Tumor marker kinetics in the monitoring of breast cancer

Article Abstract:

Tumor markers are protein antigens which are preferentially expressed by tumor cells rather than by normal tissues. Frequently, traces of these molecules may be found in the circulation, and their potential clinical value may lie in using these circulating markers to evaluate the response to therapy in cancer patients. Unfortunately, the method is not without its problems. Not all tumors express these antigens or release them into the circulation. Furthermore, reports have indicated that in some patients the circulating markers behave paradoxically; that is, the marker levels rise in patients experiencing documented tumor regression and decrease in patients showing signs of tumor progression. It is clear why investigators hoping for a simple test to evaluate treatment success have been disappointed. Thirty patients with advanced breast cancer were closely followed in order to observe the kinetics of change of two tumor markers. Carcinoembryonic antigen (CEA), which was among the first markers found and the most widely studied, and CA15-3, another marker, were measured at least four times in the first month after chemotherapy and afterwards as schedules permitted. Four distinct kinetic patterns of circulating marker levels were identified. Two followed the expected patterns, in which rising marker levels accompany continued tumor growth and falling markers indicate tumor regression. The remaining two patterns were paradoxical. It appears that continued tumor growth may result in a transient reduction in marker levels, which then begin to rise again and continue to rise along with tumor progression. Tumor marker levels may also rise paradoxically during the early stages of tumor regression, but fall thereafter. One possible explanation for the rise in marker levels among patients with regressing tumor is that the dying cells may release large amounts of marker into the blood. An explanation for the falling of tumor markers in some patients with progressing tumors is somewhat more elusive. However, there is some evidence from tissue culture experiments that chemotherapeutic agents inhibit the release of CEA from the cells, though there is no inhibition of its synthesis. The cells simply accumulate larger amounts of carcinoembryonic antigen. Although the paradoxical effects may occur with many tumor markers, in this study the kinetics of CEA and CA15-3 were similar but not identical. This raises the possibility that two or more markers may be used together to get a better picture of the clinical response to cancer treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer, Tumor antigens, Tumor markers, Biological markers, CEA (Oncology), Carcinoembryonic antigen

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National Cancer Data Base: a clinical assessment of patients with cancer

Article Abstract:

Clinical and laboratory experiments can only answer some of the important questions about cancer. Some other questions can only be answered by the tabulation of data obtained from actual cancer patients. A new program has been developed to collect data on cancer patients as well as to consolidate data from local registries of cancer patients spread around the country. This program is The National Cancer Data Base (NCDB). The NCDB has grown out of a system for the evaluation of cancer patient care established by the American College of Surgeons. The data base began with a network of 510 hospitals with cancer programs approved by the College, and an additional 140 hospitals which contributed data on their cancer patients. It is estimated that the NCDB will eventually include 1,200 hospitals and that 70 percent of all cancer patients in the US will be represented and tracked by the data base. Such data bases provide information which cannot be determined by individual medical centers alone. For example, using NCDB data, it would be possible to compare differences in cancer among various racial and ethnic groups as well as to compare cancer between rural and urban groups. NCDB information will provide new insights into cancer, but it will also yield direct benefits to patients as well by providing comparison standards against which the cancer treatment by individual physicians and hospitals may be measured. It is not sufficient, however, to simply establish a computer data base. Great efforts must be made to assure that data arriving from various hospitals and medical centers across the country are of consistent and reliable quality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Statistics, Cancer, Databases

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Poor prognosis of mediastinal germ cell cancers containing sarcomatous components

Article Abstract:

Advances in chemotherapy have improved the prognosis of germ cell tumors of the testes. However, such tumors, which include seminomas, embryonal carcinomas, choriocarcinomas, endodermal sinus tumors, and mixed germ cell tumors, are not limited to the testes. Germ cell tumors may arise in other sites, the most common being the mediastinal cavity of the chest and behind the peritoneal cavity of the abdomen. Studies of cisplatin in the treatment of these tumors have reported long-term survival rates of above 40 percent. A review of 15 cases of germ cell tumors occurring in the mediastinal cavity indicates that the histological appearance of the tumors can indicate the likelihood of successful treatment. One of the features of germ cell tumors is that tissue components resembling a wide variety of different adult tissues may arise. Among the 15 cases, the tumors of 4 patients were observed to contain sarcomatous elements, that is, tissues with the appearance of a sarcoma (a tumor arising from the embryonic mesoderm). All four of these patients died of their tumors; the median survival was nine months. Of the remaining 11 patients, 6 were disease-free 5 to 8 years after diagnosis. Sarcomatous elements seem, therefore, to portend a poor outcome among patients with mediastinal germ cell tumors. More aggressive therapy, possibly using techniques that have been effective against sarcomas, may be more appropriate in the treatment of these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Germ cell tumors, Germinoma, Chemotherapy, Sarcoma, Thoracic cancer

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