Showing papers in "CA: A Cancer Journal for Clinicians in 1973"

New cancer diagnosis

Abstract: vaginal smears every day. The tech nique was very simple. We used a small pipette and took a little fluid from the va gina every day. Our intention was to find out if there was any definite morphologi cal change in the vagina and the vaginal smear that would reveal sonie of the more important changes that occur in the ovaries and in the uterus. As you probably know, this method has been applied very successfully in other mammals, especially in the ro dents, with really surprising results. It has been possible to diagnose or to recognize certain changes in the ovaries and in the uterus. For instance, the time of ovalescence in the ovary may he

Cancer chemotherapy reports

Abstract: Reports travels a path readily recognized by its readers, a few Cancer surprises lineitscourse. Thewellappreciated vistas are Chemothera viewedoncemore, butanoccasional turninthepathoffers Re orts somethingew.Forthose ofuswhomust lookbackbefore p welookforward, thereareseveralrticles ontheuseofan imidazole carboxamide derivative in human cancers. Vogel 1@sc@ornme@a7r@ on the et al., writing from the Uganda Cancer Institute, comment on

Osteogenic sarcoma in dial painters using luminous paint

Abstract: were attributed to radium-mesothorium poisoning incurred while they were em ployed at painting watch dials with lumi nous paint, two were found to have os teogenic sarcoma of the bone. The etiology, the general and the spe cial symptomatology, the pathologic anatomy, the prognosis and the treat ment in this new industrial hazard were first described by Martland and his asso ciatesin 1925 and 1926.' Only a brief résumé of the observa tions on this disease is necessary in this paper. The paint used consisted of crystalline phosphorescent zinc sulphide, ZnS (Sidot's blend), rendered luminous by the addition of extremely small amounts of radium, mesothorium and radiotho rium. These radioactive substances were in the form of insoluble sulphates in the paint when it was used. The mode of poisoning in these cases was by ingestion. Owing to a general habit among these workers of pointing their brushes in their mouths while painting the dials, they swallowed small amounts of the radioactive paint day after day. They were also exposed to ra dioactivity by absorption of the sub stance through the skin and by inhala tion, especially of the dust of the lumi nous paint, but these portals of entry were not considered significant. The girls affected had swallowed the paint for periods of from one to four years or more. Most of the paint swallowed passed rapidly through the gastrointestinal tract and was eliminated. A small amount, however, was continually absorbed and eventually stored as insoluble sulphates of particulate or colloidal size in the main organs of the reticulo-endothelial system and,above all,inthebones.The exact mode of intestinal absorption is not clear. Whether the insoluble radio active substance was picked up by wan dering histiocytes of the intestine and taken into the thoracic duct, then to the blood and then to the storage organs, in which it was phagocytosed by the fixed histiocytes of the blood sinusoids, the Kupifer stellate cells of the liver and the splenic phagocytes, whether small quantities passed through the intestinal tract in a manner not understood, or whether the radioactive substances had some fixed position in the zinc suiphide molecule which allowed it to be ab sorbed with the zinc is unsettled at present. Perhaps the conceptions of ab sorption from the intestinal tract must be augmented and modified considerably. It should be recalled that the entrance into the body of insoluble matter of par ticulate size is thought to be easier by in halation than by ingestion. For instance, in anthracosis, the foreign matter is Reprintedfrom Archivesof Pathology7: 406-417, 1929. Read before the New York PathologicalSocietyat the New YorkAcademyof Medicine, New York, March 8, 1928.

Cancer chemotherapeutic agents.

Abstract: Feel lonely? What about reading books? Book is one of the greatest friends to accompany while in your lonely time. When you have no friends and activities somewhere and sometimes, reading book can be a great choice. This is not only for spending the time, it will increase the knowledge. Of course the b=benefits to take will relate to what kind of book that you are reading. And now, we will concern you to try reading cancer chemotherapeutic agents as one of the reading material to finish quickly.

L-asparaginase for the treatment of cancer.

Abstract: The amino acid, L-asparagine, is a nutritional requirement of both normal and cancer cells. Unlike normal cells, however, certain leukemic cells cannot synthesize asparagine and must conse quently rely on an external supply in the plasma and tissues. The administration of the enzyme, L-asparaginase, destroys this free source of asparagine, starving and killing certain cancer cells. In 1953, Kidd' noted that guinea pig serum had antitumor activity against two strains of murine lymphoma and a strain of lymphosarcoma in rats. It was subse quently shown by Broome2 in 1963 that the tumor inhibitory activity of the serum was due to L-asparaginase, which is present in high concentrations in the sera of guinea pigs and other members of similar species. In 1966, DeLowrey3 and his associates using a purified guinea pig serum treated a boy with acute lym phoblastic leukemia, and obtained an objective response. However, it was not until the isolation of an L-asparaginase from Escherichia coli, with similar anti tumor activities, that sufficient quanti ties of L-asparaginase could be synthe sized for large-scale clinical trials. In 1967, Hill4 and his associates, and Oettgen,5 first described the induction of complete remissions. Hill's paper dis cussed three patients treated with L-asparaginase prepared from E. coli. These three patients had acute lympho

Vaccine trials for osteogenic sarcoma: A Preliminary Report

Abstract: nous vaccine prepared from the primary tumor tissue was given to a child with osteogenic sarcoma and pulmonary me tastases. During the 15 day course of in jections the child gained seven pounds; following treatment the disease pro gressed and the patient died. However, the temporary improvement suggested that immunotherapy may have inhibited tumor growth. A formal controlled trial of immunotherapy in less advanced dis ease was begun in April, 1966. Patients under the age of 25 with osteogenic sar coma of the long bones but no evidence of spread beyond the primary site and who had been treated by amputation were included in the study. The auto genous vaccine was given in the post operative period following amputation. If metastases (usually pulmonary) ap peared the vaccine was judged a failure.

Chemotherapy of choriocarcinoma and related trophoblastic tumors in women.

Abstract: tial experience in the treatment of choriocarcinoma and related trophoblas tic tumors with folic acid antagonist, 4amino-N10 methyl pteroylglutamic acid (Methotrexate).' We wish now to de scribe our further findings in 27 women whose therapeutic response to Metho trexate has been observed during the past two and one half years. Our rationale in applying antifolic acid therapy in cases of malignant tro phoblastic disease of women stems from earlier laboratory and clinical studies. The high requirement for folic acid of the tissues of the female genital tract be came apparent from experimental stud ies which showed that in the rat or mon key deficient in folic acid, the uterus is incapable of growth in response to ad ministered estrogens.2 Moreover, the high fetal requirement for folic acid was demonstrated in the rat by Nelson and Evans.3 Indeed, Thiersch4 reported the induction of therapeutic abortion in women by the administration of the folic acid antagonist, aminopterin sodium. In addition, the clinical phenomenon of the macrocytic anemia of pregnancy, responding as it does to folic acid ther apy, also appeared to reflect an espe cially high requirement for folic acid in the rapidly growing fetal and maternal tissues of pregnant women.5 Accord ingly, we postulated that choriocarcin oma and related trophoblastic tumors

Cancer statistics 1973

Abstract: Deathratesformostcancersitesin crease with age. The pattern of increase, however, varies with different cancer Edwin Silverberg. B s, sites and among different age groups. In and Arthur. Holleb, M.D. the following article, mortality statistics according to age are discussed for some of the major sites of cancer—cancer of the colon, rectum, lung. stomach, pan creas, female breast, uterus, prostate, ovary and leukemia. In most of these sites, regardless of whether the overall death rate is increasing, decreasing or unchanged, the death rates by age in crease continuously until the oldest age group which has the highest death rate. For some cancer sites, such as lung cancer, there is a peak death rate before the oldest age group and then the rates drop off. In other cancers, which are more common in children, such as leu kemia, there is a higher death rate in age groups under 15, then a dropping off until the age of 45 years, followed by a steady increase in the older ages. In most cancer sites not discussed in the following article, the typical pattern of increasing death rates with increasing age holds true. Trends are examined for 1914 (the only year prior to 1930 for which de tailed cancer mortality data are avail able), for 1930-1960 by 10-year inter vals, and then for 1968, the most recent year for which complete information is on hand. Death rates are shown only for those age groups where there is signif icant mortality.

Operable breast cancer: in defense of conservative surgery.

Abstract: I welcome the opportunity of responding to Dr. Anglem's article which challenges and unfortunately mis interprets my position regarding the treatment of operable breast cancer. In this, the second, critique, Dr. Anglem implies that I have quoted Cleveland Clinic's survival rates after various pro cedures to show the superiority of simple over radical operations. In fact, I have consistently emphasized that Cleveland Clinic's fiveand ten-year survival rates following less than radical procedures seem comparable to results from other institutions which employ radical mastectomy for patients with similarly staged cancer. I have always reported the details of staging, the proportion of patients with noninvasive cancer, the type of operation performed, the reason for the selection of cases and the observed mortality rate, not the age adjusted or determinate death rates often used by Dr. Anglem for comparison. However, I agree with Dr. Anglem's call for analytic detachment and objec tivity in resolving this controversy and am fully aware that this is not “¿ an aca demic matter.― I thus again suggest that the American Cancer Society and the National Institutes of Health choose an impartial but clinically knowledgeable statistician to review the records in the Cleveland Clinic breast cancer series from 1957 through 1962, at which time less than one percent of the operations performed were radical mastectomies. I hope the statistician then classifies a sim ilar number of patients treated by radical mastectomies at another institution dur ing this same time period to determine the proportion of five-, 10and 15-year survivals. This suggestion is not made in the hope of discovering which is the best modality of treatment of breast cancer or which is the most appropriate for a given type of cancer. There is far too much se lection in our cases to allow meaningful comparison of various treatment results. But, by carefully classifying our patients and those of another institution, it could be determined whether radical mastec tomy had any greater value than the sev eral lesser operations that we now em ploy. If the results of the radical opera tion are not distinctly superior, the operation should be totally abandoned since, in my opinion, fear of a radical operation is the most significant cause of delayed treatment. For the present, however, I would like to clarify certain fallacies in Dr. Anglem †̃¿ s presentation.

Chemotherapy of skin cancer.

Abstract: Epitheliomas and precancerous le sions of the skin are common tumors of man. Approximately 100,000 new pa tients with epitheliomas are diagnosed each year and the estimated yearly inci dence of precancerous (or actinic) solar keratoses in the United States reaches 5-10 million. Skin cancers are dif ferent from other cancers in at least two ways. First, identification can be easily made and biopsy can be readily performed on suspicious lesions. Sec ond, methods for treatment are well known and fairly standard throughout the country; the cure rate approaches 98 percent. Nevertheless, 4,000 individ uals in this country die every year of the consequences of skin cancer. Faced with this appalling statistic for a tumor so readily available for diagnosis and ther apy, the search continues for different, specialized and more effective methods which can be used in unusual occasions for treatment of cancer and precancers.

Biochemical tests for cancer.

Abstract: Bodansky: A number of biochemical studies, especially certain enzyme deter minations, are extremely valuable in confirming the clinical im pression of cancer or in following the course of disease. (Table 1.) For instance, the determination of serum alkaline phosphatase ac tivity aids in the diagnosis of patients with skeletal and hepato biliary cancers; acid phosphatase has proved equally useful in pa tients with cancer of the prostate. In addition, 5'-nucleotidase, which is elevated in patients with hepatic disease but not in those with skeletal disease, is helpful in the differential diagnosis of liver and bone metastases. On the other hand, the “¿ ubiquitous― enzymes are not helpful in revealing the presence of cancer, but are extremely valuable in fol lowing the patient's progress, once the diagnosis is established.

An approach to the control of carcinoma of the endometrium

Abstract: Because of the advent of the Papanicolaou smear as a diagnostic test, cervical cancer rates have declined due to early detection and therapy. The same cannot be said of endometrial cancer, and this article outlines some possible diagnostic tests and indications for them in the hope of reducing incidence of and severity of endometrial cancer in peri- and postmenopausal women. Women at high risk of endometrial carcinoma are those with adenomatous hyperplasia, which must be recognized as a precursor of invasive endometrial cancer: carcinoma in situ of the endometrium also qualifies as a true precursor. This author recommends histologic sampling of high-risk menopausal patients, with or without the presence of dysfunctional uterine bleeding. A discussion of the technology of obtaining histological specimens follows, with emphasis on the need to devise a means of obtaining histologic samples in all menopausal women on an ambulatory basis without anesthesia for screening purposes. Vacuum curettage may be a part of such a screening. The need to adopt a regular staging formula to characterize clinically the virulence of endometrial cancer is underscored, and such a formula is presented. Other factors, in addition to screening, which will help control the incidence of endometrial cancer are recognition of the place for radiation and surgical intervention, recognition of menopause as the time of life when high risk patients may get identified, and caution in hormonal treatment in perimenopausal and postmenopausal women until evidence of its efficacy supercedes evidence of possible etiological roles in endometrial aberrations.

Operable Breast Cancer: The Case Against Conservative Surgery

Abstract: ticles by Dr. Crile have been published condemning the use of standard radical mastectomy as the operation of choice for most patients with breast cancer and advocating more conservative proce dures.' .2.3.4.5.6During this period there has been a trend toward the election of increasingly more conservative opera tions, from mastectomy with dissection of the lower two thirds of the axilla, to simple mastectomy and finally to local excision. The latter has recently been suggested as appropriate for one third of the patients with operable breast cancer. A mass of statistical data has been of fered in support of this thesis, which on casual or superficial reading appears plausible. But when these statistics are examined with anything approaching analytic detachment and objectivity, it is abundantly clear that far from furnishing support for a policy of conservative sur gery, they provide a very forceful argu ment against it and in favor of radical mastectomy. This seeming paradox appears to be a consequence of a consistent and easily demonstrable bias; the end results of fa vorably selected, conservatively treated patients are compared with less favor ably selected, radically treated patients.

Colon and rectal lesions: A tutorendoscopic view: The tutorendoscope

Abstract: More than 79,000 Americans devel oped colon and rectum cancer this year; some 47.000 people have died of their disease. Almost three out of four of these patients might have been saved by early diagnosis including a proctosig moidoscopic examination and by prompt treatment. Indeed, authorities feel that regular proctoscopy as part of a complete physical examination can save more lives from cancer than any other segment of the health check-up, espe cially in people over 40 years of age. Why then is there such a disparity be tween the accepted dictum that procto sigmoidoscopy should be widely used on the asymptomatic patient and the glaring fact that most physicians do not perform this examination? Our conclusion, supported by others, is that the study of colon and rectal dis eases continues to be one of the most neglected subjects in medical school

Rx of bladder cancer: Complex and controversial

Abstract: Complex decisions regarding the choice of treatment for the patient with bladder cancer may pose many often controversial questions. On what criteria is this choice best made? What is the role of combined preoperative irradiation and surgery? How are the complications of high dose irradiation best managed and prevented? Is chemotherapy of value in the treatment of bladder cancer? In the following series of questions and answers, these and other practical questions are discussed by some outstanding specialists in the field, including:

Combatting the health hazards of smoking

Abstract: Dr. Terry: Unfortunately, the curve has levelled off and may even be turning upward. Immediately after the 1964 Report was issued, the per capita cigarette consumption dropped and continued on a down ward trend through 1970. In 1971, it rose slightly and this gradual rise has continued through the first half of 1973. There is also evidence of a steady increase in smoking among teenage girls. In 1968, only about half as many teenage girls smoked compared to teenage boys, while today the percentage of young girls who smoke is almost as high as that of boys. If this trend continues during the next ten years, the proportion of adult

The National Cancer Program Plan.

Abstract: Cancer Act was signed into law. Under its provisions, funds were authorized to launch an intensified attack on cancer. Toward this end, the National Cancer Institute called on a broad spectrum of the scientific community to identify major research thrusts and activities as a basis for formulating a National Cancer Program Plan. In accomplishing this, 250 prominent scientists and physicians representing a wide range of biomedical and clinical disciplines met in a series of 41 planning sessions and two major review sessions between October 1971 and March 1972. In addition, discussions were held with the National Advisory Cancer Council and the American Association of Cancer Institutes. These activities were for the sole purpose of developing a scientific and operational foundation for a Na tional Cancer Program. The conquest of cancer has been rightly called a more difficult task than the first manned moon landing. The planning exercise brings to bear on the problem the experience and knowledge

The decision making process in cancer patient care.

Abstract: In recent years, the interdisciplin ary―or―multidisciplinary―approach to health care has been widely and rightly acclaimed asan important facet of cancer management. But what “¿ dis ciplines―are involved and what are the objectives of group effort'@How do they achieve their goals'@What logical steps does the physician working alone or in a group take to arrive at decisions? How are interdisciplinary decisions measured and what types of errors are most com mon? Who is responsible medicolegally for multidisciplinary decisions? What methods best insure cost-effectiveness? In order to answer these and similar questions, the medical profession must define relevant and achievable objec tives (formulated with the patient's per ception of need kept in the forefront); develop managerial methods for coor dinating and evaluating interdisciplinary decisions; and form explicit medical logic systems. There is generally adequate time to ef fectively plan for cancer patient care, planning which is itself a logical process requiring coordinated efforts. At present, this decision making process is too often given over to the logic of the computer. Most computer methods now in use, ranging from the simple proce dures of multiple regression to more highly sophisticated statistical and mathematical procedures, were estab lished years ago; they are taken from the textbook and written into computer pro grams with medical data to give a “¿ diag nosis.―In the rush to produce such com puter diagnoses, the statisticians, math ematicians, engineers and program mers who usually make the computer pro grams have often overlooked the essen tial elements of the physician's medical logic aswell asthe patient's objectives. In addition, the medical logic employed by every practicing physician is seldom sufficiently detailed to form the basis for computer programming. Of course, a highly trained physician utilizes many logical rules. But the expert often does not learn these rules in explicit form; rather he gains his knowledge through observing, emulating and performing. Through repeated attempts and repeated failures, he finally attains a state of high skill. He is so intent on the subject mat ter during the training period that he is often unaware of the rules formulated in his mind, subconsciously. These rules may be simple or highly complex; it is seldom known, for often they are not evenwellenoughunderstoodtobeeval uated. But rules there must be, or else the expert could not be so frequently cor rect. He may say that a certain phenome non belongs to a certain class simply be cause it looks that way to him; there are certain rules but they are unknown to his consciousness. The problem is to transform these subconscious, “¿ gut feeling―rules into explicit form which canbeanalyzed. The analysis ofmedicallogicisfacili tated by operations research (OR), a formofmanagement logicdeveloped during World War II, which requires Dr. Spratt is the Director of the Cancer Research Center andChief Surgeon at Ellis Fischel State Cancer Hospital, Columbia, Missouri. Dr. Watson is the Chairman of the Biomathematics Section at the Cancer ResearchCenter.

The management of chronic pain.

Abstract: Management of the cancer patient with chronic pain can be a difficult and frustrating problem or it can be very rewarding for both patient and physi cian. Unfortunately, clinicians have generally been unsuccessful in defining, interpreting, measuring or controlling pain, as evidenced by the multiplicity of relatively unsuccessful techniques in common use. An encouraging trend, however, is the multidisciplinary ap proach to the evaluation and relief of chronic pain. In many hospitals, gener alists, psychiatrists, psychologists, neu rologists, neurosurgeons, anesthe siologists, clinical pharmacologists, nurses and social workers conduct “¿ Pain Clinics;― patients with chronic pain are treated either by “¿ input― actics including physical, chemical, behav ioral or subjective techniques or “¿ out put―approaches designed to retrain the central nervous system's response to painful stimuli rather than altering its physical structure. In addition, continued study will hopefully provide more effective means of controlling chronic pain and relieving suffering. Physiologists are now at tempting to more accurately describe the anatomy of nerve pathways and to better understand the transmission of pain im pulses so that neurosurgeons can perfect surgical techniques. Because of consid erable recent interest, the 4,000-year old Chinese technique of acupuncture for the treatment of various diseases, the relief of pain and the induction of surgi cal anesthesia is now being studied by a task force of the American Society of Anesthesiologists and by an investiga tive committee appointed by the Na tional Institutes of Health.

Newer methods for evaluating thyroid nodules.

Abstract: The usefulness of classifying thyroid nodules according to their capacity for accumulating radioiodine as revealed by scintiscans is well established; thyroid cancer occurs much more frequently in nonfunctioning or "cold" nodules than in "hot" nodules. Nonfunctioning thyroid nodules, however, constitute a heterogeneous group that includes adenomas, cysts, subacute and chronic thyroiditis, multinodular goiter, various fibrotic, hemorrhagic and necrotic processes, in addition to thyroid neoplasia; cancer, indeed, accounts for only a minority of hypofunctioning or nonfunctioning nodules. Characterization of "cold" nodules to provide better discrimination between benign and malignant disorders has been attempted in several ways, including measurement of uptake of . . .