[Quantitative and qualitative composition of porphyrins in erythrocytes of cancer patients]

Content of copro- and protoporphyrins was studied in erythrocytes of women with tumor of genitals. Distinct increase in content of these porphyrins, especially of protoporphyrin, was detected in erythrocytes of the patients with malignant tumors as compared with the patterns of healthy persons.

The prevalence of plasma heparin neutralizing activity and the effect of treatment on it in women with a gynecologic malignancy

Plasma samples from some women with a variety of advanced gynecologic malignancies have been shown to neutralize exogenous heparin. The purposes of this investigation were to determine the prevalence of neutralizing activity in a referral population of women with a gynecologic malignancy and to determine whether the level of neutralizing activity is related either to histology or stage or whether it is affected by treatment. One hundred thirty-eight patients were studied over a 1-year interval; 121 had a documented malignancy, 16 were healthy, and one had a benign ovarian neoplasm. The mean heparin neutralizing activity in the healthy patients was 4.5% +/- 7% and it was 46.2% +/- 26% in the group with malignancy (p less than 0.0000, two-tailed). Seventy-five percent of all patients with malignancy had neutralizing activity greater than 25%. The percent of staged, untreated patients with neutralizing activity increased significantly with advancing stage (from 59% with stage I to 85% with stages III and IV disease). There was no significant relationship between neutralizing activity and histology, site of origin, or patient weight. In 10 patients in whom the disease outcome was clear, the change in neutralizing activity reflected (or predicted) the response to therapy. We conclude that heparin neutralizing activity is a generalized phenomenon in women with one of the malignancies studied, and it may potentially be useful in the evaluation of the patient's response to therapy.

Serum vitamin E level and risk of female cancers

A sample of 15,093 women, aged 15-99 and initially free from cancer, participated in the Finnish Social Insurance Institution's Mobile Clinic Health Survey in 1968-71. A record linkage to the Cancer Registry revealed that during a mean follow-up of eight years cancer was diagnosed in 313 women. Serum alpha-tocopherol levels were measured from stored samples (at -20 C) of the cancer patients and of 578 controls, matched for municipality and age. An inverse relation was observed between alpha-tocopherol level and risk of cancer, even if the cancers in the first two years of follow-up were excluded. Women in the lowest quintile for alpha-tocopherol levels compared to those with higher values had a 1.6-fold (95% confidence interval: 1.1-2.5) risk of cancer as adjusted for possible confounding effects of several other factors. A low level of alpha-tocopherol in general strongly predicted epithelial cancers while it carried an only slightly elevated risk of cancers in reproductive organs exposed to oestrogens. The results suggest that a low vitamin E intake is a risk factor for cancer in many, but not all, organs. The expression of its protective effect may depend on the primary causes, which vary between different cancers.

Interleukin 2 activity in peripheral blood mononuclear cells of patients with gynecologic malignancies

We studied production of, absorption of and response to interleukin 2 (IL-2) by peripheral blood mononuclear cells (PBMC) from 66 patients with gynecologic malignancies, in addition to measurement of the OKT 4/OKT 8 cell ratio. Patients with benign tumor served as controls. The OKT 4/OKT 8 cell ratio in patients with advanced (but not early) gynecologic malignancies was significantly lower than that in patients with benign tumor. PBMC from advanced cancer patients activated with phytohemagglutinin (PHA) had significantly lower IL-2 production compared to that from patients with benign tumors, while significant changes in their ability to respond to IL-2 and to absorb IL-2 were not observed. Absolute numbers of OKT 8 positive cells in PBMC of patients with good prognosis were significantly decreased after surgery and chemotherapy, while those of OKT 4 positive cells remained unchanged. Although IL-2 production in PBMC of patients with good prognosis was significantly elevated after chemotherapy, that in PBMC of patients with poor prognosis declined to about a half of pre-operative levels. The ability of PBMC to respond to IL-2 was significantly elevated not only in patients with good prognosis but also in patients with poor prognosis after termination of chemotherapy. On the other hand, the ability of PBMC to absorb IL-2 remained unchanged during the course of treatment. These findings may contribute to the understanding of tumor-induced immune suppression.

[Clinical implication of serum antibody to Thomsen-Friedenreich antigen in patients with gynecological malignancies]

Thomsen-Friedenreich antigen (T-antigen) is a carbohydrate antigen that is expressed in a variety of cancer tissues. T-antigen is thought to have an antigenicity because circulating T antibodies can be detected as natural antibodies in humans. In this study, we examined the serum T antibody titers in patients with gynecological cancer using the hemagglutination test, and studied the relationship between the expression of T-antigen in cancer tissues and serum TA-4 levels and serum T antibody titers. Serum T antibody titers in patients with gynecological cancer were lower than those in normal controls, especially in endometrial and ovarian cancer (p less than 0.05) in which T-antigen was strongly expressed. Furthermore, the low antibody titers correlated with the expression of T-antigen in cancer tissues. T antibody titers significantly increased (p less than 0.01) after operation and the inverse relationship was found with the levels of circulating TA-4 in cervical cancer patients. These findings suggests that patients with gynecological cancer immunologically responded to T-antigen and the measurement of circulating T antibodies may be useful as an indicator of the progression of cancer in tissues.

Modified properties of serum cholinesterases in primary carcinomas

Cholinesterases were characterized in the serum of 77 treated and 11 untreated patients having primary carcinomas of various tissue origins and 21 healthy volunteers which served as controls. In most of the samples, pseudocholinesterase (BuChE) accounted for almost all cholinesterase (ChE) activity and was inhibited by the organophosphorous poison tetraisopropyl pyrophosphoramide (iso-OMPA). In samples from the tumor-bearing patients, ChE degraded 733 +/- 59 nmole acetylcholine/h/mg protein, lower than the 960 +/- 175 nmole/hour/mg levels measured in controls. Tumor serum ChE exhibited elevated sensitivity to 1,5-bis-(4-allyldimethyl ammonium phenyl)-pentan-3-one dibromide (BW), the selective bisquaternary inhibitor of "true" acetylcholinesterase (AChE), with no correlation to age, sex, staging of tumor, presence of metastases or the specific treatment protocol, and with a different distribution pattern from the decrease in ChE specific activity or the sensitivity to iso-OMPA. In sucrose gradients, ChE sedimented as 12S in controls whereas in tumor serum samples from treated patients an additional component of 6 to 7 S, inhibited by both iso-OMPA and BW, also was detected. However, the ChE activity in serum of patients with diagnosed carcinomas before surgery and medical treatment appeared to be nondistinguishable from controls. These findings suggest that the modified properties of serum cholinesterases in carcinoma patients are not the result of the tumor itself, but that the common therapy protocols used in the treatment of primary carcinomas may cause the appearance of soluble ChE activity with properties of both AChE and BuChE, which accumulates in the serum.

Occurrence of CA 125 and CA 19-9 tumor-associated antigens in sera of patients with gynecologic, trophoblastic, and colorectal tumors

The present study was undertaken to test the parallel detectability of ovarian cancer antigen CA 125 and gastrointestinal cancer antigen CA 19-9 in the sera of patients with malignant ovarian tumors, benign ovarian tumors, endometrial cancers, cervical cancers, colorectal cancers, and trophoblastic tumors and in early 1st-trimester pregnant as well as in healthy nonpregnant controls. In all kinds of gynecologic and colorectal tumors raised concentrations of both antigens were found with the exception of malignant nonepithelial ovarian tumors where neither of the antigens showed positive reaction. The most positive cases were found in the group with epithelial ovarian cancers. Of the two antigens CA 125 was the more responsive. No positive cases were found with either of the antigens in nonpregnant healthy controls or in patients with benign ovarian tumors. The parallel determination of the two antigens gives us a better opportunity to recognize pelvic tumors and further may enable us to distinguish ovarian and colorectal tumors.

Beta lactoglobulin homologue placental protein 14 (PP14) in serum of patients with trophoblastic disease and non-trophoblastic gynecologic malignancy

Serum levels of beta lactoglobulin homologue placental protein 14 (PP14) were measured by a sensitive radioimmunoassay in various trophoblastic diseases and non-trophoblastic gynecologic malignancies. While trace amounts of protein were detected in sera of non-pregnant subjects (22.3 +/- 13.7 micrograms/l), during first half of normal pregnancy a dramatic rise of serum-PP14 levels was demonstrable with a peak-value at 7th-10th week of gestation, followed by a decline thereafter. Serial determinations of PP14 have been performed in 31 patients with trophoblastic tumour (20 hydatidiform moles, 4 invasive moles and 7 choriocarcinomas). In patients with hydatidiform moles and invasive moles (273.5 +/- 106.5 micrograms/l and 162.2 +/- 109.6 micrograms/l) respective values before therapy were much exceeding the non-pregnant controls. After therapy there was a rapid decline of the serum-PP14 levels within two weeks. In patients with choriocarcinoma the PP14 values were moderately elevated (66.4 +/- 25.7 micrograms/l), and declined following the remission of disease. In 32 gynecological tumours (21 carcinomas of the cervix, 4 endometrial carcinomas, 5 ovarian carcinomas, 2 carcinomas of the vulva) the pretreatment levels were not different to normal controls.

Serum copper level in gynecologic malignancies

Serum copper level was determined before operation in 179 patients with various histologically proved gynecologic tumors: malignant, benign, or metastases to the ovary. Serum copper level was significantly higher (p less than 0.01) in all groups of patients with cancer and in the benign group when compared with control subjects. Serum copper level correlated well with stage of cancer disease (r = 0.70 to 0.79) except for ovarian carcinoma, in which serum copper level was already significantly elevated in Stages I and II. The sensitivity of serum copper level greater than 150 micrograms/dl in detecting malignancy was 87% to 100% in late cancer stages in all malignancies. Our data imply that the addition of serum copper level determination to other screening tests could increase their sensitivity.

Anemia-inducing substance (AIS) in advanced cancer: inhibitory effect of AIS on the function of erythrocytes and immunocompetent cells

The effects of anemia-inducing substance (AIS), found in the plasma of tumor-bearing subjects, on red blood cells (RBC) and cellular immunity were examined. The results obtained may be summarized as follows: 1) The osmotic resistance and the deformability of RBC were decreased in patients with terminal cancer. 2) Normal human RBC were made less deformable and their membrane was made fragile by treatment with cachectic plasma from those patients, and these changes in physical properties were irreversible. 3) Energy metabolism in RBC was affected by AIS, that is, ATP concentration and pyruvate kinase activity in RBC were lowered and transmembrane glucose influx was suppressed. 4) AIS was removed from cachectic plasma by repeated adsorption with normal RBC, and the inhibitory effect on cellular immunity was lessened as AIS was removed. 5) AIS was detected in cachectic RBC membrane, monocytes, and tumor tissue by indirect immunofluorescence assay using rabbit anti-AIS antibody prepared by us. These observations suggest strongly that tumor-derived AIS appears in the blood of patients with terminal cancer, shows cytotoxicity to RBC and immunologically competent cells, and plays a role in the pathogenesis of cancer cachexy.

Heparin-neutralizing activity in the plasma of women with gynecologic malignancy: the effect of tumor stage on heparin concentration and fibrin generation after low-dose heparin

The relationship between tumor stage and the concentration of circulating heparin achieved after subcutaneous administration and its effect on fibrin generation were studied in 24 women with gynecologic malignancy. A single subcutaneous injection of 5000, 7500, and 10,000/U of sodium heparin was given in random order on different days. Plasma specimens for antithrombin III, fibrinopeptide A, and heparin were obtained serially over an 11-hour interval. Women with a Stage III or IV malignancy had significantly lower circulating heparin after the 5000 and 10,000/U doses. There was a significant decline in fibrinopeptide A as the concentration of circulating heparin increased. Thirty-three percent of women with a Stage III or IV malignancy had no detectable circulating heparin at any point examined over the 11 hours after 5000/U of heparin. Likewise, 16.7% and 8.4% had no detectable circulating heparin after 7500 and 10,000/U, respectively. A similar percentage was noted in a smaller group of women with Stage II malignancy. Next, a known quantity of heparin was added to the plasma from these patients and the concentration of heparin was determined. A significant amount of heparin-neutralizing activity was documented. We conclude that a large percentage of women with an advanced gynecologic malignancy are able to neutralize heparin administered for the prevention of thromboembolic disease. This heparin-neutralizing activity may account for the failure of low-dose heparin to prevent thromboembolic complications in this patient population.

Serum vitamins A and E and carotene in patients with gynecologic cancer

Serum concentrations of vitamin A (retinol), vitamin E (alpha-tocopherol) and total carotene were measured in 88 women with gynecologic cancer (9 vulvar, 15 cervical, 36 endometrial and 28 ovarian carcinomas) and 31 healthy controls. No significant differences were found in the serum levels of the vitamins and carotene in patients with vulvar, cervical or endometrial cancer compared to the controls. The patients with ovarian cancer had a significantly (P less than 0.01) lower mean serum level of vitamin A than the controls, while carotene and vitamin E level were similar in both groups. The results indicate that vitamin A may have a role in the metabolism of patients with advanced ovarian cancer.

Placental protein 10 (PP10) in the serum of patients with trophoblastic and nontrophoblastic gynaecological tumours

Serum levels of placental protein 10 (PP10) were measured by radioimmunoassay in patients with trophoblastic (n = 23) and non-trophoblastic (n = 122) gynaecological tumours before, during and after treatment. Elevated levels (greater than 2.0 micrograms/l) were found in 96% of patients with an untreated trophoblastic tumour, and in 22%, 20% and 12% of patients with endometrial, cervical and ovarian carcinoma, respectively. After treatment the levels fell in patients with trophoblastic disease. Although PP10 may be tumour-associated in such cases, it is premature to assume any significance for PP10 as a tumour marker in clinical practice, because changes in serum hCG levels are much more informative.

Sensitive and specific assay for human chorionic gonadotropin (hCG) based on anti-peptide and anti-hCG monoclonal antibodies: construction and clinical implications

We developed a highly sensitive and specific assay for hCG using monoclonal antibodies (Mabs) directed against a 37-amino acid synthetic polypeptide analogous to the carboxyl-terminus (CTP) of beta hCG. Five antibodies that varied by either their affinity for beta hCG or their specificity for epitopes on CTP were investigated. To measure hormone levels, we used as the radiolabeled indicator an alpha-subunit-reactive Mab. The monoclonal-immunoradiometric assay had a lower limit of sensitivity of 0.05 ng/ml. Serum levels of hCG or hCG-like material with CTP structure were measured in 229 healthy blood donors; 1.1% of healthy men and 4.6% of nonpregnant women younger than 50 yr had serum values varying between 0.05 and 0.23 ng/ml. Moreover, 6 to 7 healthy women older than 50 yr had detectable levels in the 0.05-0.20 ng/ml range. To study the disappearance rates in normal women, we followed serum hCG serum levels of 6 women who had previously received a single im injection of the hormone. These individuals failed to develop a pregnancy after in vitro fertilization; hCG declined from 0.5 to 0.05 ng/ml within 2 weeks. These results were in contrast to the findings in 12 patients with hCG-producing tumors. In 9 patients without any evidence of recurrent disease, hCG levels became undetectable within 5 months. However, 3 others had levels consistently above 0.05 but below 0.5 ng/ml. In 2 of these three patients, subsequent increasing hCG levels were associated with tumor recurrence. We conclude that this hCG assay based on both anti-peptide and anti-hCG Mabs may be useful in tumor monitoring.

Fluorescence topography in biology. III: Characteristic deviations of tryptophan fluorescence in sera of patients with gynecological tumors

The near-ultraviolet region of the total fluorescence (excitation-emission matrix) of human serum reflects essentially the fluorescence of protein-bound tryptophan. We examined topographically the tryptophan fluorescence of human serum. In comparison with fluorescence topograms from sera of healthy donors, sera of patients with gynecological malignancies showed significantly different patterns of tryptophan fluorescence, the major deviations being at 325 and 365 nm. In healthy donors, the tryptophan fluorescence intensity at 365 nm, expressed as percent of the maximum fluorescence intensity (i.e., at 337 nm) varied little, but was markedly lower for sera from patients with malignancies. We found no clear correlation between the extent of the fluorescence deviations and the relative concentration of the protein fractions as determined by electrophoresis. Furthermore, we could rule out inflammation in tumor patients as an explanation for this effect.

[Initial results in the treatment of endometriosis with the LH-RH analog buserelin]

Twenty-six women, most of them with advanced endometriosis (Stage III according to Acosta), were treated for six months with the LH-RH agonist Buserelin. After initially increased liberation both of the gonadotropins as well as of the sexual steroids there was consecutive inhibition of gonadal function, especially after inhibition of FSH secretion. Within two to four weeks estradiol production was completely and lastingly suppressed in 21 of the 26 women. In three women it lasted for three months and in two women estradiol again rose up to three times during the period of observation. Correspondingly, 22 of the women suffered from hot flushes as early as within the first two months. Twenty of the 26 women became completely free of symptoms within four to six weeks, and a clear regression of the pain was recorded in another four. In two women the complaints persisted without change. Withdrawal bleeding of short duration occurred simultaneously with the intermittent increases in estradiol levels; however, this bleeding usually caused little or no pain. Eleven of the 19 endometrium biopsies performed during therapy revealed a dormant endometrium, and only in one case was proliferated endomedium found, in the third month of treatment, in a stage of transition to hyperplasia. The remaining seven biopsies were insufficient for assessment. In seven women with advanced endometriosis, laparotomies were performed after drug treatment. Histologic study of the endometriosis tissue thus obtained revealed, except in the two nonresponders, cicatrized tissue with atrophic glands and severely reduced stroma.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum selenium and thromboxane in patients with gynaecological cancer

To explore the relationships between the antioxidant selenium and pro-aggregatory thromboxane A2 in patients with gynaecological cancer, we measured the serum concentrations of selenium and the production of thromboxane B2 (TxB2, a stable metabolite of thromboxane A2) by the aggregating platelets in patients with endometrial (n = 35), ovarian (n = 30) and cervical cancer (n = 25), and in 32 control women. The selenium concentration in endometrial (1.14 +/- 0.04 mumol/l; mean +/- SE), ovarian (0.96 +/- 0.04 mumol/l) and cervical cancer (0.97 +/- 0.06 mumol/l) was significantly lower than in control subjects (1.26 +/- 0.03 mumol/l). The release of TxB2 into serum during spontaneous clotting of the blood was significantly increased in ovarian cancer (229.2 +/- 15.9 ng/ml), decreased in endometrial cancer (142.6 +/- 12.4 ng/ml) and normal in cervical cancer (185.9 +/- 14.8 ng/ml) as compared with control subjects (185.9 +/- 11.9 ng/ml). The levels of selenium and TxB2 did not correlate with each other in the whole series or in any subgroup. Thus, selenium does not seem to be an important determinant in the biosynthesis of TxB2 in patients with gynaecological malignancy.

[Blood fibronectin changes in various neoplasms]

In 85 patients presenting with various cancers, changes in the frequencies of plasma fibronectin and of the carcino-embryonic antigen (CEA) were compared and the results were correlated with the degree of extension. Forty-six percent of patients with mammary adenocarcinoma had plasma fibronectin values higher than the age-related limit range, but only 18% had an increase in CEA. In patients with secondary metastases, the highest values were significantly different from those found in controls. In these cases, fibronectin was present in abnormal concentrations in more than 80% of the patients, and CEA in 50%. Positive fibronectin values were less frequent in other cancers, except those of the genital tract. Neither fibronectin nor CEA are organ-specific, yet these two tumoral markers differ in the frequency with which they appear, notably in patients with mammary carcinoma.

Defective release of vascular plasminogen activator in patients with gynecologic malignancies

Vascular plasminogen activator release was measured in 176 women with gynecologic malignancies and 92 normal women. Releasable plasminogen activator was considerably decreased in the patients (P less than 0.00001 by Wilcoxon's rank sum test) with 59.1% releasing less than 0.04 Committee on Thrombolytic Agents units per milliliter of plasma after a standard venous occlusion procedure. The data were also stratified by tumor location, demonstrating that this decrease in releasable vascular plasminogen activator was seen for ovarian (P = 0.0001), endometrial (P = 0.0017), and cervical (P = 0.0063) cancers. Postoperative deep vein thrombosis, with or without pulmonary emboli, occurred in 28 patients (15.9% incidence). These patients also demonstrated markedly lower levels of releasable vascular plasminogen activator compared to control subjects (P less than 0.0001). It is suggested that defective release of vascular plasminogen activator contributes to a hypercoagulable state in patients with gynecologic malignancies and predisposes to postoperative thromboembolic complications.

Serum immunosuppressive substance in patients with gynecologic malignancies and in pregnant women

The presence of serum immunosuppressive substance (IS) was determined in 134 patients with malignant gynecologic tumors (105 cervical cancers, 15 endometrial cancers, and 14 ovarian cancers), 45 patients with benign gynecologic tumors (33 uterine myomas and 12 ovarian tumors), 10 patients with severe inflammatory diseases, 326 pregnant women, and 48 healthy controls. The mean levels and percentages of positive levels (greater than 750 micrograms/ml) in both the groups of cancer patients and the group of patients with severe inflammatory diseases were significantly higher than those in the groups of patients with benign tumors or the control group. In pregnant women, however, the majority of serum levels were within a normal range, showing relatively elevated levels in the first trimester. In the patients with malignancies (cervical, endometrial, and ovarian cancers), extremely elevated levels (greater than 1000 micrograms/ml) suggested an active or a progressive state of the malignancies. It became clear that serial IS determinations are valuable for monitoring the disease state or judging the effect of therapy.

[Production of monoclonal antibodies to ferritin and development of the enzymeimmunoassay system]

A sandwich enzymeimmunoassay (EIA) system for serum ferritin was developed by newly obtained monoclonal antibodies to human placental ferritin (HPF). And serum ferritin values in 3 groups (normal control, normal pregnant women and gynecological cancer patients groups) were measured. These values were compared with those measured by the conventional sandwich EIA system, in which human liver ferritin (HLF) and conventional polyclonal antibody to HLF were used as standard substance and horseradish peroxidase (HRPO) conjugated antibodies, respectively.

RESULTS

The high coefficient of correlation of ferritin values between the new monoclonal assay and conventional assay indicated that this monoclonal assay system was useful in measuring serum ferritin. The distribution of the ferritin value in the normal control was 84.5 +/- 26.6ng/ml. The peak ferritin value in 136 normal pregnant women was found around the early second trimester. The serum ferritin value in 184 women with cancer usually exceeded the upper limit or normal range and some of them were more than 1000ng/ml. These results indicate that ferritin was a useful marker for cancer. When the correlation curve of the cancer group was compared with that of the normal control, it appeared that the assay system using HPF as the standard substance might be useful in correcting the false negative which the conventional assay system using HLF for the standard failed to pick up in the measurement of acidic ferritin (HPF or cancer ferritin).

[Acute-phase markers in gynecologic tumors]

The serum concentration of 3 acute phase reactants (APR) (Caeruloplasmin, Alpha-1-antitrypsin and C-reactive protein) was measured by Mancini-technique praetherapeutically in a group of 214 patients with different sites of gynecological tumors. A group of 27 healthy women was used for comparison. In benign tumors Caeruloplasmin had in cases of myoma significantly (5%-standard) more elevated levels than normal group. In all cases with malignancies all 3 APR had significantly more elevated levels than in benign tumors. In cases of carcinoma of ovary all 3 APR had significant more elevated levels than benign ovarian tumors. The percentage of praetherapeutically elevated Alpha-1-antitrypsin levels was higher, while the percentage of elevated CRP-levels in cases with benign ovarian tumors ("false positive") was lower in comparison to accepted markers for ovarian cancer. Thus it appears to be indicated to prove the value of measurement of APR for monitoring in gynecological oncology.

Polyamine levels in gynecologic malignancies

Polyamines are closely related to many aspects of cell growth. Since increased amounts of polyamines in the urine of human cancer patients were reported in 1971, polyamines have been studied from the standpoint of tumor markers. In this study, polyamines in erythrocytes, plasma and urine were determined in 42 controls and 105 patients with gynecologic malignant tumors. The changes in polyamine levels were investigated before and after treatment. With advances in the stage of uterine cervical cancer, the frequency of abnormal levels of polyamines (concentrations greater than two standard deviations above the mean control level) became greater, and reached nearly 80% in recurrent and ovarian cancer. In the early stage of cancer, the diagnostic value was low. Comparison with carcinoembryonic antigen (CEA) was also performed. The polyamines lack specificity for malignant diseases, but they can be used to some extent as a tumor marker in the gynecologic field.

Immunosuppressive acidic protein in patients with gynecologic cancer

Immunosuppressive acidic protein (IAP) was determined in sera of patients with gynecologic tumors using the single radial immunodiffusion method. The normal limit of IAP of 490 micrograms/ml was derived from the mean value + 2 SD of IAP in 150 healthy females. Among 141 patients with gynecologic cancers, serum IAP was elevated in 87 patients (62%). Among 190 patients with benign tumors (98 uterine myoma, 92 benign ovarian tumors) serum IAP was elevated in 14 patients (7%). Elevated levels of IAP were recognized in 43% of 77 patients with cervical cancer, in 55% of 11 endometrial cancer patients, and in 91% of 53 ovarian cancer patients. The frequency of elevated levels showed a tendency to increase with advancing stage of disease. In ovarian cancer elevation of IAP was observed even in early stages. All of 13 patients with recurrent cervical cancer had elevated IAP while only 6 of 35 (17%) previously treated patients without evidence of recurrence had elevated IAP. Immunosuppressive acidic protein determinations may be useful in monitoring the recurrence of cervical cancer. The measurement of serum IAP as a marker for gynecologic cancer is recommended as an addition to diagnostic procedures.

Serum selenium and glutathione peroxidase, and plasma lipid peroxides in uterine, ovarian or vulvar cancer, and their responses to antioxidants in patients with ovarian cancer

The concentrations of serum selenium and plasma lipid peroxides, and the activity of serum glutathione peroxidase (GSH-Px) were measured before any therapy in patients suffering from uterine, ovarian or vulvar cancer, and in association with 1-day combination cytotoxic chemotherapy of ovarian cancer following 1-week supplementation with selenium (96 micrograms/day), vitamin E (300 mg/day), selenium and vitamin E, or placebo. Patients with gynaecological cancer (N = 44) had lower serum concentration of selenium (1.15 +/- 0.04 S.E. mumol/l; P less than 0.05) and serum activity of GSH-Px (404 +/- 13 units/l, P less than 0.01) than the control subjects (N = 56; 1.25 +/- 0.03 mumol/l and 444 +/- 8 units/l, respectively). In association with cytotoxic chemotherapy selenium alone (P less than 0.05), vitamin E alone (P less than 0.05) and both of them together (P less than 0.001) decreased the plasma concentration of lipid peroxides, and the combination of selenium and vitamin E also increased the activity of serum GSH-Px (P less than 0.01). During placebo, cytotoxic chemotherapy did not affect plasma lipid peroxides but it decreased (P less than 0.001) the activity of GSH-Px. Selenium inhibited this effect. Our data suggest that antioxidative mechanisms of patients with gynaecological cancer may be defective and that treatment with selenium and vitamin E results in changes of biochemical factors related to lipid peroxidation.

Vascular plasminogen activator levels and thromboembolic disease in patients with gynecologic malignancies

Vascular plasminogen activator levels were measured preoperatively in 66 women with gynecologic malignancies. These levels were compared to levels in a matched control group of 84 women and to the incidence of postoperative venous thromboembolic disease in the patient group. Significantly lower levels of plasminogen activator were measured in patients who developed thrombotic complications (p = 0.0014). When results were stratified according to tumor location, patients with ovarian carcinoma had significantly higher activator levels than those found in control subjects (p = 0.0072), and significantly lower levels were associated with endometrial malignancy (p = 0.0140). Measurement of releasable plasminogen activator before operation may be an effective, noninvasive means of identifying patients potentially at risk for venous thromboembolic disease. Postoperative measurement of plasminogen activator may eventually find a role in monitoring tumor therapy and recurrence.

Placental-type alkaline phosphatase in ovarian cancer fluids and tissues

Placental-type alkaline phosphatase was measured in sera, cyst, and ascites fluids, and from tumor extracts obtained from gynecologic cancer patients, particularly those with cancer of the ovary. A modified assay was used that depended on long incubation (20 to 24 hours) to measure the heat-stable, phenylalanine-sensitive placental isoenzyme. The concentration of enzyme in ascites and cyst fluids was markedly higher than in serum. Cyst fluid values were generally higher than ascites fluids from the same individual. The median enzyme levels for malignant cyst fluids were 50 times greater than for benign cyst fluids. When tumor tissue and fluids were available from the same patients, it was observed that the levels in each were proportional. Determination of this isoenzyme in serum did not give a useful index of tumor burden, as metastatic disease did not consistently result in elevated serum enzyme levels. When ovarian cancer patients were divided into two groups--those in whose sera placental-type phosphatase was elevated, and those in whom it was not--the presence of the enzyme in serum at the time of tumor diagnosis appeared to be a negative prognostic indicator, judged from survival data.

[Transient form of serum albumin in gynecologic cancer]

The frequency of diagnostic errors in examination of 3827 patients with gynecological cancer diseases accounted for 21.6 up to 35%. The conformation of serum albumin in these patients was studied by means of different biochemical assays. The determination of the amount of the transitory form of albumin by reprecipitation with trichloroacetic acid appeared the most valuable for practical uses. Structural injuries to albumin depended on the localization, pattern and stage of the disease, and features of tumor metastatic spreading. The amount of the transitory form in patients with benign tumors and tumor-like processes in the ovaries (4.5-23.5%), hydatidiform mole (25%), uterine myoma (2-12.6%) rose insignificantly (5 +/- 2% in control) and increased in patients with initial stages of malignant tumors of the ovaries and uterus (28.9-43.7%). In uterine cervix carcinoma and uterine body sarcoma (stage II and higher stages) as well as in ovarian carcinoma, stages III and IV, its amount reached 57-100%.

Gynecological malignancies and disseminated intravascular coagulation

The importance of DIC in the management of gynecological malignancy, especially in advanced cases, was stressed on the basis of our experience with 8 cases. The overall incidence of DIC in our series of 366 cases of gynecological malignancies was 2.2%. However, DIC was experienced only in cases of advanced later stages and the recurrence of malignancy, and the incidence of DIC in these two groups were 2.2% and 7.2% respectively. In our 8 cases, DIC seemed to be provoked or worsened by antitumoric chemotherapy, major surgery, radiation therapy, infection, cerebral infarction and massive packed red cell transfusion. At the same time, an exceptional case of fulminating DIC which had probably been provoked by packed red cell transfusion in a patient with advanced but not detected endometrial cancer which developed in a endometriotic uterus was presented.

Nutritional evaluation of gynecologic cancer patients during initial diagnosis of their disease

Ninety-seven gynecologic cancer patients received a thorough nutritional assessment during the initial evaluation of their disease. Patients with Stages III and IV ovarian cancer were shown to have severe protein-calorie malnutrition (p less than 0.01) unrelated to any gastrointestinal obstruction or laparotomies. Patients with other types of gynecologic cancers at all stages demonstrated nearly normal nutritional assessment parameters, with the exception of recent weight loss. Nutritional assessment and active nutritional intervention therapy are suggested especially for patients with advanced ovarian cancer.

[Large granular lymphocytes (LGL) in the peripheral blood of patients with gynecological malignancies]

Large granular lymphocytes (LGL) containing almost all natural killer (NK) and killer (K) cells were studied in the peripheral blood of patients with gynecological malignancies. The results obtained were as follows: The ratio of LGL/peripheral blood lymphocytes (PBL) in normal volunteers was almost the same as that in patients with benign gynecological tumors, showing a tendency to increase, though not significantly, with age. The ratio of patients with precancerous disease or preinvasive cancer, including severe dysplasia, CIS and endometrial atypical hyperplasia, decreased more slightly than that of controls. On the other hand, that of patients with invasive malignant tumors, including uterine cervical cancer, endometrial cancer, uterine sarcoma, ovarian cancer and vulval cancer, increased significantly more than that of controls. The ratio showed no significant variation due to the difference in tumor sites and clinical stages Ia to III of cervical cancer. Out of 8 patients with ovarian cancer, 6 showed an extraordinarily high LGL/PBL ratio. It is concluded from the present study that the increase in the LGL/PBL ratio may be used as a new criterion in diagnosing invasive malignancies, including ovarian cancer, although the significance of the changing ratio still remains to be clarified.

[Plasmafibronectin in case of tumors of the female genital system]

The plasma concentration of fibronectin was measured by method of single radial immunodiffusion pretherapeutically in a group of 72 patients with different sites and various stages of gynecological carcinomas and of 27 women with benign cysts of ovary. A group of 18 healthy women was used for comparison. Fibronectin in plasma was significantly decreased in patients with ovarian tumors while in patients with other tumor localizations no significant difference to control group was evaluable.

Serum levels of placental protein 10 (PP10) in women with breast cancer and genital carcinoma and in healthy male and female subjects

PP10, a recently characterized glycoprotein from human placenta, was studied using a specific double-antibody radioimmunoassay in the serum of about 100 volunteers and 200 cancer patients. Elevated levels (greater than 20 nU/ml) were found in 87% of patients with primary breast cancer, in 100% of those with primary genital tumours and in 78% of patients with recurrent disease. PP10 was also measured in tumour extracts and in some patients with benign tumours. The serum concentration decreased within a few weeks after removal of the tumour. There were no significant correlations of the PP10 level with age, tumour size, histological grading or lymph node involvement. Sequential determinations of PP10 during cytostatic therapy sometimes showed rising levels accompany the development of metastases. PP10 can be regarded as a tumour associated protein and a tumour marker in gynaecological practice.

Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites

Serum-ascites albumin concentration gradient, a parameter of oncotic pressure gradient reflecting presence or absence of portal hypertension, was compared with the usual parameters of ascitic fluid analysis in the differential diagnosis of ascites. Twenty-nine patients with liver disease and 15 patients with malignant neoplasm were prospectively studied. The group with malignant neoplasm showed higher ascitic fluid total protein level (3.70 +/- 1.28 vs. 1.66 +/- 1.20 g/dl), ascites to serum ratio of total protein level (0.58 +/- 0.14 vs. 0.26 +/- 0.14), ascitic fluid lactic dehydrogenase level (756 +/- 693 vs. 151 +/- 125 U/L), ascites to serum ratio of lactic dehydrogenase level (1.13 +/- 0.79 vs. 0.35 +/- 0.22), and lower serum-ascites albumin gradient (0.72 +/- 0.30 vs. 1.85 +/- 0.45) (p less than 0.001 for all parameters). Results of the serum-ascites albumin gradient overlapped the least between the two groups: all but 1 patient with malignant ascites while only 1 patient with liver disease had a gradient lower than 1.1. We conclude that the serum-ascites albumin gradient offers the best diagnostic discrimination between ascites caused by liver disease and ascites caused by a neoplasm.

[Variations in the level of immunosuppressive acidic protein in patients with gynecologic tumors and pregnant women]

Immunosuppressive acidic protein (IAP) was determined in sera of patients with gynecologic tumors and pregnant women using the single radial immunodiffusion method. The normal limit of IAP of 490 micrograms/ml was derived from the mean value +2S.D. of IAP in 150 healthy females. Among 141 patients with gynecologic cancers, serum IAP was elevated in 87 patients (62%). Among 190 patients with benign tumors (98 uterine myoma, 92 benign ovarian tumors) serum IAP was elevated in 14 patients (7%). The level of IAP in sera of 201 pregnant women was almost identical with that of the healthy females. Elevated levels of IAP were recognized in 43% of 77 patients with cervical cancer, in 55% of 11 endometrial cancer patients and in 91% of 53 ovarian cancer patients. IAP determination was most effective in ovarian cancer for the early detection of cancer. IAP determinations may provide a useful method for the detection of recurrence of cervical cancer.

Free testosterone levels during danazol therapy

Danazol is a testosterone (T) derivative widely used in the clinical treatment of endometriosis. Its mechanism of action is poorly understood, but is side effects are mainly androgenic. Previously it was demonstrated that danazol can displace T from sex-hormone-binding globulin (SHBG). The binding properties of danazol to SHBG and albumin were studied with the use of labeled danazol in an aqueous two-phase equilibrium partition system. Levels of total T, SHBG, and albumin were measured in 16 women undergoing danazol treatment for endometriosis. Thereafter, free and protein-bound T levels were calculated. A marked rise in free T was found during danazol therapy as compared with pretreatment levels. The data suggest that many of the effects of danazol could be explained by increased levels of free T during treatment.

[Gynecological cancer and ferritin--a study on the carcinofetoplacental ferritin]

Serum and tissue ferritins were quantitated by a radioimmunoassay kit (SPAC KIT, Daiichi Radioisotope Lab.) and a diagnostic implication of serum ferritins in patients with gynecological diseases was evaluated. In order to investigate the potential use of tumor marker as a feto-placental antigen (protein), ferritin from ovarian cancer was compared with ferritins from normal adult and feto-placental organs. Serum ferritin levels were significantly higher (p less than 0.01) in patients with ovarian adenocarcinoma, Krukenberg's tumor, cervical squamous cell carcinoma and other malignant diseases than in normal women. Among adult organs the kidney and spleen showed the highest and the heart the lowest ferritin content. The ferritin contents of the kidney and spleen were 78.4 micrograms and 76.2 micrograms/g wet weight, respectively and that of the heart was 5.7 micrograms/g wet weight. The ferritin contents of other adult organs ranged from 10 to 25 micrograms/g wet weight. On the other hand the placenta showed the highest and the heart and stomach the lowest ferritin content among feto-placental organs. The ferritin content of the placenta was 7 micrograms/g wet weight. The ferritin contents of other fetal organs were only half as in the placenta. The ferritin contents of ovarian cancers ranged 6 to 8 micrograms/g wet weight and was almost identical to that of the placenta.

The diagnostic value of serum copper/zinc ratio in gynecological tumors

Serum copper levels (SCu) and serum zinc levels (SZn) were determined on admission in 73 women hospitalized for suspected gynecological tumor. Twenty-five of the women were subsequently found to have malignant tumor, while 48 had benign growths. The serum Cu/Zn ratio of the malignant group (2.13 +/- 0.53) was significantly (p less than 0.001) higher than that of the benign group (1.45 +/- 0.25). A good correlation was established between the Cu/Zn ratio and the stage of the malignant tumor. Serum copper level showed a linear correlation (R = 0.878) with serum ceruloplasmin values. These results indicate that the serum Cu/Zn ratio may be used as a valuable predictor of the presence of malignant gynecological tumor and its stage.

[Effect of gynecologic cancer sera on functions of monocyte from healthy volunteers]

The investigation was designed to analyse effect of cancer sera on monocyte functions. Sera were sampled from 42 gynecologic cancer patients. Monocytes were collected from healthy volunteers. After pre-incubation in media containing cancer sera or control sera, enzyme (beta-galactosidase) activity, chemotaxis, phagocytosis and helper function on T-cell mitogen response of monocytes were assayed. The results were as follows; 1) Beta-galactosidase activity of monocytes pre-incubated in cancer sera was not different from that in control sera. 2) Chemotaxis, phagocytosis and helper function on T-cell blastoid response of monocytes pre-incubated in cancer sera were significantly reduced compared with that in control sera. In uterine cervical cancer, the inhibitory effect of sera increased in parallel with its clinical stage. Thus, it was demonstrated that sera of gynecologic cancer patients have inhibitory effect on monocyte functions, and it was suggested that cancer sera play an immuno-suppressive role through inhibition of monocyte functions in cancer bearing state.

Hypercalcemia associated with gynecologic malignancies: biochemical characterization

Fasting calcium excretion, renal phosphorus threshold, plasma 1,25 dihydroxyvitamin D, immunoreactive PTH, nephrogenous cyclic AMP excretion, and tumor burden were assessed in nine patients with gynecologic neoplasms and hypercalcemia. Gynecologic neoplasms were responsible for hypercalcemia in seven of 34 (20.5%) consecutive patients with malignancy-associated hypercalcemia. The tumor burden in each patient was large. Three of four endometrial carcinomas contained squamous elements. All patients displayed biochemical evidence of nonparathyroid humorally mediated hypercalcemia (bone resorption). Treatment of hypercalcemia did not appear to diminish production of the humoral calcemic factor but eradication of tumor eliminated biochemical evidence of the humoral syndrome. It can be concluded that (1) gynecologic neoplasms are a frequent cause of malignancy-associated hypercalcemia, (2) humoral mechanisms appeared to be responsible for the hypercalcemia in 100% of the patients in this series, (3) squamous features occur with unexpected frequency in hypercalcemic endometrial carcinoma, (4) the presence of hypercalcemia connotes a large tumor burden, and (5) treatment directed at the neoplasm (but not treatment directed at hypercalcemia) may eliminate evidence of ectopic calcemic hormone production.

The detection and measurement of oncodevelopmental proteins in gynecological malignant disease

Data from the literature and our own measurements with alpha-fetoprotein (AFP), carcinoembryonal antigen (CEA), alpha 2-pregnancy-associated globulin (alpha 2-PAG), human chorionic gonadotropin (HCG), human placental lactogen (HPL) and pregnancy-specific beta 1-glycoprotein (SP-1) are related to clinical data. Only AFP in endodermal tumors and HCG in germ cell carcinomas can be used for clinical monitoring.

Effect of immunomodulating factors present in ascitic fluids and sera from cancer patients on the responses of cultured mononuclear cells from normal subjects

Ascitic fluids and sera from patients with malignant tumors were tested for their ability to modulate the mitogen-induced blastogenic responses of normal subjects' peripheral blood mononuclear cells in vitro. The addition of either ascitic fluid or serum to cultures of normal blood cells greatly enhanced the blastogenic response of cells to phytohemagglutinin P, and markedly depressed the responses to concanavalin A and succinyl-concanavalin A. The blastogenic response of the cells to pokeweed mitogen was unaffected by the addition of serum and depressed by the addition of ascitic fluid. Autologous normal serum also enhanced the response to phytohemagglutinin P but had no effect on the response to the other mitogens. These activities were concentration-dependent and heat-stable (56 degrees C, 60 min) and could be detected even if the ascitic fluid or serum was added as late as the second day of culture. Cells that had been preincubated with serum or ascitic fluid and washed well before culturing with the mitogens responded in the same manner as cells cultured in the presence of serum or ascitic fluid. The mitogen-induced blastogenic responses of mononuclear cells were not affected by the addition of autologous cells that had been preincubated with either serum or ascitic fluid, washed, and treated with mitomycin C. Indomethacin (2 X 10(-7)M) did not prevent the ascitic fluid-mediated depression of blastogenic responses of normal cells. The ascitic fluid and serum of these cancer patients appeared to contain a specific immunoinhibiting substance which exerted its effects by a direct action on the responding mononuclear cells and not by the induction of suppressor cells.