Showing papers in "CA: A Cancer Journal for Clinicians in 1972"

Studies on prostatic cancer: I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate

Abstract: Carcinoma of the prostate gland is peculiarly favorable for endocrine investigation since frequent serial observations of the activity of phosphatases in serum were found to provide objective indices of activity of the neo/~i~m when the enzymes were increased in amount above normal. In the present paper data are given for the values of serum phosphatases in carcinoma of the prostate and in normal men. We shall demonstrate that the acid phosphatase of serum is reduced in metastatic carcinoma of the prostate by decreasing the activity of androgens through castration or estrogenic injections and that this enzyme is increased by injecting androgens. We have been unable to find previous observations indicating any relationship of hormones to carcinoma of the prostate gland. An enzyme capable of hydrolyzing phosphoric esters was discovered by Grosser and Husler (4) in intestinal mucosa and kidney. Robison (16) found that this enzyme was particularly high in activity in growing bone and cartilage and that its activity was greatest at pH 9 to 9.5. This ~alkaline phosphatase," was found by Kay (9) to be increased in the serum in certain bone diseases including metastasis of neoplasms to bone and later work has shown that among these conditions is carcinoma of the prostate. Davies (3) and Bamann and Riedel (1) discovered that there occurs in the spleen and kidney of swine and cattle, in addition to the alkaline phosphatase, a phosphatase with an activity maximum at pH 4.8. An enzyme believed to be identical with this "acid phosphatase" was found by Kutscher and Wolbergs (11) to be present in very large amount in the human prostate gland. This finding of great activity of acid phosphatase in the prostate gland was confirmed and extended to include prostatic cancer by Gutman, Sproul, and Gutman (7). The serum of certain patients with disseminated prostatic carcinoma was found by Gutman and Gutman (6) and Barringer and Woodard (2) to exhibit increased acid phosphatase activity. Robinson, Gutman, and Gutman'~I5) summarized the acid phosphatase activity levels of 44 patients with carcinoma of the prostate. They concluded that a marked rise in acid phosphatase in serum is associated with the appearance or spread of roentgenologically demonstrable skeletal metastases and implies dissemination of the primary tumor and thus is of unfavorable prognostic significance. METttODS AND MATERIALS

Diffuse endothelioma of bone

Abstract: theappearanceledtothediagnosis of osteogenic sarcoma.Eightinjections of Coley'stoxinswereadministered at Mount SinaiHospital, withoutnotable effect. On April twelfth at the Memorial Hospital a radium pack of 12,760 millicurie hourswas appliedtothearm, and followed by two other packs at intervals of two weeks. The tumor begantorecedeatonceandatthe endoffiveweeksnoexternal swelling remained. On admission the radiograph showed a peculiar diffuse fading of the upper halfoftheshaftoftheradius, anda faint linefromtheoldfracture. The outline oftheslightly swollenshaft was smooth(Fig.1);therewas no boneformation, nopointofperforation, orareaoferosionoftheshaft, allof whichfeatures toldagainst osteogenic sarcoma. The prompt recession underradiumwas alsoquiteunlikeour experience withosteogenic sarcoma (Fig.2).Withtherecession ofthe tumortheshaftwas wellrestored and normalfunction regained. The patient lefthehospital withinstructions to return weekly for observation, which was continuedforseveral months. The patienthencame underthe care of her original physician who noted persistence of the nasal and ocularsymptoms,and,regarding the tumoroftheradiusasluetic, he instituted vigoroustreatment by salvar san.The injections, however,were followedby severetoxicsymptoms, vomiting, bloody urine, collapse, and For some years I have been encoun tering in material curetted from bone tumorsastructure whichdiffered markedlyfromthatofosteogenic sarcoma,was notidentical withany known formofmyeloma,andwhich had to be designated by the vague term“¿ round cellsarcoma― ofunknown originandnature. Ihadnoopportunity offollowing thecourseorlearning the outcomeofthesecases,asmostofthem weretreated byamputationofthelimb. Recently a case came under observa tion at the Memorial Hospital which revealed that this tumor is highly susceptible to radium, a fact that con vinced me that the disease was entirely different from osteogenic sarcoma, which resists treatment by the physical agents. The story of this case is briefly as follows: A fourteen-year-old girl had been treated by an outside physician in 1918 for nasal discharge and occa sional bleeding. Some ocular symptoms led to the suggestion of congenital lues, and a Wassermann reaction being weaklypositive, salvarsan was adminis tered. In November, 1918, while pull ingon arope,aspontaneous fracture oftheulnaoccurred, followedby swelling whichgradually subsided. In January, 1919, the swelling recurred and continued with pain and disability until a well-marked tumor occupied theupperpartofthearm.Thistumor was noted to fluctuate in size. The

A sarcoma involving the jaws in african children

Abstract: Thirty-eight cases of a sarcoma involving the jaws of African children are described. This is a syndrome which has not previously been fully recognized. It is by far the commonest malignant tumour of childhood seen at Mulago Hospital.

Blood and lymph vessel tumors.

Abstract: A soft tissue sarcoma arising in the blood and/or lymph vessels is relatively rare; yet, when it occurs, this type of tumor may present a challenge to the physician. Since the vast majority of such sarcomas are benign blood vessel hemangiomas, which seldom require any treatment, when a true malignant hemangioendothelioma is encountered, the physician may be at a loss in deciding on either management or prognosis. To counter this, some general findings in blood and lymph vessel tumors are dis cussed below. Remember, however, that none of these sarcomas can be posi tively identified without proper histolog ical examination—the essence of good management.

The PMPO syndrome (postmenopausal palpable ovary syndrome).

Abstract: If we are to save more women and diminish the mortality rate from ovarian cancer, we must become more liberal in our indications for operation. We suggest that the palpation of what appears to be a normal-sized ovary for a patient three to five years postmenopausal is indicative of an ovarian tumor and should be investigated promptly. These patients should not be followed and re-evaluated but rather subjected to proof as to the presence or absence of an ovarian tumor. To wait until one feels a solid tumor mass of up to 5 cm. and expect a cure is an exercise in fancy and futility. John Gardner said, “We are all faced with wonderful opportunities brilliantly disguised as insoluble problems.” Ovarian cancer is not insoluble. Perhaps, by adding a small segment at a time, the total picture will emerge to the benefit of our patients. Remember the PMPO Syndrome!

Cancer statistics 1972.

Abstract: Trends in Cancer Death Rates Cancer death rates rise or fall through the years often for reasons not com pletely clear. Better diagnosis or man agement or alterations in incidence may contribute to the changes but this report focuses primarily on past and present trends and what the future may hold rather than possible explanations. * The first comprehensive mortality statistics for any area of the United States were published by the U.S. Bureau of the Census for the year 1900.

Emotional reactions to having cancer.

Abstract: Much discussion of the management of patients with cancer centers on what to tell the patient about his diagnosis. The more basic issue of what the patient already knows has not often been considered.Fifty patients were interviewed by a psychiatrist as they registered for treatment at the Radiotherapy Center of the Mount Sinai Hospital in New York. All had cancer. Forty (80 per cent) correctly gave their own diagnosis.These 40 patients were not told of their diagnosis by their physicians. How they learned they had cancer and how they reacted to that knowledge was the focus of this study.The degree of anxiety and depression in these patients was the basis for discussion of what helped them to function. A series of mechanisms of defense was found to be in use. None of these patients had attempted suicide, despite knowledge that they had cancer.The interrelationship of neuroses existing prior to the diagnosis of cancer, with emotional reactions to that diagnosis, was noted in 7 patients. Only 1 subject devel...

Management of recurrent malignant effusions

Abstract: cinoma of the breast or lung develop a pleural effusion at some time in the course of their disease; in patients with an abdominal neoplasm, particularly ovarian carcinoma, ascites commonly occurs. The clinical findings of an effusion are well known: pleuritic pain, dyspnea, cough and fever from a pleural effusion; swelling or a feeling of fullness due to ascites; chest pain and weakness as the result of fluid in the pericardiaJ cavity. With recurrent effusions, fre quent taps may result in hypoprotein emia and further fluid retention. Obviously not all effusions are neoplastic; Lowell found that only 25 percent of 1,23 1pleural effusions were due to carcinoma.' Therefore, his tologic confirmation is essential to deter mine malignancy and to rule out such non-neoplastic conditions as infection, congestive heart failure, pulmonary embolism or the nephrotic syndrome as the cause of effusion in a patient with cancer. A neoplastic pleural or peritoneal effusion may occur as the first evi dence of disease or as a late manifesta tion a malignant pericardial effusion —¿

Detection of colorectal cancer using guaiac slides

Abstract: Theguaiac-impregnated slidetech nique* as an aid in the detection of DetectionofColorectalCancer asymptornatic colorectal cancer was UsingGuaiacSlides first described tnSeptember. 1971.To facilitate a simple. inexpensive and es thetically acceptable method of per forming multiple stool examinations, David H. Greegor, M.D. patients were given guaiac-impregnated slides and asked to prepare their own stool smears and mail them to the office for evaluation. In the November/De cember, 1969 issue of Ca—A Cancer Journalfor Clinicians, we reported that the accuracy of the procedure was in creased by requiring examinees to re main on a meat-free, high-bulk diet during the four-day period of stool collection 2 Prior to 1971, all studies on the use of the guaiac slide technique in the detec tion of silent colorectal cancer were reported by one physician.'@2 To further verify this method, other physicians' experiences with the slides were necessary. Test material and instructions were offered to the medical profession in Jan uary, 1971. Two thousand physicians elected to use the test routinely in their practices. Six months later, they were asked to report on the effectiveness of the guaiac-impregnated slide technique, complete a questionnaire and provide case summaries in all instances of proven colorectal cancer. Physicians who did not detect colorectal cancer dur ing this six-month period were not re quired to submit a report.

On a new kind of rays

Abstract: 1. A discharge from a large induction coil is passed through a Hittor's vacuum tube, or through a well-exhausted Crookes' or Lenard's tube. The tube is surrounded by a fairly close-fitting shield of black paper; it is then possible to see, in a completely darkened room, that paper covered on one side with barium platinocyanide lights up with brilliant fluorescence when brought into the neighborhood of the tube, whether the painted side or the other be turned towards the tube. The fluorescence is still visible at two metres distance. It is easy to show that the origin of the fluorescence lies within the vacuum tube. 2. It is seen, therefore, that some agent is capable of penetrating black cardboard which is quite opaque to ultra-violet light, sunlight or arc-light. It is therefore of interest to investigate how far other bodies can be penetrated by the same agent. It is readily shown that all bodies possess this same transparency, but in very varying degrees. For example, paper is very transparent; the flu...

Sacrococcygeal teratomas in children

Abstract: No Absract

Oral exfoliative cytology: An adjunct to biopsy

Abstract: Oral exfoliative cytology is not a sub stitute for biopsy. Rather, it is a useful although not essential—adjunct in the diagnosis of oral surface lesions due to cancer, viral disease, vesiculobullous dermatoses or fungal infection. Al though this painless, atraumatic and simple technique for collecting a sample of superficial cells is used extensively in the diagnosis of less visible and acces sible lesions, such as those in the uterine cervix on the lung, emphasis is here placed on its role in detecting and moni toring premalignant lesions and squamous cell carcinoma of the mouth. A recent review,' as well as papers ad vocating2 and questioning3 the utility of oral cytology will lead to a more complete understanding of the field.

Stilbestrol and vaginal cancer in young women.

Abstract: Regarding maternal ingestion of stilbestrol to high-risk pregnant patients during the late 1940s and early 1950s and the appearance of vaginal adenocarcinoma in their female offspring years later physicians are advised to examine patients whose mothers received stilbestrol during pregnancy. Once these females reach the menarche periodic vaginal examinations are required. A diagnosis of cancer should be considered when abnormal vaginal bleeding occurs. It is hypothesized that these cancers originate from adenomatous vaginal lesions that become malignant. The high incidence of benign vaginal adenosis suggests that an anomaly of vaginal epithelial development may be a predisposing condition. Since reporting on 8 patients in 1970 there is more evidence of an association between maternal stilbestrol administration and vaginal cancer in the offspring. More than 80 cases of vaginal and cervical adenocarcinoma in young women have been diagnosed. In most cases the maternal medical history revealed intrauterine exposure to stilbestrol dienestrol or hexestrol. The Food and Drug Administration has warned all physicians that stilbestrol is contraindicated in pregnant women. Physicians who are contacted by worried mothers or anxious young women can be assured that as yet the risk appears to be low but the public should be made aware that adolescent females and young women who had fetal exposure to stilbestrol need regular vaginal examination.

Staining techniques: screening tests for oral cancer.

Abstract: irrigation of the mouth with Gey's balanced salt solution may be a useful screening test for squamous cell or epidermoid carcinoma in the oral cavity. Likewise, the topical application of toluidine blue, an acidophilic meta chromatic nuclear stain, helps differ entiate areas of carcinoma in situ or invasive carcinoma from normal tissue. However, these two procedures —¿ the mouthwash technique and the toluidine blue test—while helpful, are nota substitute for biopsy and a negative smear does not preclude the presence of cancer.

Biology of cancer and the cancer cell: Normal and abnormal regulation of cell reproduction

Abstract: The distinguishing property of the cancer cell is its capacity to multiply and invade in situations where normal cells are restricted. The extraordinary research effort of the last decades to translate this primary difference be tween cancer and normal cells into unique and specific biochemical dif ferences is based on the very reasonable premise that the discovery of a unique biochemical property for all cancer cells is virtually an essential step in the even tual design of completely and absolutely specific anticancer chemotherapeutic agents.Unfortunately,theefforts to achievesuchtranslation have sofar largely failed, but in the course of this “¿ failure,― an enormous amount has been learned about cell chemistry, physiology and reproduction. We have learned to make a sharp distinction between abnormal cell repro duction and abnormal regulation of cell reproduction. The failure to recognize this difference has sometimes been a source of confusion, has inspired some fruitless research and has led to point less controversy. Neoplasia is defined as the formation of any new and abnormal growth,butthereisno evidencethat in a neoplasm the cells grow and divide by any other than the same rules and mechanisms by which cells grow and divide in any normal tissue or in any other situation (e.g., in culture). Thus, the abnormality in neoplasia is present not in the processes that con

Report on national surveys of cytologic facilities

Abstract: Background This paper presents data from a na tional survey, conducted in 1968, on the utilization of cervical cytology services provided by pathology laboratories, and compares the findings of this survey with those of earlier surveys in 1961, 1963 and 1966. The 1961 survey was con ducted jointly by the College of Ameri can Pathologists and the American Cancer Society. The 1963, 1966 and 1968 surveys were conducted by the College of American Pathologists and the Cancer Control Program of the U. S. Public Health Service. In all four surveys, a questionnaire was mailed to each member of the Col lege of American Pathologists in the 50 states and the District of Columbia. Repeated mailings were made to nonrespondents. Of the 4,994 members surveyed in 1968, 81 percent responded compared to 83 percent in the 1961 sur vey, 92 percent in 1963.and 65 percent in 1966.

Open letter to dr. l. wittelshoefer

Abstract: It is with great pleasure that I comply with your request to relate to you the details of the stomach resection I performed on Jan. 29 of this year. It is essentially a question dealing with the problem of whether the all-too-frequent stomach cancer, against which all internal therapy is helpless, can be cured surgically. Seventy years have passed since a young physician, Karl Theodor Merrem, published a dissertation in which he proved, through experiments with dogs, that the pylorus can be extirpated and that the stomach can be joined with the duodenum; two of three animals so operated upon survived. He was heroic enough to propose that this operation could be carried out on human beings with incurable pyloric carcinoma. However, on the one hand, the opinion that the processes of life, its disturbances and its equilibrium is the same in animal and human bodies had not yet been established; on the other hand, the operative technique was not yet advanced enough for the meaning of these experiments to be grasped entirely and the physiological results correlated to humans. The question con cerning the best technique of combining stomach and intestinal wounds has perplexed surgeons for some time and comes up again and again in discussions. The leading anatomists and surgeons of France, England and Germany have busied themselves with this topic in the course of this century since Lembert found the only proper principle for this operation (exact apposition of serosa to serosa). After this came many successful utilizations of this suture for intestinal lacerations. As regards extirpation of diseased intestinal portions, certainly no one as yet has had the courage to do so. Only in the course of the last decade were new and satisfactory advances ushered in in this field. In 1871! proved that one can extirpate pieces of the esophagus in large dogs. The esophagus healed well with a slight narrowing which could be dilated easily. Czerny was the first to perform this operation successfully in man. Then followed Czerny's experiments on the extirpation of the larynx, a few years after which I successfully removed a carcinomatous larynx in a human being. There followed the experiments of Gussenbauer and Al. v. Winiwarter of resections of pieces of bowel and stomach, which in turn were proven and enlarged upon by Czerny and Kaiser. Martini's and Gussenbauer's success in resection of the sigmoid and my successful gastrorrhaphy (1877) proved that further advances in this realm would be feasible. The last-mentioned operation also eliminated the question of whether the gastric juices would dissolve the scar of the stomach thus formed. That is why I closed the report of that operation with these words, “¿ It is only a courageous step from this operation to the resection of a piece of carcinomatous degenerated stomach.―

Benign oral tumors and tumor-like conditions†

Abstract: roplakia, ulceration, ulcerated masses or a brownish-black pigmentation in the oral cavity alerts the physician and dentist to the possible presence of oral cancer—highly curable if detected at an early stage. However, many benign conditions may also be encountered in the oral cavity which require therapy or at least recognition. Some of the follow ing conditions are true benign neo plasms; others are non-neoplastic but may beconfusedwithtumors. Mucocele: The mucocele, a retention cyst caused by occlusion of the ducts ofthemucous glandsintheoralcavity, is a thin-walled, tense mass of bluish color noted most often on the inner aspectofthelowerliporthefloor ofthe mouth.(Fig.1.)Mucocelesvaryinsize from a few millimeters to several centi meters. A larger retention cyst in the floor of the mouth, caused by obstruc Fig. I. Niucocele of the lower lip. Note bluish color of the thin-walled cystic mass.

Initiation of immune responses against cancer cells

Abstract: Studies on tumors induced in animals by viruses and chemical carcinogens have made it clear that many tumor cells contain antigens foreign to the host and that the host responds immunologically to these tumor antigens. Such immune responses can be highly effective in sup pressing the emergence and growth of developing tumors but established tumors are much more resistant to these defense reactions. It has been an article of faith for many years amongst tumor immunologists that human tumors would ultimately be found to contain similar antigens and that immunological responses in humans might prove to have an impor tant role to play in preventing or delay ing the development of such cancers. Recent work has now succeeded in dem

The treatment of oral cancer.

Abstract: The treatment of patients with cancer of the oral cavity is the responsibility of all members of the health team. Initially, the primary care physician performs an adequate examination and either estab lishes a liagnosis or refers the patient to a secondary individual or group. He then checks to make sure that the patient has arrived at the referred area since fright ened patients sometimes fail to enter into the next echelon of investigation, even though referral avenues have been cor rectly outlined to them. Ultimately, the surgeon, radiotherapist, dentist (sur geon and prosthodontist), chemothera pist and related allied health profes sionals combine their skills in order to attain the optimal treatment for each patient. Surgical excision and/or adequate radiotherapy remain the most effective means of treating the patient with oral cancer; present-day chemotherapy, whether administered systemically or intra-arterially, has not proven curative. However, experimental studies utilizing chemotherapy as an adjunct to surgery or irradiation are in progress and prelim inary reports indicate that some benefit may accrue to the patient. For the present, however, the surgeon and radiotherapist must plan the treatment jointly, deciding whether one or both modalities of treatment are indicated, and, if both are used, predetermining the exact function of each.

Bypass surgery: Nutritional palliation for alimentary tract cancer

Abstract: nitrogen balance and an improvement in the patient's weight, strength and general sense of well-being. All of these factors increase the patient's chances of responding favorably to chemotherapy and radiation. On the other hand, parenteral hyper alimentation, which has recently re ceived a great deal of interest, while it certainly aids in the nutrition of the cancer patient, also carries its own set of complications, mainly those associated with long-term central venous cannula tion and fluid and electrolyte imbalances. Therefore, whenever feasible, bypass surgery is preferable since it utilizes the natural alimentary tract. Elemental liquid diets—containing amino acids, sugars, vitamins and the necessary electrolytes and trace minerals —¿ are now available for use in various tube feedings to provide rather massive caloric and nitrogen intake. These diets are rapidly absorbed, relatively bulk-free and have the added advantage of not stimulating intestinal, pancreatic or biliary secretions, thus eliminating the bothersome diarrhea of earlier tube feedings. The folJowing illustrations present the most frequent areas of alimentary tract obstruction due to cancer and the most commonly used surgical procedures designed to bypass the ob struction and establish an effective route for nutrition. The complexities of the nutritional problems in cancer have been reviewed by Shils,' and the effective utilization of intravenous hyperalimentation has been presented by Dudrick.2 Bypass surgery is but another step toward improving the quality of survival for the patient with cancer.