and monocyte phagocytic functions--ingestion and intracellular killing--were determined in a group of 27 patients with ductal invasive breast carcinoma, stage I-III, before and 7 months following postsurgical telecobalt radiotherapy, divided into two subgroups, one of them receiving tamoxifen (TMX group) and the other one not receiving any further therapy (control group). In control group, proportion of all lymphocytes and CD8+ cells as well as absolute number of all lymphocytes, CD4+, CD8+, CD16+ and B lymphocytes were decreased following TCT in comparison to their pre-TCT values, while in TMX group only absolute number of all lymphocytes remained decreased following TCT. Moreover, post-TCT proportions of all and CD8+ lymphocytes as well as absolute numbers of all and CD4+ and CD8+ lymphocytes in TMX patients were significantly increased in comparison to the same parameters in control post-TCT patients, although there was no difference between the two subgroups before TCT. At the other hand, granulocyte ingestion was decreased in post-TCT TMX patients compared to post-TCT values in control patients and NK cell activity showed a similar, although statistically not significant, tendency. It seems that TMX helps recovery of lymphocyte populations decreased by radiotherapy, probably by stimulation of cells carrying estrogen receptors, but its effects on phagocytic functions and probably NK cell activity seemed to be rather inhibitory than stimulatory.

Tumor marker determinations.

A combination of 2 or 3 tumor markers was determined in the serum of 478 patients with malignant tumors. In 195 out of 213 patients with differentiated thyroid cancer and without relapse or metastases, the Tg concentration has undetectable. In 9 patients with nonfunctioning thyroid metastases the Tg level was correlated with the progress of the disease or the success of the treatment. In 114 patients with gastrointestinal cancer CA 19-9, TPA and IAP were measured simultaneously. The highest discrepancies between patients with relapse or metastases (increased values in 1/2 of patients) and patients without relapse or metastases (increased values in 1/4 of patients) were given by CA 19-9. In the serum of 90 patients with breast cancer increased CA 15-3 values were found in 2/3 of patients with relapse or metastases and in 1/4 of patients without signs of tumor. A combination of universal tumor markers TPA and IAP had no value in monitoring 26 patients with melanoma.

[Is an early diagnosis of neoplastic processes of the rectum possible?]. / Da li je moguca ranija dijagnoza neoplasticnih procesa rektuma

The better operative results and lasting cure of malignant tumors can be ascribed to early detection rather than to the improvement of surgical techniques. In the cancer of the breast and gynecological carcinoma the importance of early detection has been more emphasized than in cancers of other location. On a total of 5210 rectoscopies performed the authors detected 285 malignant tumors of the rectum. On the average the diagnosis was made 9 months after the appearance of the first symptoms. In 74% of cases the tumors were detected already by the digital examination, while in 46.9% of the rest of the patients inoperable carcinoma was involved. By obligatory digital examination in all cases of "hemorrhoidal" complaints and additional rectoscopy neoplasms of the rectum can be detected at an early time and more patients can be afforded lasting cure.