Carcinoembryonic antigen and bladder carcinoma

Urine carcinoembryonic antigen levels are more useful than serum levels for early detection of Bilharzial and non-Bilharzial urinary bladder carcinoma: observations of 43 Egyptian cases

Background

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen (CEA).

Patients and methods

Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 nonbiharzial cases, in addition to 10 normal control cases.

Results

A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial, versus 62% in nonbilharzial bladder carcinoma. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial, was higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels.

Conclusion

Urinary CEA is more useful than serum CEA in the early detection of urotherlial carcinoma particularly if provoked by bilharziasis. Its level is also correlated with the tumor stage.

The significance of serum lipid-bound sialic acid in bladder tumours

Tumour markers with high sensitivity and specificity for bladder cancer are still lacking and several markers have been investigated up to now. Serum lipid-bound sialic acid (LSA) was claimed to be a tumour marker by some investigators and this study tried to assess the value of LSA as a tumour marker in patients with bladder cancer. The results obtained from 27 patients and 30 controls showed that serum LSA levels remained within the suggested normal limits of the method used but they were significantly higher than in the controls. The value of serum LSA is questionable as an initial tumour marker for bladder cancer, but variations from the basal level may indeed be helpful in monitoring the efficacy of the therapy and in detecting relapses during follow-ups.

Bladder cancer detection and surveillance: carcinoembryonic antigen as a monitor of neoplastic transformation

Routine cytopathology of exfoliated urothelial cells will identify only 70% of patients with transitional cell carcinoma (TCC) because most well-differentiated bladder tumors are not detected. Carcinoembryonic antigen (CEA) was identified on urothelial cancer cells from 66% of patients with grade I TCC, 65% with grade II TCC, 65% with grade III TCC, and 80% of patients with CIS. Immunoperoxidase labelling of CEA can enhance the sensitivity of exfoliative cytology.

Urinary carcinoembryogenic antigen (CEA) in the diagnosis and follow-up of bladder carcinoma

The level of urinary carcinoembryogenic antigen (CEA) was evaluated in the diagnosis and follow-up of urothelial carcinoma of the bladder. Urinary CEA concentration, cystoscopic findings and the histopathology of an eventually resected bladder tumour were correlated in 177 cases. The sensitivity proved to be 34%, the specificity 82%. Possible correlations with sex, infection, primary tumour or recurrence, differentiation and invasion of an eventually resected tumour and influence of adjuvant therapy were also evaluated. A comparison was made with the results of other authors and different factors which may influence urinary CEA levels are discussed.

Carcinoembryonic antigen detection by immunocytochemical methods in carcinomas of the colon and stomach

CEA was studied in paraffin sections from 50 cases of colonic and 50 cases of gastric adenocarcinoma using immunoperoxidase and immunofluorescence techniques. CEA was positive more frequently in colonic (86 per cent) than in stomach carcinoma (76 per cent). Immunoperoxidase was found to be the more sensitive technique for the detection of CEA in both organs. The non-neoplastic peritumoral colonic mucosa was more often CEA positive than was the peritumoral gastric mucosa. CEA was found more often, and the intensity of the staining was stronger in well-differentiated colonic and gastric carcinoma than it was in poorly differentiated carcinoma. No relation was found between the presence of CEA in colonic and gastric carcinoma and the stages of the disease. CEA was detected more frequently in carcinomas of the left colon than in carcinomas of the right colon.

New concepts in staging and follow-up of bladder carcinoma

This article presents new staging systems and methods for properly assessing bladder carcinoma by computerized tomography (CT) scanning and transurethral ultrasound. The practical clinical modalities for following bladder cancer including cytology and random biopsy are presented, in addition to tumor markers. Also, newer methods of detecting recurrence and predicting invasion such as ABO(H) antigen testing, chromosome analysis, and flow cytometry are reviewed in an attempt to understand better the cellular and nuclear abnormalities in malignant transitional cells.

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) and its correlation with grading and staging on tissue sections of urinary bladder carcinomas

In 150 transitional cell carcinomas (TCC) of the urinary bladder, 50 each of Grades 1, 2, and 3, the content of carcinoembryonic antigen (CEA) was examined immunocytochemically and correlated to grading and staging. Fifty-seven percent of the TCC contained CEA-positive tumor cells. Their distribution in tumor tissue is described. They were found in 24% of Grade 1 cases, in 72% of Grade 2 carcinomas, and in 76% of Grade 3 tumors. None of the Grade 1 cases contained more than 10% CEA-positive cells, whereas 34% and 40% of the Grade 2 and 3 tumors, respectively, revealed more than 10% CEA-positive tumor cells. According to the correlation found between grading and staging, the percentage of TCC containing CEA-positive tumor cells was 34% in pTA, 59% in pT1, and 80% in pT2/3 tumors. The results show a correlation between CEA content of tumor tissue and histopathologic malignancy in TCC of urinary bladder.

Urinary CEA for prediction of survival time and recurrence in bladder cancer

The prognostic information from carcinoembryonic antigen was evaluated in bacteria-free urines of patients with bladder carcinoma. Patients with elevated (greater than or equal to 30 ng/ml) U-CEA had a poorer relative and symptom-free survival than patients with initial U-CEA below 30 ng/ml. Patients in whom U-CEA decreased from before to after radiation treatment had a better survival rate than patients with increasing U-CEA. These findings were most significant in cases with large (T3 + T4) tumors or with tumors of a lower differentiation (G3). U-CEA appeared to be an independent variable for prognostic evaluation of survival, since these differences were also true within the subgroups of known variables such as classes or grades. All but one of the patients, in whom short-term local control was obtained, had a posttreatment U-CEA below 50 ng/ml. In oncology units, where the more malignant bladder tumors are treated, U-CEA determinations may indicate which patients require intensified monitoring or treatment.

Carcinoembryonic antigen localization in benign and malignant transitional epithelium

Transitional epithelium from 30 cases, including transitional cell carcinoma of various grades and stages, carcinoma in situ, cystitis cystica, and glandularis, as well as normal bladder epithelium, was studied for carcinoembryonic antigen (CEA) content by the immunoperoxidase technique. The results indicate that CEA is present in normal transitional epithelium and that its level frequently decreases in transitional cell carcinoma. These results are related to the findings in studies of urinary CEA excretion.

Histogenesis of Brenner tumors, II: histochemistry and CEA

The histochemical characteristics of 21 benign Brenner tumors were studied. The mucins associated with these tumors are of transitional cell origin and do not represent a secondary metaplasia of transitional to intestinal-type epithelium. The goblet and ciliated columnar cells associated with the proliferative Brenner tumor are thought to represent a parallel mucinous metaplasia from celomic epithelium. Thirteen of the 16 benign Brenner tumors and the one proliferative Brenner tumor were found to contain carcinoembyronic antigen (CEA), indicating an additional antigenic similarity to transitional epithelium.

Assessment of serial CEA determinations in urine of patients with bladder carcinoma

Carcinoembryonic antigen (CEA) levels in urine and serum from 294 patients with bladder cancer in varying stages have been clinically evaluated. All urine samples were obtained from patients with intact renal function and without bacterial infection in the bladder. The samples were collected before, during, and at follow-up examination after radiotherapy. They were perchloric acid extracted before being assayed in a double-antibody radioimmunoassay. The geometric mean of urine CEA levels for patients with primary tumors of Stage T1 or T2 was significantly lower than that for those with Stage T3 or T4 disease. The urine CEA levels for patients with tumors of various histologic grades did not differ. The urine CEA levels decreased from before to after radiation treatment of the primary tumor. Patients with recurrence within six months after undergoing primary treatment had higher initial mean urine CEA levels than did those without evidence of recurrence. The prognostic information for recurrence was limited to the more advanced tumors. Differences were also found between the means of samples taken before recurrence and after treatment of recurrent tumors; with regression of the tumor, a lower mean urine CEA level was found; with progression, a higher value. Urine CEA levels before any treatment were higher when the patients had a short survival time. Serum CEA levels were not related to stage or grade of the primary bladder tumor but levels were slightly elevated with metastases. The determination of urine CEA levels seems to be useful in the follow-up of patients with bladder carcinoma because when initially high, it adds to the information of the T classification and predicts early recurrence, and the monitoring of individual patients after primary treatment is useful for detecting recurrence.

Screening tests for detection of bladder cancer

Eighty-one individuals had urine cytologic studies, urinary carcinoembryonic antigen (CEA) determinations, and urinary immunoglobulin levels performed to evaluate various screening tests for the diagnosis of bladder cancer. Urinary cytologic studies detect the presence of bladder malignancy, and while false positive tests were troublesome, remain the primary screening test for bladder cancer. Urinary CEA was of little value in detecting vesical malignancy. Urinary immunoglobulins, particularly IGG and IGA, were significantly elevated in the presence of bladder cancer.

Carcinoembryonic antigen (CEA) levels in patients with brain tumours

Plasma and cerebrospinal fluid CEA determination was done in 97 patients with neurosurgical disorders. Elevated titres were found in 14 of 64 patients with brain tumours. CEA levels were elevated significantly in patients with metastatic brain tumours. Following treatment, the values fell in three patients with ependymoma, medulloblastoma, and unverified brain tumour. This study suggests that CEA levels may be of value in the differential diagnosis of primary and metastatic brain tumours, and useful in the evaluation of patients with brain tumours after treatment. CEA in the cerebrospinal fluid was absent in eight patients with brain tumours.

Improved performance of a double antibody radioimmunoassay for carcinoembryonic antigen

A new double antibody solid-phase radioimmunoassay (RIA) for carcinoembryonic antigen (CEA) is critically analyzed. The aim of the study was 4-fold: (a) to define the level of sensitivity (a comparison of 3 different assay procedures revealed that our sequential assay was more sensitive than most previously reported RIAs, while competitive and non-equilibrium assay had wider measuring ranges); (b) to analyze recoveries of CEA in either serum, plasma or urine (the recovery, even in urine, was very close to expected values, indicating that no CEA is lost or degraded during brief storage or in the extraction procedure); (c) to evaluate inter- and intra-assay variations, since most clinical management is dependent on serial assays rather than single determinations. The coefficients of variation were low both within and between assays. A change of 3 ng CEA is required for significant change (greater than 2 S.D.) at the normal serum level which is 16 ng CEA/ml in our assay. At levels above normal, a change of 4 ng is required; (d) the assay was also developed for determination of CEA levels in a large series of perchlorid acid treated serum, plasma or urine samples. This forms the basis for an assay suitable for serial assays with high sensitivity and accuracy in various neoplastic diseases.

Carcinoembryonic antigen in urine in patients with urothelial carcinoma. An expression for the extent of inflammatory reaction of the urinary tract

The concentration of carcinoembryonic antigen (CEA) in urine and serum was determined repeatedly during one year in 213 patients followed because of previously treated urothelial carcinoma of the bladder. The findings were correlated to grade and stage of previously treated tumour, given therapy, recurrence and the cytological evaluation of a midstream urine specimen. During the period of follow up 43 recurrences were clinically observed. With the exception for the content of inflammatory cells no correlation was found between the CEA levels in urine or blood and the parameters studied. Thus CEA in urine and/or serum cannot substitute for cystourethroscopy, urography and exfoliative cytology in the follow-up of patients previously treated for urothelial carcinoma.

Cellular content of carcinoembryonic antigen in urothelial carcinoma

CEA containing cells can be demonstrated in 25--60% of urothelial carcinomas. No staining was seen with benign urothelial cells. Using microfluorometry of single cells, mean fluorescence intensity with anti-CEA antisera was 3--6 times that of preparations stained in parallel with nonimmune sera. A comparison of the IF results with RIA implies a possibility to detect less than 1 pg CEA/cell in unfixed specimens. The cells which stained with anti-CEA antisera did not have any apparent morphologic properties differentiating them from neighboring nonstained cells but it was mainly in the cell populations from well- and moderately well-differentiated tumors that CEA containing cells were seen. Therefore quantitative measurements of CEA amount/cell may be a parameter, in addition to morphologic differentiation, to study new properties of tumor cell populations.

Use of heterogenous and monospecific antisera for the diagnosis of bladder cancer

A rabbit antibody to antigens present in urine from bladder cancer patients was prepared and used in conjunction with various monospecific antisera to detect urine components related to bladder cancer. All urine samples were centrifuged routinely, dialyzed and concentrated 10 times before assay by gel diffusion versus the various antisera. Urine was considered positive when it showed reactivity with 2 or more antibodies. This method of analysis resulted in the diagnosis of 64% of the bladder papillomas and 77% of the bladder cancers tested, compared to only a 7% falsely positive rate with normal urine. These data support the potential usefulness of an antiserum panel in the immunological diagnosis of bladder cancer in the general population and in high risk individuals.

The clinical value of urinary carcinoembryonic antigen-like substances in urothelial cancer

Although there is a positive correlation between the concentration of urinary carcinoembryonic antigen-like substances and urothelial cancer the clinical value of this association is in doubt. Urinary carcinoembryonic antigen values have been determined in large numbers of specimens from patients with a variety of urologic diseases but most studies have recorded only single measurements at the time of diagnosis. We examined the role of carcinoembryonic antigen in urothelial malignancies by comparing serial carcinoembryonic antigen, and cytologic and histologic analyses done on simultaneously collected urine and tissue specimens. We were particularly interested in the value of carcinoembryonic antigen as a diagnostic adjunct to cytology in low grade carcinoma and dysplasia, and the role of serial measurements of this substance in followup. The results of 102 analyses in 48 patients during a 15-month period indicate that urinary carcinoembryonic antigen measurements have little value in the diagnosis of bladder cancer, are of limited usefulness in combination with cytologic studies and are poorly correlated with simultaneously determined cytologic and histologic findings. Although the initial results were not promising serial measurements may be useful in followup.