Biochemical markers in bronchogenic carcinoma

Small cell lung carcinoma: clinicopathological, immunohistochemical, and ultrastructural study

Sixty-seven cases of small cell lung carcinoma (SCLA) in Tri-Service General Hospital (TSGH) during the past 16 years were studied. For patients with extensive stage of disease, the mean survival time and 2-year survival rate were 7.2 months and 3.1% versus 13.4 months and 16.7% for patients with limited stage. A better prognosis was obtained by treatment with a combination of intensive chemotherapy and radiotherapy. Immunohistochemical studies were performed by the peroxidase-antiperoxidase method. The positive rates in descending order were bombesin (80%), synaptophysin (74.3%), neurofilament (68.6%), neuron-specific enolase (60%), low molecular weight cytokeratin (54.3%), high molecular weight cytokeratin (25.7%), chromogranin-A (22.9%), adrenocorticotrophic hormone (0). Seven cases were examined and found to be ultrastructure; only 3 cases were found to contain neurosecretory granules. We emphasize that electron microscopy is not necessary as a routine diagnostic procedure, while light microscopy should be employed whenever possible; the immunohistochemical study should be considered within this context.

Implications of hypercalcemia with respect to diagnosis and treatment of lung cancer

This study had two objectives. The first was to determine if hypercalcemia presents as an isolated finding in patients with lung cancer prior to the development of abnormalities on chest radiography. The second was to correlate the presence of hypercalcemia with survival after surgical therapy. A review of clinical material over a seven-year period yielded 67 patients with diagnoses of hypercalcemia and lung cancer. No patient presented with surgically curable lung cancer associated with hypercalcemia. A review of the literature disclosed only four cases in which a putative cure occurred in the presence of hypercalcemia. Review of the clinical material and the literature revealed no instance in which hypercalcemia per se led to the diagnosis of clinically occult lung cancer. Hypercalcemia was almost always associated with large tumor masses. Median survival after the discovery of hypercalcemia complicating carcinoma of the lung was one month.

Tumor markers and neurological signs in asbestosis patients

Ninety asbestosis patients were examined clinically with special emphasis on the function of the peripheral and the central nervous system. Serum specimens were analyzed for carcinoembryonic antigen(s) (CEA), ferritin, and beta 2-microglobulin (beta 2m) content. The patients were classified into four subgroups: (1) those with peripheral neuropathy, (2) those with involvement of central nervous system, (3) those with both types of neurological signs, and (4) those with normal neurological status. The levels of serum CEA, ferritin, and beta 2m were elevated in all four subgroups. No statistically significant differences were found between the groups in the prevalence of elevated values of the three tumor markers (equal or above the following limits: CEA, 5 micrograms/liter; ferritin, 400 micrograms/liter, and beta 2m, 3 mg/liter). The patients currently smoking had a higher level of serum CEA than nonsmokers or exsmokers, but the differences were not statistically significant. In the subgroup that comprised those asbestosis patients in whom the disease could be considered progressive according to the ILO 1980 classification of the chest radiographs, the mean level of CEA in serum was higher than that of the patient group without such progression of the disease (p less than 0.05, Student's t test). Although the prevalence of abnormal neurological signs was high in these asbestosis patients, no obvious correlation was found between the neurological findings and the tumor markers studied.

A simple numerical discriminant in the follow-up of lung cancer

Statistical analysis of laboratory data obtained during a study on a group of patients with lung cancer suggests that a simple numerical discriminant may have value in the follow-up of such patients. The discriminant is based on six common laboratory tests and is rapidly derived in the consulting room using a simple pocket calculator.

Markers in breast and lung cancer

We have investigated the role of biochemical markers in breast and lung cancer but have found that currently available tests have little role in management. In breast cancer, for example, we have found that the most sensitive method for routine screening for metastases is by using chest x-ray and clinical examination, liver function tests, and carcinoembryonic antigen measurements. We are now examining other methods for detecting metastases using immunocytochemistry in cytological preparations of bone marrow and attempting to raise monoclonal antibodies to breast cancer cells. In lung cancer, the major effort has been directed towards characterisation of large-molecular-weight ectopic hormones, particularly calcitonin.

Ferritin, finger clubbing, and lung disease

The serum ferritin concentration has been determined by an immunoradiometric assay in 90 subjects with a variety of pulmonary diseases. No association between ferritin concentrations and finger clubbing has been found in any of the diseases studied. Ferritin levels were significantly raised in the subjects with bronchial carcinoma, but were not useful in monitoring recurrence of the tumour. Pulmonary artery and pulmonary vein ferritin concentrations were similar to systemic venous concentrations. It is therefore unlikely that the tumour releases ferritin into the pulmonary circulation. Ferritin levels were raised in patients with acute pneumonias but did not correlate with the total white cell count or erythrocyte sedimentation rate. Serum ferritin concentrations were also increased in a variety of chronic lung diseases but were normal in subjects with asbestosis.

Diagnostic and therapeutic implications of ectopic hormone production in small cell carcinoma of the lung

In 75 unselected and untreated patients with small cell carcinoma of the lung, plasma ACTH, serum calcitonin, and antidiuretic hormone (ADH) in plasma and urine were related to corresponding clinical symptoms and biochemical findings at the time of diagnosis. The significance of elevated concentrations of these substances in relation to treatment was also investigated. Plasma ACTH concentrations were increased in 22 patients (29%), and 25 patients (33%) were considered to have inappropriate ADH secretion. Only one patient had definite hypokalaemic alkalosis, and one patient pronounced hyponatraemia, with associated clinical syndromes of ectopic ACTH and ADH secretion. Serum calcitonin concentrations were increased in 48 patients (65%). No related clinical symptoms were disclosed, and all these patients had normal serum calcium concentrations. Thirty-three of 66 patients (50%) had raised levels of free cortisol in a 24-hour urine and these levels were significantly related to plasma ACTH concentrations. The median survival was slightly shorter in patients with increased values of the three substances, but this was not related to increased plasma ACTH concentrations and was not statistically significant. Survival rates and results of treatment were independent of the pretreatment levels of the three substances.