The cancer associated antigen test as an index to failure of complete removal of urological cancers

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.

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.

Carcinoembryonic antigen in serum, urine and cells of patients with bladder carcinoma

A raised level of CEA-like substance has been demonstrated by radioimmunoassay in the urine of patients with bladder carcinoma, in concentrations which increase with a more advanced stage, and in serum of patients with advanced disease. In a 2-year follow-up of patients receiving chemotherapy, a correlation of raised urinary CEA to local recurrence was seen, as well as rising and high serum values with metastases. In the patients who responded to treatment, CEA values became normal. CEA was also located in carcinoma cells from bladder washings in 24--61% of the cases. Combined studies of CEA in serum, urine and cells may be used to study the biology of the tumour and perhpas also in the monitoring of patients with urothelial carcinoma.

Characterization of urothelial carcinoma with respect to the content of carcinoembryonic antigen in exfoliated cells

A sutstance immunologically similar to carcinoembryonic antigen (CEA) was demonstrated in urothelial bladder carcinoma cells. When indirect immunofluorescence with specific anti-CEA antisera was used, CEA-containing cells were seen in 18 out of 40 cases in 5% to 30% of the cells. Among patients with tumor cells of well differentiated morphology, 61% had CEA-containing cells, compared with only 24% of patients with a poorly differentiated tumor. Microfluorometry of single cells was performed in six cases to estimate the range of CEA content. The mean fluorescence intensity with anti-CEA antiserum was three to six times that of the same tumor cell population stained with non-immune rabbit sera. This fluorescence was decreased when the anti-CEA anti-sera were incubated with CEA but not with nonspecific cross-reactive antigen. The results show a wide range of CEA antigen content in exofoliated bladder tumor cells. In addition to proliferative status and differentiation, quantitative CEA measurements give further possibilities to study characteristics of tumor cell populations.

Measurement of urinary CEA-like substance. An aid in management of patients with bladder carcinoma

Urine and serum samples from patients with bladder carcinomas were studied for the occurrence of and variations in CEA content before, during, and after radiation therapy. The concentration of CEA-like substances in urine increased with a more advanced clinical stage of the tumor, although there were large intercase variations. In serum, slightly increased values were noted only in advanced cases. During radiation therapy, high CEA values were found at around mid-course. This could be related to a breakdown of tumor tissue. Judging from data for urine from radiation-treated prostatic carcinomas without known tumors in the bladder, radiation alone was not responsible for the elevation of CEA. Urinary infections contributed to raised levels of CEA-like substances in some cases. At the end of successful radiation therapy (as verified by cystoscopy, cytology, and clinical examination), 25 patients had CEA values in the urine comparable to normal values (14 +/- 7 ng CEA/ml). The decrease was significant from the initial values to those after radiotherapy (p less than 0.01). Four patients whose tumors persisted had high values (68 +/- 46 ng CEA/ml). In patients who had previously received radiation treatment for bladder carcinomas, CEA values were high in 20 with recurrences (58 +/- 36 ng CEA/ml) while they were lower in 13 who were free of recurrence (14 +/- 6 ng CEA/ml). These findings indicate that urinary CEA determinations may be used in the immediate followup and management of patients treated for bladder carcinoma. It also appears to be of prognostic significance.

[Carcinofetal antigens. III. Further carcinofetal antigens (author's transl)]

The occurrance and significance of important carcinofetal antigens other than AFP and CEA are reported. These included the alpha 2 H-protein which is produced in the liver and increases in serum of patients with various tumors, the fetal sulphoglycoprotein antigen FSA from the gastric juice of patients with gastric cancer, the carcinoplacental alkaline phosphatase (REGAN-isoenzyme)which is found in the serum of patients suffering from e.g. bronchogenic, mammary, urogenital and gastrointestinal carcinomas, the beta-S-fetoprotein which is most likely to be identical with C-reactive protein, gamma-fetoprotein, the carcinofetal antigen in glial tumors (CFGA); ectopic production of placental hormones like human gonadotropin, placental lactogen, plasminogen-activators; leukemia-associated antigens. Furthermore, some other less known carcinofetal antigens are mentioned.