Use of serum copper/zinc ratio in patients with large bowel cancer

The serum copper/zinc ratio was measured in 44 patients bearing primary large bowel malignancies. Measurements were repeated following removal of the primary tumour and again at the time of development of clinical evidence of cancer recurrence in order to evaluate the clinical value of the ratio to accurately reflect the presence or absence of malignancy. Estimation of serum copper levels do reflect the presence of malignancy, but the copper/zinc ratio is of no added value. As other acute phase proteins have been shown to be superior to serum copper as markers for monitoring of cancer patients, it is concluded that in patients with large bowel cancer, monitoring with serum copper/zinc is of no clinical value.

Tennessee antigen: its value in the monitoring of patients with colorectal cancer

Serial estimations of serum Tennessee antigen have been performed at regular three-month intervals on 35 patients with colorectal cancer who had undergone resection of all macroscopically obvious tumor but who were considered to be at high risk of developing subsequent metastases. The results were interpreted by a panel of surgeons in order to assess the clinical relevance of using serum Tennessee antigen for monitoring of patients. The serial estimation of serum Tennessee antigen was found to be very variable, difficult to interpret, and clinically unreliable as an accurate marker for the development of recurrent cancer in this group of patients. There are unacceptably high false-positive and false-negative diagnostic rates for serum Tennessee antigen estimations in comparison with serial estimations of carcinoembryonic antigen.

Tennessee antigen: the predictive value of preoperative and postoperative assays in large-bowel cancer

Twenty-nine of 31 patients bearing resectable colorectal cancers had elevated levels of serum Tennessee antigen in comparison with only eight of 31 patients for carcinoembryonic antigen. This high detection rate is, however, of limited value since the level of serum Tennessee antigen is not specific for the presence of malignancy. There appeared to be no relationship between the level of preoperative serum Tennessee antigen and subsequent prognosis. Furthermore, in only nine of 31 patients did the serum Tennessee antigen level fall after removal of all macroscopic cancer. There also appeared to be no relationship between the level of serum TennaGen at three months after resection and subsequent prognosis. These findings are in contrast to estimations of serum carcinoembryonic antigen.

Serum glycoproteins in diagnosis and monitoring of patients with large-bowel cancer

The profile of serum glycoproteins is altered in malignancy with a relative increase in acute phase reactant proteins. A prospective study has been performed to investigate three sugar moieties (hexose, hexosamine and sialic acid) of these glycoproteins in the serum of large-bowel cancer patients as a possible guide to recurrence, and to compare these three variables with carcinoembryonic antigen (CEA). The three variables indicated the presence of colorectal cancer in over 65 per cent of 107 cancer-bearing subjects. Furthermore, the appearance of metastatic disease was associated with abnormalities in these variables in 10 of 11 patients, and appears more accurately reflected than with CEA. However, the three variables and CEA are cumulative in their value for predicting recurrent cancer. Monitoring of acute phase reactant proteins may therefore be of potential clinical benefit for monitoring of colorectal cancer patients at high risk of recurrence.

Value of serial carcinoembryonic antigen determinations for early detection of recurrent cancer

Carcinoembryonic antigen (CEA) has been monitored at intervals of approximately three months in patients who had undergone potentially curative surgery for breast cancer, head and neck cancer, lung cancer, and colorectal cancer, but who were considered to be at high risk of recurrence. Monitoring of CEA in patients' serum was of no value for the early detection of tumour recurrence in either breast or head and neck cancer patients. It was of value for the early detection of lung cancer recurrence, but these patients were always beyond the scope of cure. In colorectal cancer patients, two-thirds of recurrences were heralded by a rising CEA, but only one of 15 patients had disease confined to local tissues which could be totally excised, although a further three patients had liver metastases which were apparently localized to one lobe of the liver. For colorectal cancer patients, serial CEA estimations are an effective method for the early diagnosis of recurrence, although this seldom translates into improved patient benefit.

Chemotherapy in the management of invasive bladder cancer. A review

In this review of the management of invasive carcinoma of the bladder the results of primary and systemic therapies are evaluated in the light of the natural history of the disease. The clinical and pathological causes of treatment failure are assessed in an attempt to identify new approaches that may be used in the future management of patients with bladder cancer. To improve survival in this disease requires different approaches to both the control of local disease and the early control of metastatic disease.