Treatment of circulating neoplastic cells

The differentiation of tissues and organs during ontogeny increases the necessity of integration of the different structures. These developmental processes of integrations by body fluids, immunologic, endocrine and nervous systems culminate in mammals, since they possess the most diversified system of body fluids. Typical of the most developed mammals are the bone marrow, the lymphatic system with regional lymph nodes and consequently the pathologic development of the diversity of leukemias, malignancies without stroma. In the German literature the leukemias are considered systemic diseases because the floating cells they discharge are more or less uniformly pathologically underdeveloped. The leukemias are named according to the major abnormal cell type (e.g. monocytic acute leukemia). Acute and chronic is the distinction of the time limitation regarding the development and duration of the disease. More complicated is the discharge of motile cells from primary tumors or daughter tumors deriving from solid tumors. These motile cells enter into the circulation via the lymphatic spaces or by penetration of the endothelium of the blood vessels. They move freely in the circulatory system until settling in a more or less distant region. The process of detecting these cells is known as carcinocythemia. Other movable cells during neoplastic progression are those populating effusions in the coelomic cavities. Non-movable, that is only growing in succession like a tissue chain are those tumors which distribute by direct tumor spread within the veins, keeping the connection with the primary tumor. This condition is especially well-known in renal cell carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Bio-immunotherapy for cancer in experimental studies and clinical application: current status and future challenges

Although successful treatment of patients with primary tumor by conventional surgery and radiotherapy is often possible, death frequently results from tumor metastases. Since metastasis has already occurred in many cancer patients at the time of diagnosis, a major emphasis of cancer treatment is and will continue to be the prevention or successful management of tumor metastases. Systemic chemotherapy has been widely used in the past in the hope of preventing or controlling micrometastases. The results of this treatment have been disappointing with little impact on survival in the vast majority of solid tumors. Bio-immunotherapy has emerged as another modality and is finding acceptance and use in treating patients with cancer. The role of bio-immunotherapy in traditional surgery, radiotherapy, chemotherapy and hyperthermia will be discussed. In order to evaluate new and innovative treatments, we and others have used murine models of erythroleukemia and solid tumors with metastatic potential to assess the effects in vivo of bio-immunotherapy. Tumor metastases can be dampened and immunosuppression restored by bio-immunotherapy, especially when used in combination with other forms of treatment. Most of the combination treatments used in animal models are encouraging but are by no means totally adequate or curative yet. The molecular basis of cancer is now understood to involve activation of dominant oncogenes and inactivation of tumor suppressor genes. These genetic events may represent novel targets for cancer treatment. The potential use and ethical implications of gene transfer to alter the behavior of somatic cells in patients with cancer has been noted. Also reported is genetic immunomodulation by introducting genes for cytokines into tumor cells or lymphocytes to stimulate a cytotoxic immune response against the tumor. As with bone marrow, human cord blood can be used for transplantation in the autologous, related allogeneic and unrelated allogeneic settings, and as a target cell for gene treatment. It is believed that the greatest therapeutic results of bio-immunotherapy, including biological response modifiers, cytokines, gene treatment and bone marrow transplantation, will come in combination with other established effective modalities including surgery, radiation treatment, chemotherapy and hyperthermia in the treatment of patients with cancer.

Cancer related syndromes from a comparative viewpoint

Neoplasms are the most prominent portion of the neoplastic disease process. The cancer patient is affected by hormonal, metabolic, immunologic and paraneoplastic discrepancies. Paraneoplastic syndromes consist a large group of body abnormalities which appear in a specific manner. Why special components of such abnormalities occur together is nearly always unknown. This article gives a tabulation of the paraneoplastic and other neoplasia-related syndromes providing certain key characteristics in each case.

Hodgkin's disease: treatment and secondary neoplasms

Hodgkin's disease is a lymphoma which occurs in man in the lymph nodes or in extra-lymphatic tissue. The disease was first described in 1832 by Thomas Hodgkin, a British physician. The disease develops with different patterns of histology in several types which a varying degree of malignancy: stages of the disease processes may be encountered. Lymph nodes appear phylogenetically first in the mesentery of crocodiles and reach the top of their development in the mammal. Here they are important during the neoplastic development as regional stations thereof. The treatment, depending on the cellular make-up of the type, may vary from advantageous to very toxic. Successful treatment in several cases on the one hand, in contrast to high therapeutic toxicity, and the development of secondary neoplasms on the other, are outlined.

Recombinant human interleukin-1 alpha: a potent bio-immunomodifier in vivo in immunosuppressed mice induced by cyclophosphamide, retroviral infection and surgical stress

Recombinant human Interleukin-1 Alpha (rhu IL-1 alpha) was assessed for its efficacy in modifying the immunosuppression of mice compromised by Cyclophosphamide (CY), retrovirus infection or surgical stress. Sublethal dose (300 mg/kg) of CY caused neutropenia, decreased cellularity of bone marrow and inhibited Natural Killer (NK) cell activity and lymphokine-activated killer (LAK) cell activity in DBA/2 mice. A single dose of rhu IL-1 alpha (1000 units/per mouse) i.p. accelerated recovery of blood neutrophils and bone marrow cellularity and restored NK and LAK cell activity in CY-treated mice. Mice infected with Friend Virus Complex (FVC) had decreased percentages of L3T4+ cells and a reversed L3T4+/Lyt-2+ ratio; NK and LAK cell activity also decreased. These impaired cellular parameters were restored by rhu IL-1 alpha treatment (1000 units/per mouse/daily i.p. starting on day 5 for 5 days). NK and LAK cell activity was impaired by surgical stress. A single dose of rhu IL-1 alpha (1000 units/per mouse) i.p. 20 hours before transfemoral amputation restored NK and LAK cell activity to normal levels in these mice. These studies indicate that rhu IL-1 alpha possesses immunomodulatory effects in vivo for a broad range of stresses.

Comparison of direct spreading and local recurrence of neoplasms

Neoplastic progression proceeds most commonly with metastatic spreading but also with direct spreading and some minor forms of neoplastic distribution. The difference between metastatic spreading and direct tumor spreading is shown by the fact that metastatic cells are motile and separate from the primary tumor, whereas in direct spreading the progressing cells are less motile and connected with the primary tumor. This latter type of spreading is especially common in kidney cancers. In the case of local recurrence where portions of the primary tumor have been spared from destruction, regrowth of these portions may occur after different intervals. It is a precondition that the neoplastic metabolism has gained power again. Local recurrence is an offspring of growth from the primary tumor or from a not fully removed metastasis and should be considered as a growth comparable to direct spreading. It may switch during further progression to metastatic progression.

Biological viewpoints of neoplastic regression

Progression during the growth processes, normal and pathologic, serves the production of new structures. On the contrary, regression serves the destruction of structures in the normal and pathologic organism. In the case of catastrophic development (as in homometabolic insects), the regressive processes, known there as autolysis or histolysis respectively, open the way for structural replacement followed by replacement of the removed structures by new ones. This process may be called normal indirect regression, whereas the regression of malignant neoplasms is better termed direct regression because it is not followed by a replacement. Oncologic interest is concerned mainly with the development of neoplastic growth, whereas the spontaneous regression has been rather neglected, even though its understanding may offer therapeutic possibilities in human and veterinary medicine. This paper offers some new thoughts based on recent cases of neoplastic regression.

Comparative aspects of neoplastic invasion of the brain

This review of the invasion of the human brain by tumors is based upon a comparative approach. The taxonomic distribution of a structure of the CNS to be considered a brain is present in the following taxonomic groups: Mollusca (Cephalopoda, Pulmonata) Sipunculida, Echiurida, Annelida, Arthropoda and Vertebrata (fishes, amphibians, reptiles, birds and mammals). The comparative approach (inter-, and intraspecies specific) provides a more informative, indicative, understanding of invasion of the human brain; especially in view of the morphological and functional heterogeneity of structures playing a role in the neoplastic invasion to and from the brain. It can be distinguished among primary invasiveness (as cancer in situ) and local recurrence on the one hand and remote spreading, such as metastasis, on the other. A review of the recent literature arranged according to tumor types is provided and comparative conclusions elucidated, especially to underline the tumor specificity of the invasion of brain tumors, especially the second or intra-species specific approach is therapeutically important. This is set forth against a background of epidemiology and species specificity. Due to the lack of bony skull capsule an extensive knowledge of the brain of cephalopod molluscs with its functional and morphological similarity to the human eye, and also that of the pulmonate Helix pomatia, the vineyard snail, could well serve as excellent oncologic models. Some conclusions can be drawn dealing with the theoretical possibility of first appearance of the different and heterogeneous components of the complicated structure known as brain including its supporting accessory organs during phylogeny.

Abnormal growth processes in plants and animals: a comparison

Tumorigenesis in eukaryotic organisms is based on the deregulation of normal cell growth and development. This deregulation may be elicited by external as well as endogenous factors. We distinguish between benign and malignant growths depending on the inducing tumorigenic agents and on the genetic make-up of the affected organism. This review discusses similarities of neoplasmatic (epigenetic) and neoplastic transformations in plants and animals as well as inherent differences in the growth parameters between the two kingdoms. Examples given for neoplasmatic tissues are the hyperplasias and insect galls (zoocecidia) in plants and hypoplasia, aplasia and agenesis in animals (and man). Neoplastic transformation in plants is the result of either the incorporation of foreign nuclear material into the plant genome or an imbalance of inherited chromosomes (in hybrids). Examples for neoplasias are the crown gall disease and Kostoff's genetic tumors in plants, and the carcinomas and leukemias in animals. The more than 80 year old, but neglected, concept of a correlation between tumorigenesis in animals and plants has been revived through advances in molecular and cell biology and molecular genetics which will stimulate a new form of biological reasoning and thought, fueled by new insights into cellular regulatory processes.

Therapeutic possibilities and opportunities for comparative oncopathology

In reviewing abnormal growth, we may distinguish autonomous and nonautonomous growth processes. The highest diversification is reached in the autonomous non-self-limiting processes, the malignant neoplasms which, if not treated, are characterized by extensive growth and progression. In their development these processes exhibit autonomy on one hand and heterogeneity on the other. Neoplastic and related diseases are extremely complex. It is unacceptable to view them exclusively as genetic or metabolic diseases, or merely as the tumor itself, including its progressive stages, as evidenced in neoplastic metastasis. All these characteristics appear in the different types of neoplastic malignomas, e.g. genetic variations in the neoplastic cells from the normal cells of the parent tissue(s). Included here are tumor progression and cloning of the neoplastic cells, stagewise development of host metabolism and of tumor metabolism; neoplastic hereditary and endocrine-like syndromes as well as paraneoplastic syndromes and cachexia. Neoplastic progression, as observed in the metastatic cascade, derives from the cells of the primary tumor. In contrast, multiple primary tumors originate from different host tissues, whereas the syndromes themselves constitute a symptom complex developing in a neoplasm-bearing host and cannot be assigned to local or distant spread of neoplasms. The only possible explanation for these apparently contrasting processes lies in the interaction of tumor and host metabolism, which seemingly varies in tumor-bearing hosts and in those cases where the tumor has been surgical removed. Antigens and other compounds again show an increase with the usually ensuing secondary tumor spread, a course which provides the basis for most deaths from cancer.

The role of dendritic cells in the motility of melanoma cells in initial lymphatic metastasis

Malignant melanoma is well known for its aggressive metastatic behavior, following upon the earliest initial stages. It is the purpose of this preliminary paper to add some new ideas, based on electron microscopy, to our understanding of the complex progression of malignant melanoma, using cutaneous melanoma as a model for the subtypes. Special attention is paid to cellular interaction in the progression of melanoma, with emphasis on the subtypes.

Electron microscopic investigations of progressive early metastasis of cutaneous melanoma

Primary metastasis of cutaneous malignant melanoma seems to occur especially via the initial lymphatics (IL). In samples of 50 melanomas examined by TEM melanoma cells (MCs), invading IL were demonstrated in 24 specimens. MCs were scarcely found in the immediate vicinity of blood vessels. After the MC has escaped from the MC-complex, connective tissue fibers and cells represent physiological guide-ways that lead the MC to the IL. Located close to the IL, the MC develops pseudopodium-like cytoplasmic processes that penetrate the abluminal fibrous network, fuse partially with the endothelium and destroy it. It seems to be important that the melanomas invade IL as single cells and not in form of cell clusters.

Comparison of arteriosclerosis, neoplasms and diabetes as the three main killers of man in the industrialized world

Arteriosclerosis, neoplasms and diabetes are the three main killers in the industrialized world, complemented by infectious and parasitic diseases in the less developed countries. Neoplasms, the second most frequent killer in the industrialized world, exhibit the highest diversity of pathologic structures involved. Arteriosclerosis, the first killer in the industrialized world, is more complex, dealing with aberrations of the arterial wall. In contrast to neoplasms, cases are restricted to a closed circulatory system as noted in the various phyla. Neoplasms are also known from the kingdom of plants and fungi, whereas arteriosclerosis is restricted to specific animal phyla, at least theoretically. Even more restricted is the distribution of diabetes which is known only in certain vertebrates. All three disease groups have a substantial impact on man's health.

Some characteristics of the mesenchymal stem cell of soft tissue tumors

"Soft tissue tumors" is an unnatural term, used by clinicians and for convenience by pathologists, which unites the neoplasms of mesenchymal origin as opposed to those of the soft epithelial tissues. Not included are the reticuloendothelial system, glia and supporting tissues. The mesenchymal stem cell, the cell of the embryonal connective tissue, exhibits in man and mammals the most pronounced embryonal potential. A restricted comparison to the embryonal potential in larval and pupal cells of invertebrates, such as in hemi- or holometabolic insects and to meristematic cells in vascular plants is justified. The great embryonal potential may explain why the mesenchymal stem cell, at present a hypothetical unit, is able to transform and differentiate into the connective tissue as such, the muscular, supporting and hematogenic tissues. The musculature comprises the bulk of the mammal's body weight. The development of the normal ontogenetic specialization as well as especially those differentiations leading to soft tissue tumors are comparatively shown in this publication and placed in the framework of vertebrate and invertebrate animals with true tissues.

Comparative aspects of the quality of life in cancer patients

Chronologically, neoplastic diseases can be divided into two categories of which the first includes the fast and aggressive disease groups which exhibit a short course after the diagnosis has been established and the second those with dormancy or a slow path of which the development extends over years, even decades. The developed treatment modalities have even expanded the time duration of both groups, and thus cancer has become a group of chronic diseases in many cases. This requires a special adaptation in regard to the life style and quality of the cancer patient. The assessment of the quality of life in the cancer patient has been evaluated through questionnaire to relatives and friends as well as through social experience with cancer patients. The diversity of the disease group is reflected in the need for a more heterogeneous improvement of life style and its quality according to the need of the patient groups. A distinction can be made between acute and chronically ill pediatric patients, the cancer patient who is able to continue his work, the outpatient not requiring hospitalization, the patient with the need for hospital care (for a shorter or longer Period), the hospice patient, the elderly patient, and the terminally ill patient as well as the patient in the last days of life. In a study of 1,227 elderly decedents in Fairfield County, Connecticut, for which 260 respondents reported cancer as the cause of death, approximately 1/5 were reported to have been in moderate or severe pain six hours before death, with little change from the previous month.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the course of cancer

Many neoplasms cannot be cured but the life span of the patient afflicted with such diseases has in a remarkable number of cases been prolonged. The course of neoplastic diseases has been changed, improving life-style and survival on the one hand, but resulting in new side effects including multiple primary neoplasms on the other. In contrast to neoplastic diseases with aggressive acute development, we can observe an increasing number of neoplastic diseases with a chronic, prolonged that progress. To understand this it is necessary to remember that neoplastic diseases are heterogenic in nature, and also diseases of autonomic growth comprising modification of the host along with progression of the tumor.

The possible role of the initial lymph vessels of the skin during metastasis of malignant tumors

The metastasizing potential of a malignant tumor is derived primarily from its biological characteristics. The second most important factor in metastatic spreading lies in the host tissue/organ and host metabolism. The aggressiveness of a malignant skin melanoma depends clinically upon the width and, especially, the depth of the preceding lesions(s). Histological and electron microscopic studies reveal that the increase of malignant aggressiveness is directly related to the arrangement of the initial lymphatic vessels in the different layers of the skin. Sudden increase in the density of lymphatic vessels permits a corresponding increment of malignant seeding via the lymphatic system.

Cancer growth and progression in the framework of comparative oncology. A new approach to cancer therapy

The influence of comparative oncology is most timely in view of the fact that there are significant intra- and interspecies differences in tumor development, tumor behavior and tumor reaction to various types of treatment, chemotherapy, radiotherapy, immunotherapy and multimodality-therapy. A comparison of the diverse processes which occur under normal, physiological, neoplastic and therapeutic conditions will result in a clearer understanding of tumor growth and progression. Similarly, it can be applied for selection of suitable treatment by enriching our knowledge about the progression of neoplastic diseases. Such a course will also enhance a general acceptance of the value of comparative oncology.

The respiratory epithelium. III. Histogenesis of epidermoid metaplasia and carcinoma in situ in the human

The histogenesis of epidermoid metaplasia and carcinoma in situ was analyzed in human bronchial epithelium. The conclusion is that epidermoid metaplasia and carcinoma in situ can result from conversion of mucous cells. This implies the direct transformation of one type of fully differentiated cell to another. The study therefore emphasizes the differentiation potentialities of the mucous cells that can divide and undergo goblet cell hyperplasia and epidermoid metaplasia. Epidermoid metaplasia is a common reaction to injury in the bronchus. In our series of cases it was especially frequent in patients without neoplastic disease who had undergone intratracheal intubation or tracheostomy and who had been maintained on a respirator in the Shock Trauma Unit, University of Maryland. Future studies will be required to distinguish the difference, if any, between epidermoid metaplasia destined to become malignant carcinoma and that which is not. One difference noted in this study was the absence of overt cornification in epidermoid metaplasia in patients without neoplastic disease.

The carcinogenic activity of ordinary tea

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