Carcinoembryonic antigen in cancer of the female reproductive system. Serial plasma values correlated with disease state.

The results of plasma carcinoembryonic antigen (CEA) determinations done over 600 patients with gynecologic malignancy will be presented. It would appear from this extensive survey that the likelihood of a patient having a positive value is increased with advancing stage and bulk of disease. The incidence of positive values in patients with clinical recurrence is quite impressive and presents a possible mode of follow-up for patients after standard treatment techniques have been administered for cervical cancer. Most interesting is the effect of radiation therapy or surgery on squamous cell cancer of the cervix and vulva in patients who have a positive value of the onset. Treatment of the disease by either modality appears to be associated with a precipitous drop in plasma value of CEA. Unfortunately, the presence or absence of CEA is not reliable and to date it is impossible to predict which patients with gynecologic malignancy will manifest a positive plasma value. Comments will be made concerning retro-de-differentiation and de-repression as a mechanism for the production of this antigen in patients with gynecologic cancer.

Carcinoembryonic antigen in patients with untreated central nervous system tumors.

This study was designed to determine whether immunological examination of carcinoembryonic antigen (CEA) levels in blood serum and cerebrospinal fluid would be helpful in detecting central nervous system tumors. Forty patients with tumors of the central nervous system were compared with 108 control patients. The findings suggest that: 1) CEA determinations are not helpful as a screening test in detecting preclinical central nervous system tumors; 2) Serum CEA determinations may be useful in determining the presence of a malignant tumor in patients with a circumscribed uptake on brain scan or a nonspecific mass lesion at cerebral angiography; 3) Cerebrospinal fluid CEA determinations were of no value in detecting central nervous system tumors; 4) Further study on a larger population of malignant central nervous system tumors is warranted.

Carcinoembryoinc antigen in cervical and vulvar cancer patients. Serum levels and disease progress.

Serial carcinoembryonic antigen (CEA) assays were performed on 10 patients with primary invasive squamous cell carcinoma of the cervix, 7 patients with recurrent squamous cell carcinoma of the cervix, and 5 patients with invasive squamous carcinoma of the vulva. Plasma CEA determinations were accomplished by radioimmunoassay, using a modification of Hanson's method. In 8 of the 10 patients with invasive squamous cell carcinoma of the cervix, positive CEA values dropped to normal ranges during the course of radiotherapy, usually in the first 4 weeks of treatment. A similar decrease in patients' serum values was seen after surgical extirpation of recurrent squamous cell carcinoma of the cervix by pelvic exenteration. Serum values also dropped to within normal limits in a limited number of patients with squamous cell carcinoma of the vulva after complete removal of all gross disease. Persistence of disease was associated with all gross disease. Persistence of disease was associated with chronically elevated values. A suggestion is made that patients with elevated CEA values may be followed with serial determinations to substantiate complete eradication of their disease.

Carcinoembryonic antigen in patients with gynecologic malignancies.

The determination of carcinoembryonic antigen (CEA) in plasma has been of much interest currently concomitant with the search for an immunologic diagnosis test. Recent reports have shed some doubt on the specificity of carcinoembryonic antigens for gastrointestinal tract malignancies. This report details the plasma CEA values in 341 patients with varying gynecologic malignancies. These studies have demonstrated that plasma CEA is elevated in close to 50 per cent of patients with invasive gynecologic cancer. The incidence of positive values is appreciably higher in the advanced stages of disease. Of particular interest was that 84 per cent (21 of 25) of the patients with recurrent squamous-cell carcinoma of the cervix had a positive CEA value. Similar results were found in patients with cancer of the vulva, ovary, and endometrium.

The separation of alpha-2 macroglobulin into five components with differing electrophoretic and enzyme-binding properties.

The alpha-2 macroglobulins from human serum and plasma were isolated by Bio-Gel P-300 and A5m gel filtration. The material showed a single peak on sedimentation velocity ultracentrifugation, a mol wt of 650,000 by sedimentation equilibrium ultracentrifugation, and a major precipitin arc in the alpha-2 macroglobulin region by immunoelectrophoresis against whole human serum. Two bands were observed in the alpha-2 macroglobulin region when acrylamide gel electrophoresis was performed with a pH 8.9 running gel. When a pH 7.8 gel was used, five electrophoretic species were observed. In both cases, the preaddition of stoichiometric amounts of trypsin or chymotrypsin added to alpha-2 macroglobulin resulted in disappearance of slower bands leaving only one band on acrylamide gel electrophoresis patterns. Preparative acrylamide gel electrophoresis separated alpha-2 macroglobulin obtained from Bio-Gel into five closely-spaced species. Separation was sufficiently adequate to show that those species of alpha-2 macroglobulin which bound trypsin and chymotrypsin were represented by slower moving species and that the fastest moving material had lost virtually all of the ability to bind these enzymes. Preparative acrylamide gel electrophoresis of a mixture of alpha-2 macroglobulin-trypsin complex and alpha-2 macroglobulin revealed that the fast moving component was alpha-2 macroglobulin-trypsin complex and that the slower moving material was unbound alpha-2 macroglobulin. The naturally occurring amidase activity of the alpha-2 macroglobulin using benzoylarginine-p-nitroanilide (BAPNA) as substrate was investigated and unlike its trypsin-binding activity, amidase activity was found to be of the same specific activity in all electrophoretic fractions. Binding of trypsin and chymotrypsin to alpha-2 macroglobulin revealed that alpha-2 macroglobulin maximally bound 2 moles of trypsin and 1 mole of chymotrypsin. When the enzymes were added simultaneously there was competition. Chymotrypsin added to alpha-2 macroglobulin before the addition of trypsin prevented all trypsin binding even though only one site was filled with chymotrypsin. These results were explained by the acrylamide gels which showed that 1 mole of chymotrypsin was sufficient to convert all the alpha-2 macroglobulin to a species with the fastest mobility which no longer binds additional enzyme.