Carcinoembryonic antigen in patients with gynecologic malignancy

Lipid Bound Sialic Acid in Cancer Patients

Serum lipid-bound sialic acid (LSA) was measured with a recently described procedure in 108 healthy subjects and in 138 patients with a variety of solid tumors and hematologic malignancies. At the time of serum sampling, 128 patients had active disease and 10 patients had no evidence of disease. LSA was elevated in 104 of 128 (81.2%) patients with active disease, while carcinoembryonic antigen, analyzed in 74, was elevated only in 21 (28.4%) (P < 0.05). Sensitivity of the serum LSA test ranged from 66% for breast and gastrointestinal cancer to 92% for lung cancer. In patients with lung cancer, ovarian cancer or Hodgkin's disease, LSA was correlated with the extent of disease and it also proved to be useful in following the course of disease. Our preliminary data indicate that this test can be used as a monitor of tumor burden.

A Double Determinant Radioimmunoassay Mov2-Mov8* for Monitoring Ovarian Carcinomas: Definition of the Methodology

A double-determinant radioimmunoassay for the detection of circulating antigens associated with human ovarian carcinoma was developed using two monoclonal antibodies: MOv2 and MOv8 employed respectively as catcher and tracer. The development of the method through three different procedures enabled us to detect the presence of CaMOv2-CaMOv8 carrying molecules in 14 out of 15 ascitic fluids from ovarian carcinoma patients whose tumors were found to be positive with MOv2 and MOv8 monoclonal antibodies by immunofluorescence. Moreover, 13 out of 15 ovarian carcinoma patients presented high levels of antigen in their serum (60-170 Ua/ml). Low levels of antigen were observed in the normal population, the values ranging from 30-40 Ua/ml. However, in 13 out of 100 apparently healthy women high levels of antigen were found in the serum

Clinical Significance of Serum Interleukin-31 and Interleukin-33 Levels in Patients of Endometrial Cancer: A Case Control Study

Aims. Previous evidence has proved that interleukin-31 (IL-31) and interleukin-33 (IL-33) can be potential markers in some cancers' formulation. We aimed to determine the potential role of IL-31 and IL-33 in prognosis of endometrial cancer patients. Methods. Serum samples were collected from 160 patients with endometrial cancer and 160 healthy controls. The ELISA kits (Raybio® Systems) specific for human IL-31 and human IL-33 were used. Serum levels of tumor markers (CEA, CA-125, and CA19-9) were measured by chemiluminescence immunoassay. A two-side P value < 0.05 was indicated to be significant. Results. Serum levels of IL-31 and IL-33 in patients were significantly elevated compared to those of healthy controls. The interleukin levels were also related to clinical characteristics, including tumor stages, depth of invasion, and existence of node metastases and distant metastases. The sensitivity and specificity of IL-31 and IL-33 were higher than the counterparts of tumor markers, both separately and in combination of IL-31, IL-33, and the clinical markers. Conclusions. This report is the first one mentioning the possible association between serum IL-31 and IL-33 and endometrial cancer. With their sensitivity and specificity, the interleukins may be useful biomarkers for endometrial cancer's prognosis.

Prognostic value of pretreatment carcinoembryonic antigen after definitive radiotherapy with or without concurrent chemotherapy for squamous cell carcinoma of the uterine cervix

PURPOSE

To evaluate whether pretreatment carcinoembryonic antigen (CEA) levels have a prognostic role in patients after definitive radiotherapy for squamous cell carcinoma (SCC) of the uterine cervix.

METHODS AND MATERIALS

A retrospective study of 550 patients was performed. The SCC antigen (SCC-Ag) and CEA levels were regarded as elevated when they were ≥2 and ≥5 ng/mL, respectively. A total of 208 patients underwent concurrent chemoradiotherapy (CCRT). The Kaplan-Meier method was used to calculate the distant metastasis (DM), local failure (LF), disease-free survival (DFS), and overall survival (OS) rates. Multivariate analysis was performed using the Cox proportional hazards model. The hazard ratio (HR) with 95% confidence interval (CI) was evaluated for the risk of a poor prognosis.

RESULTS

Compared with the patients with normal CEA/SCC-Ag levels, CEA levels ≥10 ng/mL but without elevated SCC-Ag levels was an independent factor for LF (HR, 51.81; 95% CI, 11.51-233.23; p < .001), DM (HR, 6.04; 95% CI, 1.58-23.01; p = .008), DFS (HR, 10.17; 95% CI, 3.18-32.56; p < .001), and OS (HR, 5.75; 95% CI, 1.82-18.18; p = .003) after RT alone. However, no significant role for CEA was noted in patients with SCC-Ag levels ≥2 ng/mL. In patients undergoing CCRT, a CEA level ≥10 ng/mL was an independent factor for LF (HR, 2.50; 95% CI, 1.01-6.21; p = .047), DM (HR, 3.41; 95% CI, 1.56-7.46; p = .002), DFS (HR, 2.73; 95% CI, 1.39-5.36; p = .003), and OS (HR, 3.93; 95% CI 1.99-7.75; p < .001). A SCC-Ag level of ≥40 ng/mL was another prognostic factor for DM, DFS, and OS in patients undergoing not only CCRT, but also RT alone. The 5-year OS rate for CCRT patients with CEA <10 ng/mL and ≥10 ng/mL was 75.3% and 35.8%, respectively (p < .001). CCRT was an independent factor for better OS (HR, 0.69; 95% CI, 0.50-0.97; p = .034).

CONCLUSION

Pretreatment CEA levels in patients with SCC of the uterine cervix provide complementary information for predicting LF, DM, DFS, and OS, except for in patients with abnormal SCC-Ag levels before RT alone. More aggressive therapy might be advisable for patients with CEA levels of ≥10 ng/mL.

High-resolution proton nuclear magnetic resonance spectroscopy of ovarian cyst fluid

Most ovarian tumors are cystic structures containing variable amounts of fluid. Several studies of ovarian cyst fluid focus on one specific metabolite using conventional assay systems. We examined the potential of (1)H-nuclear magnetic resonance spectroscopy in evaluation of the overall metabolic composition of cyst fluid from different ovarian tumors. Ovarian cyst fluid samples obtained from 40 patients with a primary ovarian tumor (12 malignant and 28 benign) were examined. After deproteinization and pD standardization, we performed (1)H-NMR spectroscopy on a 600 MHz instrument. With (1)H-NMR spectroscopy we found detectable concentrations of 36 metabolites with high intersample variation. A number of unassigned resonances as well as unexpected metabolites were found. We introduce an overall inventory of the low-molecular-weight metabolites in ovarian cyst fluid with corresponding resonances. Significant differences in concentration (p < 0.01) were found for several metabolites (including an unknown metabolite) between malignant and benign ovarian cysts. Furthermore, higher concentrations in malignant- and lower in benign fluids were found compared to normal serum values, indicating local cyst wall metabolic processes in case of malignant transformation. We conclude that (1)H-nuclear magnetic resonance spectroscopy can give an overview of low-molecular-weight proton-containing metabolities present in ovarian cyst fluid samples. The metabolic composition of cyst fluid differs significantly between benign and malignant ovarian tumors. Furthermore, differences between benign subgroups possibly related to histopathological behaviour can be detected. The presence of N-acetyl aspartic acid and 5-oxoproline exclusively in serous cystadenoma samples is remarkable. Future studies will concentrate on these findings and explore the possibilities of extrapolating information from the in vitro studies to in vivo practice, in which metabolic differences between malignant and benign subtypes can be of great importance in a pre-operative phase.

Evolution of screening for epithelial ovarian carcinoma: the quest for early diagnosis

Epithelial ovarian carcinoma remains the most fatal of gynecologic malignancies, causing approximately 13,300 deaths annually. This high mortality rate is due to the presence of advanced stage disease at time of diagnosis. Symptoms early in the course of the disease are frequently nonspecific and go unrecognized by both the patient and the physician. The cause-specific mortality may decrease if a sufficiently sensitive screening modality can be developed to allow early diagnosis and curative therapy. The ideal screening tests or algorithm utilizing several tests must have sufficient specificity to minimize false positives, which contribute to patient anxiety and inefficient use of health care dollars. The development and refinement of the various methodologies used in screening of epithelial ovarian carcinoma will be the subject of this review.

Membranous expression of carcinoembryonic antigen (CEA) in the normal cervical squamous mucosa

Using a panel of polyclonal and monoclonal antibodies to CEA-related antigens in paraffin-processed cervical biopsies, CEA and NCA expression has been demonstrated on the cell membrane of normal mature cervical squames. Cytofluorimetry of disaggregated cervical squames confirmed membranous expression and immunogold labelling of ultrathin cryostat sections localized CEA to the glycocalyx and to within cytoplasmic membrane-bound vesicles of mature squames. Immunoblotting of cervical tissue showed that most of the CEA reactivity was expressed as a glycoprotein of molecular weight around 180 k, probably CEA itself. Localization of the CEA to the cell membrane of mature cervical squames suggests a key role for these antigens in maintaining the integrity of the squamous mucosa, through the putative function of an adhesion molecule.

CEA in tumors of other than colorectal origin

Carcinoembryonic antigen has been demonstrated to be a valuable clinical aid in the management of patients with colorectal carcinoma. Its elevation in the serum prior to evidence of clinical recurrence in up to 80% of patients highlights its utility. CEA has also been found to be elevated in the serum of patients with other epithelial malignancies, but these have not been as well studied as has colorectal carcinoma. In patients with breast cancer CEA elevations may be found in 40-73% of patients presenting with disease in stages I-IV. In addition, 80% of patients will have a CEA elevation 3-10 months prior to clinical symptoms of recurrence. Seventy-seven percent of patients with bronchogenic lung cancer will have an elevated preoperative value. However, cigarette smoking also causes an increase in the CEA assay level and, thus, differentiation between benign and malignant conditions is more difficult. In small cell carcinoma of the lung, CEA assay levels above 10 ng/ml correlate highly with metastatic disease, while values less than 2.5 ng/ml correlate with localized disease. Pancreatic and gastric malignancies demonstrate CEA level elevations in just over 50% of cases. But these, however, have not been clinically useful. Epithelial neoplasms of the female reproductive tract (cervix, uterus, and ovary) also produce CEA in 47-75% of cases and may correlate with stage of disease at diagnosis and level of cellular differentiation. CEA assay levels are elevated in a variety of tumors and correlate with tumor stage, degree of differentiation, and effectiveness of therapy; they may also be the earliest marker of recurrence.

Establishment and characterization of a cell line (OMC-3) originating from a human mucinous cystadenocarcinoma of the ovary

A new human ovarian carcinoma cell line, designated OMC-3, was established from the mucinous cystadenocarcinoma of a 59-year-old woman. This cell line has grown well for 65 months and has been subcultured more than 50 times. Monolayer-cultured cells are polygonal in shape, showing a pavement-like arrangement and a tendency to pile up without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the hypodiploid range. The cells were transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. Ten thousand OMC-3 cells produced CA-125 (228-580 U) and CA-19-9 (2900-5640 U) during 17 days in culture media. CA-125 and CA-19-9 were demonstrated immunohistochemically in the original tumor, heterotransplanted tumor, and OMC-3 cells. The cells contain no estrogen or progesterone receptors. OMC-3 cells were sensitive to actinomycin D, 4-hydroperoxycyclophosphamide, and mitomycin C in vitro. Three other reports of ovarian mucinous carcinoma cell lines are reviewed.

Establishment and characterization of CA 125 producing cell line (OMC-2) originating from a human endometrial adenocarcinoma

A new human endometrial carcinoma cell line, designated OMC-2, was established from the endometrial adenocarcinoma of a 59-year-old woman. This cell line has grown well for 51 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, showing a pavement-like arrangement and a piling up tendency without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the diploid range. The cells were transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. 1 X 10(5) OMC-2 cells produced CA 125 (184-682 U) during 19 days in culture media. CA 125 was demonstrated immunohistochemically in the original tumor, heterotransplanted tumor, and OMC-2 cells. The cells contain no estrogen or progesterone receptors. Twenty-nine other reports of endometrial carcinoma cell lines are reviewed.

The use of serum TA-4 in monitoring patients with malignant transformation of ovarian mature cystic teratoma

The development of cancer in mature cystic teratomas of the ovary is rare and sometimes difficult to detect because of sampling errors. Six cases of squamous cell carcinoma arising in ovarian mature cystic teratomas were studied, five of which showed an elevated level of a squamous cell carcinoma-associated antigen, TA-4, in the sera obtained preoperatively; the preoperative determination was not performed in the sixth case. However, no elevated TA-4 level was detected in the sera of 28 patients with mature cystic teratomas of the ovary. Moreover, serial determination of the serum TA-4 level showed a good correlation between the clinical course and the serum TA-4 level. Interestingly, an abnormal TA-4 level preceded the clinical detection of recurrence by 2 months in two patients. Thus, determination of the serum TA-4 concentration may be useful for diagnosing and monitoring patients with squamous cell carcinoma arising in mature cystic teratomas of the ovary.

Explanation of the limited correlation between tumor CA 125 content and serum CA 125 antigen levels in patients with ovarian tumors

The concentration of the tumor marker CA 125 in tumor tissue, cyst fluid, ascites fluid, and serum from patients with epithelial ovarian tumors was quantitated. Immunohistologic studies showed that CA 125 was present in 90% of the nonmucinous epithelial ovarian tumors. Quantitative analysis of the fluid from 57 cysts revealed that CA 125 was present in concentrations of up to 2140,000 U/ml in samples from malignant nonmucinous epithelial ovarian lesions, and up to 116,000 U/ml in mucinous tumors, but also in concentrations of up to 371,000 U/ml in benign serous cystadenomas. In contrast, pre-operative serum CA 125 levels were elevated in almost all of the patients with malignant ovarian tumors but not in most of those with benign ovarian tumors. These findings suggest that in benign ovarian tumors there is an effective barrier between the cyst fluid and the circulation that prevents the appearance of CA 125 in the serum, whereas in malignant tumors infiltrative growth leads to the release of antigen into the circulation. Furthermore, CA 125 values in ascites fluids were up to 130 times higher than the serum antigen levels, which indicates that the peritoneum serves as a barrier for high molecular weight tumor antigens. The current results show that tumor basement membranes and peritoneal barriers play a notable role in the transit of tumor antigens, one which must be taken into account in the monitoring of serum marker levels of cancer patients.

Studies on the special tumor marker of cervical cancer of the uterus

Although cervical cancer is the most common malignancy of the gynecologic system, very few tumor markers have been specially prepared for this disease. This article reviews some of the current investigations of those markers, particularly describing TA-4, a tumor antigen of cervical squamous cell carcinoma, which has currently been widely used in clinical practice.

Biochemical and immunohistochemical studies on carcinoembryonic antigen of ovarian mucinous and serous tumors

The carcinoembryonic antigen (CEA) in the cyst fluid of ovarian mucinous and serous tumors was investigated. The molecular weight and antigenicity of the CEA from both ovarian tumors were very similar to those of colon cancer CEA as determined by SDS electrophoresis and double immunodiffusion on agar plates. In the cyst fluid of ovarian mucinous tumors, the amount of CEA was generally high and CEA of molecular weight (MW) 200,000 was increased. In contrast, in the cyst fluid of ovarian serous tumors, the CEA amount was low and CEA variants of MW 370,000 and 180,000 were present in addition to the main CEA of MW 200,000. Immunohistochemically, CEA was stained mainly in the intestinal type epithelium of ovarian mucinous tumors, and the CEA revealed a tendency to be stained more frequently and strongly with increasing degree of tumor malignancy. Thus, ovarian mucinous tumors (especially the intestinal type epithelium) produced large amounts of CEA which closely resembled colon cancer CEA, whereas ovarian serous tumors produced small amounts of CEA, including some CEA variants. In the study of ovarian epithelial tumors, CEA may be useful as a marker for the malignant transformation of ovarian mucinous tumors.

Longitudinal study of CEA and CA125 in ovarian cancer

Carcinoembrionic antigen (CEA) and cancer antigen 125 (Ca125) levels were measured at regular intervals over a 24-month period in 19 patients with proven ovarian cancers. In 91.5% of the cases with recurrent or progressive disease, Ca125 levels were increased whereas only 34% of these patients had increased CEA levels. Furthermore, reduction of the tumoral mass was associated with a decrease of Ca125 levels in all patients. It is proposed that determination of Ca125 levels in ovarian cancer might provide a valuable prognostic tool for the assessment of the evolution of the disease.

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.

What's new in prognosis of uterine cancer?

Prognosis represents an attempt of prediction of a future evolution, based on the critical judgement of a present status. A prognosis may have a qualitative as well as a quantitative character. The qualitative evaluation considers whether the course of a disease is modified, which means, whether it is influenced in a favourable or a disadvantageous way. In case of a quantitative statement, healing or absence of symptoms are taken as definitive criteria. It is our aim to analyse the prognostic significance of different criteria in patients with carcinoma of the uterus.

Mixed mesodermal tumor of the ovary with carcinoembryonic antigen and alkaline phosphatase production. Histochemical, autoradiographic, and electron microscopic studies of heterotransplanted tumors in athymic nude mice

A mixed mesodermal tumor of the ovary with carcinoembryonic antigen (CEA) and alkaline phosphatase (ALP) production was serially heterotransplanted into nude mice. The original tumor was diagnosed as homologous tumor, with sarcomatous component consisting of nonspecific spindle-shaped cells. These features were basically retained in the transplanted tumors, including CEA and ALP production. But, heterologous, chondrocytic-differentiated foci were found in the tumors at the third and sixth passages. Transitional-type cells from sarcomatous to carcinomatous cells were sometimes found in the transplanted tumors by light and electron microscopy. Ciliated sarcomatous cells, which may also represent the epithelial differentiation of sarcomatous cells, were found in the tumors at first passage. The current results support the combination tumor theory, which means that both the carcinomatous and sarcomatous components are of common stem cell origin.

The immunohistological demonstration of carcinoembryonic antigen in intra-epithelial and invasive squamous carcinoma of the cervix

Using the sensitive peroxidase, anti-peroxidase immunohistological technique, carcinoembryonic antigen (CEA) was studied in formalin-fixed, paraffin-embedded cervical specimens from 225 patients. CEA was demonstrated in 33% of moderate dysplasia, 78.5% of severe dysplasia, 79% of in-situ carcinoma and 78% of invasive carcinoma. CEA was not demonstrated in normal squamous epithelium, squamous metaplasia, reserve cell hyperplasia nor in mild dysplasia.

Immunohistochemical studies on carcinoembryonic antigen in adenocarcinomas of the uterus

In order to distinguish endocervical adenocarcinoma from endometrial adenocarcinoma, an immunoperoxidase stain for carcinoembryonic antigen (CEA) was tried. All of 10 endocervical adenocarcinomas revealed CEA and an adenosquamous carcinoma in the uterine cervix also showed it, while a mesonephroid adenocarcinoma in the uterine cervix did not. The immunohistochemical reaction products for the antigen were not observed in the glandular structures of 20 endometrial adenocarcinomas, although CEA was detected in all foci of squamous epithelial metaplasia occurred within 7 endometrial adenocarcinomas. CEA was detected in the endocervical type of glandular epithelium within a special endometrial adenocarcinoma containing predominantly endocervical type glandular epithelium. The immunoperoxidase staining pattern for CEA in the endocervical adenocarcinoma was related to the degree of histological differentiation of tumors, as follows; in the well differentiated glandular structure CEA was located on the luminal surface, while it was detected in the whole cytoplasm of tumor cells within the moderately and poorly differentiated areas. In conclusion, the immunoperoxidase stain for CEA would be useful for estimating malignancy of glandular structures within the uterus, distinguishing endocervical adenocarcinoma from endometrial adenocarcinoma, and grading of histological differentiation of endocervical adenocarcinoma.

Value of tumor-antigen (TA-4) of squamous cell carcinoma in predicting the extent of cervical cancer

The value of a tumor-antigen (TA-4) of squamous cell carcinoma in evaluating the extent of disease was studied in patients who primarily had surgical treatments with a diagnosis of cervical squamous cell carcinoma. Pretreatment serum TA-4 levels were determined by a radioimmunoassay method. The extent of disease was determined by surgical evaluation and postoperative histologic examinations. Furthermore, all patients were followed for at least two years, and those patients who developed recurrence at the sites which were unresectable by radical hysterectomy were retrospectively regarded as the unresectable case. It was found that serum TA-4 levels reflected the extent of disease, and that high pretreatment TA-4 levels indicated the presence of the widespread tumor which was unresectable by radical hysterectomy.

Serum enzyme changes during chemotherapy for ovarian cancer

Serum lactate dehydrogenase (LD), gamma-glutamyl transferase (gamma GT) and alkaline phosphatase (ALP) activities have been measured in 105 patients with ovarian cancer for periods of up to 4 years. The extent of the disease was assessed at laporotomy according to the FIGO classification. Chemotherapy was started one week after surgery, at which time 25% of patients had elevated LD, 29% elevated gamma GT and 21% elevated ALP. Of 51 patients who went into complete remission, 4% still showed elevated LD, 25% elevated gamma GT and 12% elevated ALP. Reactivation of tumour growth was apparent in 32 patients; there was a significant increase in the serum LD, gamma GT and ALP activities when remission and recurrence were first detected in 65%, 50% and 35% of patients respectively. With 14 patients, there was an unexplained increase in the activity of one or more of the enzymes 1-6 months prior to recurrence being detected; these changes may predict that chemotherapy is losing effect. During long-term remission, serum LD was increased in patients suffering from urinary tract infection or bladder dysfunction.

Oncofoetal antigens in cancer of the cervix and ovary

The incidence of oncofoetal antigens has been reported to be increased in patients with gynaecological cancers. In this study the incidence of CEA, AFP, and hCG (beta subunit) were studied in patients with adenocarcinoma of the ovary, adenocarcinoma of the cervix, and squamous-cell carcinoma of the cervix. Using a low cut-off point (CEA 2.5 microgram/l, AFP 5 microgram/l, and hCG 3 i.u./l) there is an unacceptably high proportion of control patients having one or more positive tests (42-54%) compared to cancer-bearing patients (67%). The specificity of the tests can be increased to over 95% by increasing the cut-off point to CEA 10 microgram/l, AFP 10 microgram/l, and hCG 10 i.u./l). Although this reduces the sensitivity considerably, the incidence of false positives in the control population is reduced to nil in non-cancer patients and to 2% in cancer patients tested when free of tumour, compared to 17% of patients with cancer of the ovary, 33% with adenocarcinoma of the cervix, and 6% with squamous-cell carcinoma of the cervix. Patients with adenocarcinoma of the cervix were clearly distinguishable from those with squamous-cell carcinoma of the cervix by these tests. There was also a significant correlation between AFP and hCG levels in adenocarcinoma of the cervix (r = 0.53, P less than 0.05).

Immunologic aspects of gynecologic cancer

All vertebrates have a defense mechanism, the immune defense system, that protects them from disease-causing microorganisms. Its deliberate exploitation has conquered many infectious diseases and has been a major achievement of medical science in preventing suffering and saving lives. At the beginning of this century, hope was held that dissimilarities between normal and neoplastic cells could be demonstrated by immunologic methods and that vaccination against cancer might become possible. When it was recognized that the many claims of tumor=specific antigenicity were based on experiments in which an immunity to normal alloantigens, rather than tumor-specific antigens, had been demonstrated, the field of tumor immunology came into disrepute. The work of Gross in 1943 and Prehn and Main in 1957 rekindled interest in tumor immunology. Many contributions have advanced the concept of tumor immunology. They are the following: (1) an abundant supply of highly inbred (syngeneic) animals; (2) extensive work on experimental transplantable tumors; (3) an understanding of the mechanism causing rejection of grafted normal and cancerous tissues in animals; (4) identification of the function of the humoral and cell-mediated mechanisms following organ transplantation; (5) the observation that cancers do arouse a specific immune response in the organisms in which they appear; (6) antigenic differences represent the first known qualitative distinction between cancer cells and their normal counterparts; (7) the application of improved technology--columns, use of fluorescein-tagged antibodies, urea as a chaotropic agent, nephelometer; (8) hybridoma to produce a supply of monoclonal antibodies; (9) new vaccines directed against invasive tumors, and (10) the exploration of the role of immune complexes in oncology. The areas of promise and the future of cancer immunology have once again challenged the minds of scientists.

Morphology of the spleen in women who died of metastatic genital tract cancer

The histology of the white pulp of the spleen was assessed in 56 women who died of metastatic genital tract cancer and in 56 age-matched women who died of a myocardial infarction or a stroke. Special attention was paid to the areas associated with T cells and B cells. The T-cell and B-cell areas were profoundly depleted in patients with carcinoma. This suggests that women who die of genital tract cancer have impaired humoral and cell-mediated immunity.

Multiple biochemical markers in patients with gynecologic malignancies

Plasma levels of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) were measured in 253 patients with gynecologic malignancies and in 317 patients with benign gynecologic diseases. Plasma concentrations of each of these antigens were elevated in a significantly (p less than 0.001) greater number of patients with invasive gynecologic cancers than in the control population. Carcinoembryonic antigen was the most commonly elevated marker, followed by AFP and hCG. Prior to therapy, over 85% of patients with ovarian or cervical cancer had elevated plasma levels of one or more antigens. Specifically, CEA was most often elevated in patients with mucinous adenocarcinomas of the ovary and endocervix. Alpha-fetoprotein was most often increased in patients with germ cell or stromal tumors of the ovary and in patients with large-cell nonkeratinizing cervical cancers. In contrast, hCG concentrations were highest in patients with serious cystadenocarcinomas of the ovary and in patients with keratinizing squamous cell carcinomas of the cervix. Plasma antigen levels were directly related to tumor differentiation and stage of disease, and generally returned to normal eight to 12 weeks following therapy. Effective plasma and tumor antigen screening during initial evaluation of patients with gynecologic tumors should help to identify the most appropriate antigen for immunodetection procedures and for serial plasma determinations following therapy.

An immunohistochemical study of distribution of carcinoembryonic antigen in epithelial tumours of the ovary

An immunohistochemical study of the tissue CEA content of 82 epithelial neoplasms of the ovary has shown that mucinous tumours contain more of this substance than do their serous counterparts; otherwise a knowledge of tissue CEA content appears to be of little value in the differential histological diagnosis of this group of neoplasms. Among mucinous tumours there is only a partial correspondence between their degree of malignancy, as assessed histologically, and their content of CEA. It is postulated that immunohistological study of tissue CEA may add a degree of finesse to morphological analysis of these neoplasms and thus allow for a more precise grading of their degree of malignancy.

Carcinoembryonic antigen in carcinoma of the uterine cervix. 2. Tissue localization and correlation with plasma antigen concentration

Immunoperoxidase staining for carcinoembryonic antigen (CEA) was performed on the tumors of 241 patients with invasive carcinoma of the cervix. Positive tissue staining indicative of a CEA concentration of at least 3 microgram/gm was present in 154 tumors (63%) as opposed to 0 of 30 specimens of normal cervix (p less than .001). Plasma CEA values were obtained at the time of tissue staining on all patients. Plasma CEA concentration was related more directly to total tumor burden (tumor CEA content x extent of disease) than to tumor CEA concentration alone. Progressively rising plasma CEA levels predicted recurrent disease in over 80% of patients whose tumors stained positively for CEA. In contrast, serial plasma CEA values correlated positively with clinical disease status in only 28% of patients whose tumors were devoid of CEA. Immunoperoxidase staining of tissue specimens identifies those patients whose tumors contain high levels of CEA and who therefore should benefit most from subsequent plasma antigen determinations.

Clinical studies on carcinoembryonic antigen in pancreatic cancer

We studied serum carcinoembryonic antigen (CEA) levels in 82 patients. Thirty-four of these had benign diseases while 48 had malignant diseases. Highest incidence and levels of CEA occurred in the sera of patients with pancreatic cancer and stomach cancer. In this paper we focused our particular attention on the serum CEA of 25 pancreatic cancer patients, and examined differences in serum CEA levels in relation to histologic differentiation and sites of pancreatric cancer. No statistical difference in serum CEA level was found among various histologic types and sites of the pancreatic cancer. Clinical courses of two patients with pancreatic cancer were also studied. Serial determinations of CEA levels are most useful in assessing the effect of operation or chemotherapies and are a useful indicator for differentiating pancreatic cancer from chronic pancreatitis but cannot be a conclusive factor for the diagnosis. Finally, we correlated serum CEA levels with those of RNase and confirmed a positive correlation.

Carcinoembryonic antigen and beta 2-microglobulin as serum tumor markers in women with genital cancer

A comparative study of carcinoembryonic antigen (CEA) and beta 2-microglobulin (beta 2-MG) in serum was made by radioimmunoassay in 77 women with genital cancer. With a positive level defined as 5 ng of CEA/ml and 3.0 microgram of beta 2-MG/ml, CEA was positive in 31% of the women with cancer of the corpus, 36% of those with cancer of the cervix and 36% of those with cancer of the ovary the corresponding figures for beta 2-MG were 6%, 27% and 56%, respectively. The additional use of beta 2-MG provided an increase in positive results, especially in cases of cancer of the ovary. A direct relationship between the extent of tumor and serum marker level was more evident for beta 2-MG than CEA. There was no correlation between serial levels of CEA and beta 2-MG in most patients. CEA levels appeared to predict subsequent tumor behavior more accurately in patients with good prognoses (ie, complete or partial tumor response), whereas beta 2-MG levels gave the same prediction in those with bad prognoses (ie, nonresponsive or progressive tumor).

Carcinoembryonic antigen in carcinoma of the uterine cervix. 1. The prognostic value of serial plasma determinations

Plasma carcinoembryonic antigen (CEA) determinations were obtained prior to therapy in 300 patients with invasive carcinoma of the uterine cervix followed at the University of Kentucky Medical Center from 1971 to 1976. Carcinoembryonic antigen levels were elevated (greater than 2.5 ng/ml) in 48% of cervical cancer patients, and varied directly with stage of disease and histologic differentiation of the tumor. Plasma CEA levels were more commonly elevated in patients with endocervical adenocarcinoma than in those with squamous cell carcinoma, but were not related to vascular invasion in the specimen or regional lymph nodal morphology. Two hundred and four patients had 2 to 15 (mean = 5) follow-up plasma CEA determinations after treatment. Thirty patients had progressively increasing plasma CEA levels following therapy, of which 29 developed recurrent cervical cancer. A progressive rise of plasma CEA preceded the clinical diagnosis of recurrence by 1 to 23 months (mean = 6 months) in 13 of these patients, and occurred at the same time or after the clinical diagnosis of recurrence in 16 cases. Patients with progressively rising plasma CEA levels following therapy for cervical cancer should be extensively evaluated to rule out the presence of occult recurrence.

The clinical significance of carcinoembryonic antigen in the plasma and tumors of patients with gynecologic malignancies

Carcinoembryonic antigen is elevated in the plasma of approximately 30% of patients with endometrial adenocarcinoma, 50% of patients with ovarian carcinoma, and 60% of patients with cervical carcinoma. The incidence of elevated plasma CEA is directly related to stage of disease, and in ovarian cancer to cell type. Immunodiffusion and immunoelectrophoretic studies have indicated that CEA from ovarian and cervical cancers is similar to colonic cancer CEA. Tumor staining for CEA by the immunoperoxidase method (indicating a CEA concentration of greater than or equal to 3.0 microgram/g tissue) is positive in about one-half of the patients with elevated plasma CEA levels. However, there is no definite relationship between tumor and plasma antigen levels. Carcinoembryonic antigen levels charcteristically return to normal within 8 weeks following complete surgical removal of tumor. In contrast, antigenemia often persists up to 4 months following curative radiation therapy. A progressive rise in plasma CEA has preceded clinical diagnosis of recurrence in about half of the patients studied. Serial plasma CEA determinations in patients whose plasma or tumors initially contain elevated amounts of antigen provides information concerning the biologic behavior of malignancy which may be of clinical significance to the patient.

Carcinoembryonic antigen (CEA) and other tumor markers in ovarian and cervical cancer

Combinations of carcinoembryonic antigen (CEA), gamma glutamyl transpeptidase (GGT), pregnancy-associated macroglobulin (PAM) and placenta-like alkaline phosphatase (PLAP) were studied in groups of patients with ovarian and cervical cancer. In ovarian cancer, only CEA and PLAP levels appeared to reflect tumor burden and were complementary in detecting active disease. In cervical cancer, CEA and GGT reflected tumor burden, while PLAP showed just the reverse--the highest degree of positivity being present in minimal disease. PLAP positivity was even more pronounced in patients with cervical dysplasia and carcinoma in situ while CEA and GGT were negative. The data indicate that the use of marker combinations can improve our capacity to detect minimal disease and provide information regarding tumor biology that may not be available by studying individual markers or by other means. It remains to be determined whether the use of tumor markers can influence existing therapy sufficiently to alter the outcome in cancers which are notoriously difficult to treat.

The use and abuse of CEA test in clinical practice

Charts of 437 patients having plasma carcinoembryonic antigen determinations during the period January 1, 1976 through April 30, 1976 were reviewed to determine whether CEA results led to clinical decisions altering management patterns. Data analysis disclosed that CEA test results did not result in any change in management in 167 patients with non-neoplastic disease. Most had single determinations. In 270 patients with neoplastic disease, CEA results led to changes in management in one patient with lung cancer and two patients with colon cancer, which may have altered prognosis. In a fourth patient, CEA results led to discovery of unresectable pancreatic cancer at laparotomy. Cost benefit analysis indicated a CEA test cost of $5,047.50 per patient benefitted in 299 patients eligible for analysis. We conclude that maximal benefit to the patient results from serial CEA test use in follow-up of colon cancer patients after curative therapy.

[Carcinoembryonic antigen in retinoblastomas (author's transl)]

In 47 patients (46 children and 1 adult) with unilateral and bilateral retinoblastoma, the titer of the carcinoembryonic antigen (CEA) was determined. The CEA titer of children with active retinoblastomas was 1.44 +/- 0.26 ng/ml (x +/- SEM). Those patients whose retinoblastoma was inactivated by therapy did not show a significantly lower CEA titer. In the group of children with one eye removed because of a unilateral retinoblastoma, the CEA titer was significantly (P less than 0.1) lower. The globes of 25 children were examined histologically. In those cases with invasion of the optic nerve or choroid, the CEA titer was significantly higher (P less than 0.1) as compared with those where the tumor was limited to the retina alone.